THE NEW ZEALAND GAZETTE. 555

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 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 Declaration to be indorsed on Contract for Life
Assurance, where same is effected for the Benefit of the
Wife, or of the Wife and Children, or of the Children or
any Child of the Assured, under Section 8 of the Act of 1870.

KNOW all men by these presents that the within contract of
Assurance has been effected by me for the benefit of [*Here
insert words designating the person or persons to take benefit].

In case the Assured intends to apportion the amount of
Insurance money, add as follows:—

And I hereby declare that the amount insured by the said
contract shall be apportioned as follows [Here insert proposed
mode of apportionment].

As witness my hand and seal, this day of
one thousand eight hundred and

Signed, sealed and delivered
by the above-named
in the presence of
A.B.,
The officer issuing the within contract.

Form of Contract for Purchase of Endowment by a Single
Payment.

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, was duly appointed and is now acting as Go-
vernment Annuities Commissioner for the purposes of the said
Acts: And whereas of has contracted with
the said Commissioner for the purchase of an Endowment or
sum of £ to be paid to on the
said attaining the age of years, and
has deposited with the said Commissioner a proposal and
declaration dated the day of one thousand
eight hundred and and signed by the said as
the basis of the contract for the purchase of such Endowment,
in which proposal it is stated, amongst other things, that the
age of the said is not less than years: And
whereas the said has paid to the said Commissioner the
sum of £ being the purchase money for the said Endow-
ment:-Now it is hereby declared that the said Commissioner
shall, pursuant to the said Acts, upon the said
the age of years, be subject and liable to pay to or for
the benefit of the said child the sum of £
But this contract is made subject to the condition that it
shall be void, and all payments made by or on behalf of the
said under it shall be forfeited, in either of the
following cases:-

1. If the statements of the Proposer, as set forth in the pro-
   posal, be untrue, or any information required by the
   said Commissioner in respect to the proposal has been
   wilfully withheld by the Proposer.
2. On default of payment of the annual payment to be
   made thereunder.

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

• "My wife," or "my wife and children," or "my children
  by my present wife," or "my child A.B." [naming it], or
  otherwise as the case may require.

Form of Contract for Purchase of Endowment by Payment
of Annual Premiums.

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, was duly appointed and is now acting as Go-
vernment Annuities Commissioner for the purposes of the said
Acts: And whereas of has contracted with
the said Commissioner for the purchase of an Endowment or
sum of £ to be paid to on the
said attaining the age of years, and
has deposited with the said Commissioner a proposal and
declaration dated the day of one thousand
eight hundred and and signed by the said as
the basis of the contract for the purchase of such Endowment,
in which proposal it is stated, amongst other things, that the
age of the said is not less than years: And
whereas the said has paid to the said Commissioner the
sum of £ being the first payment due and payable under
the said contract:-Now it is hereby declared that if the said
shall pay to the said Commissioner the sum of £
on the day of next ensuing the date thereof,
and the like sum on the day of in every subse-
quent year until the said child shall have attained the age of
years the said Commissioner shall, pur-
suant to the said Acts, upon the said attaining the age of
years, be subject and liable to pay to or for the
benefit of the said child the sum of £

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

1. If the statements of the Proposer, as set forth in the
   proposal, be untrue, or any information required by the
   said Commissioner in respect to the proposal has been
   wilfully withheld by the Proposer.
2. On default of payment of the periodical payment to be
   made thereunder.

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 Purchase of Endowment by Payment
of Half-yearly or Quarterly Premiums.

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, was duly appointed and is now acting as Go-
vernment Annuities Commissioner for the purposes of the said
Acts: And whereas of has contracted with
the said Commissioner for the purchase of an Endowment or
sum of £ to be paid to on the
said attaining the age of years, and
has deposited with the said Commissioner a proposal and
declaration dated the day of one thousand
eight hundred and and signed by the said as
the basis of the contract for the purchase of such endowment,
in which proposal it is stated, amongst other things, that the
age of the said is not less than years: And
whereas the said has paid to the said Commissioner the
sum of £ being the first payment due and payable under
the said contract:-Now it is hereby declared that if the said
shall pay to the said Commissioner the sum of £
on the day of next ensuing the date thereof,
and the like sum on the in every subse-
quent year until the said shall have attained
the age of years, the said Commissioner shall, pur-
suant to the said Acts, upon the said attaining the age
years, be subject and liable to pay to or for the
benefit of the said child the sum of £
But this contract is made subject to the condition that it
shall be void, and all payments made by or on behalf of the
said under it shall be forfeited-
If the statements of the Proposer, as set forth in the pro-
posal, be untrue, or any information required by the
said Commissioner in respect to the proposal has been
wilfully withheld by the Proposer.

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