THE NEW ZEALAND GAZETTE.
63

Postmaster, shall require the Proposer to answer the
questions contained in that form, and any other
questions which he may think proper to be asked,
shall record the Proposer's answers in writing in the
form, and shall read over to the Proposer the said
answers and the declaration at the foot of the form.
And the Proposer shall sign the said declaration in
the presence of the Medical Examiner.

Statement of age, if admitted, is not to be afterwards
questioned.

6. If the said Commissioner, before the execution
   of the contract, shall be satisfied that the Proposer
   has stated his age correctly, he shall, if he think fit,
   declare in the contract that he has admitted the
   Proposer's statement of age; and if the Proposer's
   statement of age be thus admitted in the contract, it
   shall not subsequently be called in question.*

Premiums fixed by duly framed tables. Extra risk to be
covered by additional Premiums.

7. If the said Commissioner shall think fit to enter
   into a contract for the insurance of the Proposer's life,
   he shall require the proposer to pay according to age
   the premiums fixed by the tables framed under the
   authority of "The Government Annuities Act, 1869,"
   unless he be made aware of any circumstances con-
   nected with the health or habits of the Proposer which
   may tend to shorten the Proposer's life, or unless the
   proposer shall at the date of his Proposal follow any
   occupation which shall seem likely to be attended by
   special risk to life, in which case the said Commis-
   sioner shall, if he think fit, require him to pay such
   additional premiums as shall appear sufficient to cover
   the additional risk.

Forms of Contract.

8. If the said Commissioner shall think fit to enter
   into a contract for the insurance of the Proposer's
   life, the contract shall be in the following form, and
   shall specify-

(1.) The name of the person insured under the
contract;
(2.) The amount insured;
(3.) The amount of Premium;
(4.) The periods at which the Premiums will
become due and payable.
(5.) The conditions under which the Premiums
will be forfeited, and the contract rendered
null and void.

Form of Contract for the Insurance of Life by a single
Premium.

WHEREAS under the provisions of "The Government Annuities
Act, 1869," the Government Annuities Commissioner is
authorized to execute contracts for the insurance of lives; and
whereas of , hereinafter called the Assured, has
contracted with the said Government Annuities 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 18 to a Medical Examiner;
and whereas the Assured has paid the sum of £ to the said
Government Annuities Commissioner; now it is hereby declared
that on the death of the Assured the Government Annuities
Commissioner for the time being shall, pursuant to the said Act,
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 £ ,

• The said Commissioner may decline or refuse to contract
  for any payment on death or other event under the provisions
  of "The Government Annuities Act, 1869," in any case where
  there shall be in the opinion of the said Commissioner sufficient
  grounds for refusing or declining so to do.

or any of them, be untrue, or if the assured has wilfully
withheld any of the information required from him.
2nd. It shall be void, and the payment made under it by
the Assured shall be forfeited, if the Assured shall, with-
out the license of the said Commissioner, go on the high
seas, except in time of peace in passing from one part of
the Colony to Europe, or to any part of the Colony of
New Zealand to the Colonies of Tasmania, South
Australia, Victoria, New South Wales, and Queensland.
3rd. It shall be void, and the payment made under it by
the Assured shall be forfeited, if the Assured shall, with-
out license from the said Commissioner, take up and
follow the occupation of
4th. It shall be void, and all the payments made under it
shall be forfeited, if the Assured shall die by his own
hands within twelve months, or by the hands of justice.
The Assured is hereby admitted
to be at the date hereof in
the year of his
age
Date
Witness

Form of Contract for the Insurance by Annual Payments.

WHEREAS under the provisions of "The Government Annuities
Act, 1869," the Government Annuities Commissioner is
authorized to execute contracts for the insurance of lives; and
whereas of , hereinafter called the Assured, has contracted with the said
Government Annuity 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
declarations dated the
day of
18 to a Medical Examiner;
and whereas the Assured has paid the sum of £
to the said Government
Annuity Commissioner, being the first payment due under such
contract; now it is hereby declared that if the Assured shall
pay to the Government Annuities Commissioner for the time
being, the sum of £
in the present and every
subsequent year of his life, the Government Annuities Com-
missioner shall, pursuant to the said Act, 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 Commissioners of the sum

But this contract is made subject to the following provisos:---
1st. It shall be void, and all the payments made by the
Assured under it shall be forfeited, if the statements
contained in the aforesaid proposal and declaration, or
the statements made by the Assured to the Medical
Examiner, or either or any of them, be untrue, or if the
Assured has wilfully withheld any of the information
required from him.
2nd. It shall be void, and the payments made under it
by the Assured shall be forfeited, if the Assured shall,
without the license of the said Commissioner, go on the
high seas, except in time of peace in passing from one
part of the Colony to Europe or to any part of the
Colony, or in passing from the Colony of New Zealand
to the Colonies of Tasmania, South Australia, Victoria,
New South Wales, and Queensland.
3rd. It shall be void, and all the payments made under it
by the Assured shall be forfeited, if the Assured shall,
without license from the said Commissioner, take up and
follow the occupation of
4th. It shall be void, and all the payments made under it
shall be forfeited, if the Assured shall die by his own
hands or by the hands of justice.
The Assured is hereby admitted
to be at the date hereof in
the year of
his age.

Premiums to be paid at office where the contract is made until
otherwise desired.

9. The contract shall be delivered to the Con-
   tractor on payment by him of the first Premium
   due under the contract at such one of the offices
   appointed for the purpose as the Contractor shall
   select; and the Contractor shall continue to pay the
   Premiums due under the contract at the said office,
   until he shall give notice to the said Commissioner,
   on a form to be obtained at any Money Order Office,
   of his desire to pay them at some other office than
   that which he at first selected.