552
THE NEW ZEALAND GAZETTE.

6th. On breach, non-observance, or non-performance, in
any other respect, of the Acts or Regulations for the time
being in force affecting the same.

In witness whereof the said Commissioner hath here-
unto set his hand and seal this day of
one thousand eight hundred and

Signed, sealed, and delivered
by the said Commissioner,
in the presence of

Form of Contract for Insurance by Annual Payments.
WHEREAS under the provisions of "The Government Annuities
Act, 1869," and "The New Zealand Government Insurance and
Annuities Act, 1870," William Gisborne, of the City of Wel-
lington, Esquire, has been appointed Government Annuities
Commissioner for the purposes of the said Acts: And whereas
the said Commissioner is authorized to execute contracts for
the insurance of lives: And whereas
herein-
after called "the Assured," has contracted with the said Com-
missioner for an Insurance of the sum of £ on his own
life, and has deposited with him a proposal and declaration,
dated the day of one thousand eight hundred
and and signed by him as the basis of the contract
for such Insurance, and has also made certain statements
and a declaration dated the day of one
thousand eight hundred and to a Medical Ex-
aminer: And whereas the said Assured has paid to the said
Commissioner the sum of £ as the first annual premium for
such Insurance:-Now it is hereby declared that if the Assured
shall die at any time within the term of twelve calendar months
from this date, the said Commissioner shall, pursuant to the
said Acts, be subject and liable to the payment to the executors,
administrators, or assigns of the said Assured, immediately after
satisfactory proof of his death shall have been received by the
said Commissioner, of the sum of £ : And further, that if
the said Assured shall survive the said term of twelve calendar
months, and shall, on or before the day of
now next ensuing, and on or before the day of
in every succeeding year during his life, duly pay the like
amount of premium, then the said Commissioner shall, pursuant
to the said Acts, be subject and liable to the payment unto
the executors, administrators, or assigns of the said Assured,
immediately after satisfactory proof of his death shall have
been received by the said Commissioner, of the sum of £

But this contract is made subject to the condition that it
shall be void, and all the payments made by or on behalf of
the said Assured under it shall be forfeited, in any of the
following cases:---
1st. If the statements of the Proposer, as set forth in the
proposal, or of the person or persons examined by the
Medical Examiner, as set forth in the medical examina-
tion, or any of such statements respectively, be untrue,
or if any person whose life is assured has wilfully with-
held any information required of him.
2nd. On default of payment of the annual or other
periodical payment to be made thereunder.
3rd. If the person, or any of the persons upon the con-
tingency of whose live or lives the particular transaction
is to depend, shall go or travel beyond the limits allowed
by the Regulations without the leave of the said Com-
missioner.
4th. If the Assured shall adopt any trade or occupation
declared by the said Commissioner to be hazardous
without the leave of the said Commissioner.
5th. If the Assured shall die by his own hand, or by
duelling, within twelve months, or by the hands of
justice.
6th. On breach, non-observance, or non-performance, in
any other respect, of the Acts or Regulations for the
time being in force affecting the same.

In witness whereof the said Commissioner hath here-
unto set his hand and seal this day of
one thousand eight hundred and
Signed, sealed, and delivered
by the said Commissioner,
in the presence of

Form of Contract for Insurance by Half-yearly or Quarterly
Payments.
WHEREAS under the provisions of "The Governmennt Annuities
Act, 1869," and "The New Zealand Government Insurance and
Annuities Act, 1870," William Gisborne, of the City of Wel-
lington, Esquire, has been appointed Government Annuities
Commissioner for the purposes of the said Acts: And whereas
the said Commissioner is authorized to execute contracts for
the insurance of lives: And whereas
herein-
after called "the Assured," has contracted with the said Com-
missioner for an Insurance of the sum of £ on his own life,
of
:
said Assured shall survive the said term of
months, and shall, on or before the
now next ensuing, and on or before the
in each year during his life duly pay the like amount of
premium to the said Commissioner, then the said Commissioner
shall, pursuant to the said Acts, be subject and liable to the
payment unto the executors, administrators, or assigns of the
Assured, immediately after satisfactory proof of his death shall
have been received by the said Commissioner, of the sum of
£
But this contract is made subject to the condition that it
shall be void, and all the payments made by or on behalf of
the said Assured under it shall be forfeited, in any of the
following cases:
1st. If the statements of the Proposer, as set forth in the
proposal, or of the person or persons examined by the
Medical Examiner, as set forth in the medical examina-
tion, or any of such statements respectively, be untrue,
or if any person whose life is assured has wilfully with-
held any information required of him.
2nd. On default of payment of the annual or other
periodical payment to be made thereunder.
3rd. If the person, or any of the persons upon the con-
tingency of whose life or lives the particular transaction
is to depend, shall go or travel beyond the limits allowed
by the Regulations without the leave of the said Com-
missioner.
4th. If the Assured shall adopt any trade or occupation
declared by the said Commissioner to be hazardous
without the leave of the said Commissioner.
5th. If the Assured shall die by his own hand, or by
duelling, within twelve months, or by the hands of
justice.
6th. On breach, non-observance, or non-performance, in
any other respect, of the Acts or Regulations for the
time being in force affecting the same.
In witness whereof the said Commissioner hath here-
unto set his hand and seal this
one thousand eight hundred and
Signed, sealed, and delivered
by the said Commissioner,
in the presence of
day of

for such Insurance, and has also made certain statements and a
declaration dated the day of one thousand eight hundred and
to a Medical Examiner: And whereas the said
Assured has paid to the said Commissioner the sum of £
as the premium for such Insurance for twelve calendar months,
commencing from the date hereof:-Now, it is hereby declared
that if the said Assured shall die at any time within the term
of twelve calendar months from this date, the said Commissioner
shall, pursuant to the said Acts, be subject and liable to the
payment unto the executors, administrators, or assigns of the
said Assured, immediately after satisfactory proof of his death
shall have been received by the said Commissioner, of the
sum of £

But this contract is made subject to the condition that it
shall be void, and all the payments made by or on behalf of the
said Assured under it shall be forfeited, in any of the fol-
lowing cases:---

Form of Contract for Assurance for term of One Year.
WHEREAS under the provisions of "The Government Annuities
Act, 1869," and "The New Zealand Government Annuities and
Insurance Act, 1870," William Gisborne, of the City of Welling-
ton, Esquire, has been appointed Government Annuities Com-
missioner for the purposes of the said Act: And whereas the
said Commissioner is authorized to execute contracts for the
insurance of lives: And whereas
of
hereinafter
called "the Assured," has contracted with the said Commissioner
for an Insurance of the sum of £ on his own life, and has
deposited with him a proposal and declaration dated the
day of one thousand eight hundred and
and
signed by him as the basis of the contract for such Insurance,
and has also made certain statements and a declaration dated
the day of one thousand eight hundred and
to a Medical Examiner: And whereas the said
Assured has paid to the said Commissioner the sum of £
as the premium for such Insurance for twelve calendar months,
commencing from the date hereof:-Now, it is hereby declared
that if the said Assured shall die at any time within the term
of twelve calendar months from this date, the said Commissioner
shall, pursuant to the said Acts, be subject and liable to the
payment unto the executors, administrators, or assigns of the
said Assured, immediately after satisfactory proof of his death
shall have been received by the said Commissioner, of the
sum of £
But this contract is made subject to the condition that it
shall be void, and all the payments made by or on behalf of
the said Assured under it shall be forfeited, in any of the
following cases:---