2234
THE NEW ZEALAND GAZETTE.
[No. 102]

Form 4 (Reg. 4).
Under “The Old-age Pensions Act, 1898.”
NOTICE TO CLAIMANT.

To…………………
……………………
……………………

Your pension-claim has been forwarded to me instead of to the Deputy Registrar of the Old-age Pension District, being the district in which it appears from your claim that you reside: I have therefore forwarded it to him.
Dated at , this day of , 1 .

Deputy Registrar for the Old-age Pension District.

Form 5 (Reg. 7).
Under “The Old-age Pensions Act, 1898.”
NOTICE TO CLAIMANT TO ATTEND ON INVESTIGATION OF PENSION-CLAIM.

To…………………
……………………
……………………

TAKE notice that the investigation of your pension-claim (No. ) will be made on day, the day of , 1 , at the Magistrate’s Court House at , at o’clock in the noon, and that you may then and there attend in support thereof by the production of papers or other evidence.
Dated at , this day of , 1 .

Clerk of the Court at .

Form 6 (Reg. 10).
Under “The Old-age Pensions Act, 1898.”
STIPENDIARY MAGISTRATE’S CERTIFICATE OF ESTABLISHMENT OF PENSION-CLAIM.

To the Deputy Registrar for the Old-age Pension District.

I HEREBY certify that the pension-claim No. , made by ……………………
……………………
……………………

has been this day established before me, and you are hereby authorised to issue a pension-certificate for one year’s pension of £ , payable in equal monthly instalments of £ , at the Post-office Money-order Office. The pension-year commences on the first day of the calendar month next after the date of the issue of the pension-certificate, and the first instalment is due on the first day of the calendar month next after the commencement of the pension-year.

The income-year ends on the day of , 1 , and on the same day in each subsequent year.

The amount of the first year’s pension is ascertained thus,—

Maximum amount of pension .. .. £ s. d.
Less deductions, viz.,—
Income for first income-year £
Less allowance by Act .. 34 0 0 £

Net capital value of accumulated property at end of first income-year .. .. £
£1 for every complete £15 thereof .. .. £

Amount of year’s pension .. .. .. £

Dated at , this day of , 1 .

Stipendiary Magistrate.

Form 7 (Reg. 13).
THE DISTRICT OLD-AGE PENSION REGISTER.

Pension-certificate No. .
Name of pensioner, in full [Surname to appear first]:
Occupation of pensioner:
Address of pensioner:

Form 8 (Reg. 14).
Under “The Old-age Pensions Act, 1898.”

Name of district:
Name of pensioner:
Pension-certificate No. .

To the Registrar of Old-age Pensions, Wellington.

I HAVE to advise you that the following entry in connection with the above-mentioned pension-certificate has this day been made by me in the Pension Register: [Here make a copy of the entry].
Dated at , this day of , 1 .

Deputy Registrar for the Old-age Pension District.

Form 9 (Reg. 15).
[ROYAL ARMS.]
NEW ZEALAND.
Under “The Old-age Pensions Act, 1898.”
PENSION-CERTIFICATE.
(Not transferable.)

No. . [The number of the pension-certificate consists of the number of the pension-year, with (as base number) the number by which it is recorded in the Old-age Pension Register—e.g., 415.]

THIS is to certify that [Name of pensioner, occupation, and address] is entitled to a pension of [Set out amount in words] for the year commencing the 1st day of , 1 , payable by twelve equal monthly instalments of [Set out amount in words], of which the first instalment is payable on the 1st day of , 1 , and each subsequent instalment on the first day of each calendar month thereafter, at the post-office money-order office at [Name of post-office].
Dated and issued at , this day of , 1 .

Deputy Registrar for the Old-age Pension District.

[Every pension granted under the aforesaid Act shall be deemed to be granted and shall be held subject to the provisions of any amending or repealing Act, and no pensioner shall have any claim for compensation or otherwise by reason of his pension being affected by any such amending or repealing Act.]

Form 10 (Reg. 16).
Under “The Old-age Pensions Act, 1898.”

To the Deputy Registrar for the Old-age Pension District.

I, of , being a pensioner under the aforesaid Act, hereby make application for a duplicate pension-certificate in lieu of the original certificate No. , and in support of the application I hereby solemnly and sincerely declare as follows:—

(1.) The original certificate was duly issued to me as pensioner, and has been lost [or, as the case may be, destroyed].

(2.) [If destroyed, state when and how.]
[If lost] I have made diligent search for the lost certificate, but have been unable to find it.

And I make, &c. [as in the case of a pension-claim].

Form 11 (Reg. 18),
Under “The Old-age Pensions Act, 1898.”
APPLICATION FOR TRANSFER OF PENSION-CERTIFICATE FROM ONE DISTRICT TO ANOTHER.

To the Deputy Registrar for the Old-age Pension District.

I, , being the pensioner [or, as the case may be, the authorised payee of the instalments of the pension payable