THE NEW ZEALAND GAZETTE.

N.B.-All persons presenting this Form must give
the date when the Affidavit above alluded to was
deposited.
(1.) Name and address of owner of Bonds to be plainly
written.
(2.) The amount of Coupons to be set out in writing.
(3.) If not in owner's possession, insert the words "are my
own property."
[Declaration C. No. 2.]

No. B.
Declaration to be made by Bankers or Merchants in
London, holding Bonds the property of a Foreigner
residing abroad, and who have already made an
Affidavit as to the following Bonds.

We (1) , as described beneath, do hereby
make oath and certify, that the Coupons amounting
to £ say (2) , as set forth at the
back hereof, are derived from Bonds, which Bonds
are in our possession, and are the property of (3)
and do not belong, either directly or indirectly, to
any British subject or Foreigner residing in the
United Kingdom of Great Britain and Ireland, and
we therefore claim to have the interest paid free of
Income Tax.

Sworn at this day of 186 ,
before me,
The signature of the Agents or Merchants,
Address, sufficient to find the Agents or Mer-
Date, chants by post,

(1.) Name and address of Agents or Merchants of Bonds to
be plainly written.
(2.) The amount of Coupons to be set out in writing.
(3.) Name and address of owner of Bonds.
[Affidavit B.]

No. E.
Affidavit to be made by Bankers or Merchants residing
abroad, and holding Bonds the property of a
Foreigner residing abroad.
We (1) , as described beneath, do hereby
make oath and certify that the Coupons amounting
to £ say (2) as set forth at the back
hereof are derived from Bonds, which Bonds are in
our possession, and are the property of (3)
and do not belong, either directly or indirectly, to
any British subject or Foreigner residing in the
United Kingdom of Great Britain and Ireland, and
we therefore claim to have the interest paid free of
Income Tax.

Sworn at this day of 186
before me (4)
The signature of the owner
Address, sufficient to find the owner by post,
Date,

(1.) Name and address of Agents or Merchants of Bonds to
be plainly written.
(2.) The amount of Coupons to be set out in writing.
(3.) Name and address of owner of Bonds.
(4.) A Consul, Notary Public, Magistrate, or public functionary.
[Affidavit E.]

181

No. F.
Affidavit to be made Abroad for the Owner of the
Bonds.
We as described beneath, do hereby
make oath and certify, that according to the bona
fide declarations made by our principals, which we
conscientiously believe to be true, and which we
engage ourselves to produce, if required, the Coupons
amounting to say, £ as set forth at the
back hereof, are derived from Bonds, which Bonds
are in their possession, and do not belong, either
directly or indirectly, to any British subject or
Foreigner residing in the United Kingdom of Great
Britain and Ireland. We therefore claim to have
the interest paid free of Income Tax.
Sworn at this day of 186 ,
before me*

• A Consul, Notary Public, Magistrate, or public functionary.

Affidavit to be made Abroad by the Owner of the
Bonds.
I (1) as described beneath, do hereby make oath
and certify that the Coupons amounting to £
say (2) as detailed hereafter are derived
from Bonds, which Bonds are in my possession, (3)
and do not belong, either directly or indirectly, to
any British subject or Foreigner residing in the
United Kingdom of Great Britain and Ireland, and
I therefore claim to have the interest paid free of
Income Tax.
Sworn at this day of 186 ,
before me (4)
The Signature of the owner
Address, sufficient to find the owner by Post
Date

(1.) Name and address of owner of Bonds to be plainly
written.
(2.) The amount of Coupons to be set out in writing.
(3.) If not in owner's possession, insert the words "are my
own property."
(4.) A Consul or Notary Public.
[Affidavit F.]

Form to be signed by the Person presenting the
Coupons in London.
declare that have received the
Coupons set forth below from our Corres-
pondent and, in consequence of the Affidavit
annexed to this form, claim to have the interest paid
free of Income Tax, and hereby undertake to hold
you harmless from any demand made upon you by
the Board of Inland Revenue.
Signature Quality Address
Date

SPECIFICATION OF COUPONS.
To contain the numbers and the amounts of
the Coupons, and the Names and
Residences in full of the Foreigners,
who are the bona fide owners of the
Bonds.