CO129-432 - Governor Sir May - 1916 [3-5] — Page 549

SCHEDULE.

545

|

I

equest that the sum of

(Name and office)

dvanced to me by the Government at 6% interest. My salary is $

may be

per annum.

require this advance to meet the liabilities stated hereunder, and I certify that this statement is

full and complete statement of my liabilities and correctly discloses my financial position.

Name of Lender.

Nature of

Loan

Amount lent.

Amount to be repaid.

Remarks.

Dule

191

!

!

(Signature of Applicant.)