THE NEW ZEALAND GAZETTE. 553

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 contin-
gency 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
dwelling, 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 of Life by Payment of Annual
Premiums for term of Seven Years.

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 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 of
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 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 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 £ : And further, that if the said Assured
shall survive the said term of twelve calendar months, and shall,
on or before the day of next ensuing, and on or
before the day of in every succeeding year during
the continuance of this Insurance if the said Assured shall then
be living, duly pay to the said Commissioner the like amount of
premium, and, having duly made such payments, shall depart
this life within the term of seven years, computed from this
date, 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 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 withheld
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 transactions
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
dwelling, 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 the Insurance of Life by Payment of
Annual Premiums for a Specified Number of Years.

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 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 of here-
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 the sum of
£ as the first of annual premiums for such
Assurance: 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 to the payment to the
executors, administrators, or assigns of the said Assured, im-
mediately 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 next ensuing, and on or before the
day of in every succeeding year during the con-
tinuance of the term of years, computed from this date,
inclusive of this date, if the said Assured shall then be living,
duly pay to the said Commissioner 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, adminis-
trators, or assigns of the said Assured immediately after satis-
factory 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
dwelling, 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 of a Sum of Money payable at
Death, or the attainment of a specified Age.

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