FEB. 19.]

THE NEW ZEALAND GAZETTE.

187

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
, 188
, from on board the
of
, and the
, whereof
is at present master, viz.:--
Marks. Numbers. Description of Goods. Value.

And I further declare that the goods are of the value herein re-
presented, and that the sum of £
is the actual pur-
chase-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,
Signature of
this
day of
Consignee
, 188
.

CERTIFICATE OF COLLECTOR OF CUSTOMS OR OTHER
ACKNOWLEDGED 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
, 188 ; 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,
, 188
}
(SEAL.)

FORM C.
FORM FOR CLAIM FOR DRAWBACK UPON GOODS
SUBJECT TO A FIXED RATE OF DUTY.
Port of
Act 36 Vict., No. 434. Regulations of
Victoria.
Her Majesty's Government, Dr. to
To drawback of duty upon the goods specified in
Export Warrant No.
, 188
, and exported
on the
for
Total quantity
Drawback at
£
s.
d.
I,
of
, carrying on business at
, under
, 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
, 188
}
Examined and found correct:
Landing Surveyor.
Approved :
Collector of Customs.
Received this
day of
, 188
, 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 EXPORTED
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
, 188 ; 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,
, 188
}
(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 suc-
cessors, 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 eighty
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 drawhack
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 of Trade and Customs, and shall not be reintro-
duced into Victoria except on payment of the full duties charge-
able thereon, then this obligation to be void, otherwise to be
and remain in full force and virtue.
Sealed and delivered by the above-named
in the presence of
,

BOND TO BE GIVEN ON ENTRY OF TRAVELLERS'
SAMPLES 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 suc-
cessors, 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 eighty
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)-
, in charge of
, traveller for
the aforesaid firm, 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 of Trade and Customs, and shall not be reintro-
duced into Victoria except on payment of the full duties charge-
able thereon, then this obligation to be void, otherwise to be
and remain in full force and virtue.
Sealed and delivered by the above-named
in the presence of
,

FORM D.
FORM OF DECLARATION IN EXPORT ENTRY OF
TRAVELLERS' SAMPLES FOR DRAWBACK.
WE,
, do hereby declare that we are the exporters of
the goods mentioned in this entry and the invoice dated
and signed by us; and that the values therein given represent
the true price to be paid or accounted for to us
, with-
out any discount, rebate, or other allowance, by
the traveller of our firm, for
, under the style
and title of
; and we further declare that these goods
were properly cleared at the Customs, and duty paid on im-
portation, and that none of the said goods were the produce of
or manufactured in Victoria, except as specified in the said
invoice.

FORM E.
FORM OF DECLARATION IN CLAIM FOR DRAW-
BACK UPON TRAVELLERS' SAMPLES.
I,
of
, do hereby declare that I am traveller
for
, trading under the style and title of
; and