80 THE NEW ZEALAND GAZETTE.

SCHEDULE I.—continued.

FORM A.

NOTICE OF INTENTION TO PACK.

To the Collector of Customs, Melbourne, 187 .

I, , of , carrying on business at , under the style and title of , do hereby give notice that I intend to pack sundry goods for exportation for drawback at , at o'clock, on 187 , and would beg to request the attendance of an officer of Customs for that purpose, and I deposit £ in payment of the officer's services.

FORM B.

FORM FOR CLAIM FOR DRAWBACK UPON GOODS SUBJECT TO AN AD VALOREM DUTY.

Act 36 Vict., No. 434. Regulations of
Port of Victoria.
Her Majesty's Government, Dr. to £ s. d.

To drawback of duty upon the goods specified in Export Warrant No. , 187, and exported on the for
Total amount of invoice
Drawback at per cent

I, , of , carrying on business at , under the style and title of , do hereby declare that the goods above specified have been landed at as per certificate at the back hereof, and that the said firm exported the said goods, and is alone entitled to the drawback thereon, and which I on behalf of the said firm hereby claim.
Signature of Claimant :

Declared before me at this day of , 187 .}
Examined and found correct:
Landing Surveyor.

Approved :
Collector of Customs.

Received this day of , 187, from the Collector of Customs, the sum of pounds shillings and pence in full payment of above drawback.
Witness to payment :

CERTIFICATE OF THE CONSIGNEE.

I, , of , trading under the style and title of , do hereby declare that the goods or merchandise hereinafter described have been landed at this port between the of and the , 187 , from on board the , whereof is at present master, viz.:—

And I further declare that the goods are of the value herein represented, and that the sum of £ is the actual purchase-money paid by me to of , or to be paid upon the following terms, i.e., without any rebate, discount, or other allowance, and that the said goods have arrived in good order.

Declared before me at the Customhouse, this day of 187 .
{ Signature of Consignee. }

CERTIFICATE OF COLLECTOR OF CUSTOMS OR OTHER ACKNOW-
LEDGED OFFICIAL.

I, , Collector of Customs at the port of , hereby certify that the goods above described were imported and landed at this port; that they were duly entered at the Customhouse here on the day of , 187 ; that the said goods were worth the duty at the time of such entry; and that the duties imposed by law in this colony upon the said goods have been paid or secured to be paid at the value above specified.
Collector of Customs.
[or British Consul, if no Collector of Customs.]
Customhouse, , 187 .} (SEAL.)

FORM C.

FORM FOR CLAIM FOR DRAWBACK UPON GOODS SUBJECT TO A FIXED RATE OF DUTY.

Act 36 Vict, No. 434. Regulations of
Port of Victoria.
Her Majesty's Government, Dr. to £ s. d.

To drawback of duty upon the goods specified in Export Warrant No. 187, and exported on the for
Total quality Drawback at

I, , of , carrying on business at , under the style and title of , do hereby declare that the goods above specified were exported by the said firm and have been landed at , as per certificate at the back hereof, and that the said firm exported the said goods, and is alone entitled to the drawback thereon, and which I on behalf of the said firm hereby claim.
Signature of Claimant :

Declared before me at this day of , 187 .}
Examined and found correct:
Landing Surveyor.

Approved :
Collector of Customs.

Received this day of , 187, from the Collector of Customs, the sum of pounds shillings and pence in full payment of above drawback.
Witness to payment :

CERTIFICATE OF COLLECTOR OF CUSTOMS OR OTHER ACKNOW-
LEDGED OFFICIAL AS TO GOODS AT FIXED RATES Ex-
PORTED ACROSS THE BORDER.

I, , Collector of Customs at the Port of , hereby certify that the goods above described were imported and landed at this port; that they were duly entered at the Customhouse here on the day of 187; that the said goods were worth the duty at the time of such entry; and that the duties imposed by law in this colony upon the said goods have been paid or secured to be paid on the quantities above specified.
Collector of Customs.
[or British Consul, if no Collector of Customs.]
Customhouse, , 187 .} (SEAL.)

BOND TO BE GIVEN ON ENTRY OF GOODS ENTITLED TO DRAWBACK.

36 Vict., No. 434.

KNOW ALL MEN by these presents that we, , are jointly and severally held and firmly bound unto our Sovereign Lady Victoria, by the Grace of God of the United Kingdom of Great Britain and Ireland Queen, Defender of the Faith, in the sum of pounds to be paid to our said Lady the Queen, her heirs or successors, for which payment well and truly to be made we bind ourselves, and each of us jointly and severally, our and each of our heirs, executors, and administrators, and every of them firmly by these presents.
Sealed with our seals. Dated this , day of , in the year of our Lord one thousand eight hundred and seventy-

WHEREAS the above bounden hath entered outwards for exportation from the Port of to , in the ship , whereof is master, the following goods (that is to say)- which said goods are entitled to a drawback of Customs on exportation:

Now the condition of the above written obligation is such, that if the above bounden comply with all the regulations approved by virtue of Act 36 Vict., No. 434, or 41 Vict., No. 594, and pay any penalty which may be imposed in default of such compliance, and if the said goods and every part thereof shall be duly shipped and exported to and landed at aforesaid, or otherwise accounted for to the satisfaction of the Commissioner