(2)
10. Whether each of the Appointments held by the Applicant has been on the Fixed Establishment
of the Colony.
Yes.
11. Whether the duties of the several offices or situations held since the Applicant entered the Civil Service have been such as to require that the holder should give his whole time to the Public
Service.
Ges.
12. Whether holding any other Public Appointment, or receiving or claiming to receive any Public
Money by Compensation, Half-pay or otherwise.
No.
13. If any kind of Pension or other Allowance has been commuted under the Imperial Pensions Commutation Acts, 1869 and 1871, and annual amount of Pension or Allowance so commuted
and the date of Commutation should be inserted.
No.
14. Absence, beyond ordinary Vacation leave:-
IC
(8)
18. Statement, if the chcumstances manant it, that the Applicant "bas discharged his duties with "diligence and fidelity, to the satisfaction of the Bead Officer or Officers of his Department," to be signed by any two of such Head Cfficers, if there shall be more than one, or by such Head Officer if there shall be but one, together with "such a statement as will exhibit the "merit, and value, and labour of the services of the Person recommended, embracing as long a "period of his public service as can be authentically stated," and observations as to Special Services, Suspension, Reprimand, &c, with full particulars of any injuries received on duty or other claims or matters for consideration,
I certify that ich. A. Fr. Charebier has
diligure and
15. Charelice has dislarged his
dulin with
fidelity. Lo
ему
salisfaction.
19. Computation, by the Colonial Treasurer, of the Pension, &c.
Matt Director of Pable work.
15th. Alauch, 1915.
Year.
Period of Absence
Number of Days."
Cause of Absence.
On the ground of Service.
17.1.7. From 7th August 2019.2.18 195
1
''
1
1 ......
1
*
+3
}}
*35
A
1
11
1
1
1
1
21
"
"
J
3. Commeelest from half pay leave.
15. Date of Cessation of Duty,....
16. Date of Cessation of Salary,...
.1.9.10... Fehrecary 1.9.18....
19 February 19...
12.0.0.,.Rech....Hetheavy. 1918.
17. Date from which, inclusively, Pension will commence,..?
I certify that the
according to the Rules of the Colonial Service amounts to
and I base my Certificate on the following calculation:--
which may be paid to the Applicant
+390
The applicant is entitled to draw bis pension at the rate of
Contribution to Widows' and Orphans' Pensions at the rate of.
aunum should be deducted, up to the..........
day of
and the full amount of the pension should thereafter be paid.
19
per
inclusive,
Colonial Treasure).
Governor, &c,
[Instructions.
513
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