768
THE NEW ZEALAND GAZETTE.
[No. 31

RETURN of the Income of [Name of company in full, and postal address], made in pursuance of “The Land and Income Assessment Act, 1900,” and the Regulations thereunder.

Income derived during the year ending , 19 , from investments of any kind other than investments in land or upon mortgages in land, as per details shown within:

I, , the duly appointed public officer of the above-named company, do solemnly and sincerely declare that the foregoing return is true and accurate in every particular, and that the copy of the balance-sheet hereto attached is a true copy of the balance-sheet of the said company issued to shareholders, or prepared for issue, last prior to the date of this return. And I make this declaration under the provisions of “The Land and Income Assessment Act, 1900.”
Dated this day of , 19 .
[Usual signature.]

Return as Agent for Debenture-holders [as in Form 7].

Return of Persons in the Service or Employ of the Company [as in Form 6].

Return of Directors, Auditors, and Others [as in Form 7].

Particulars of Investments.

10. RETURN OF INCOME BY FIRE, MARINE, OR ACCIDENT INSURANCE COMPANY.

“The Land and Income Assessment Act, 1900.”

In pursuance of the above Act and of the regulations made thereunder, every company in receipt of income within the meaning of the said Act is required to fill up the following return as far as is applicable to its particular case, and deliver the same at, or forward it by post to, the office of the Commissioner of Taxes, Wellington, on or before the day of , 19 .
, Commissioner of Taxes.

RETURN of the Income of [Name of company in full, and postal address], made in pursuance of “The Land and Income Assessment Act, 1900,” and the Regulations thereunder.

Income derived during the year ending , 19 , excluding income derived from business carried on outside New Zealand, as per details shown within: £

I, , the duly appointed public officer of the above-named company, do solemnly and sincerely declare that the foregoing return is true and accurate in every particular, and that the copy of the balance-sheet hereto attached is a true copy of the balance-sheet of the said company issued to shareholders, or prepared for issue, last prior to the date of this return. And I make this declaration under the provisions of “The Land and Income Assessment Act, 1900.”
Dated this day of , 19 .
[Usual signature.]

Return as Agent for Debenture-holders [as in Form 7].

I claim to deduct from net income, &c. [as in Form 6].

Return of Persons in the Service or Employ of the Company [as in Form 6].

Return of Directors, Auditors, and Others [as in Form 7].

Statement of Gross Income and Deductions for the Year ending , 19 .

Amount. Total.
£ £
Gross premiums received .. ..
Less—
Returns .. .. ..
Reinsurances (with companies represented in New Zealand only) .. ————

Deduct losses on risks undertaken in New Zealand, less recoveries .. .. .. ————
Income from investments in New Zealand
Other income in New Zealand .. .. .. ————
Gross income in or from New Zealand .. £

Deductions from Gross Income.
Salaries, wages, and commissions ..
Rent (include only rent of premises or portion of premises used exclusively for the purposes of the business; not to include rental value of premises owned by taxpayer) .. .. ..
Rates on business premises (not to include payments for land- or income-tax) ..
Annual license-fee .. .. ..
Fire insurance (on business premises and stock only) .. .. ..
Interest, exchange, and discounts allowed, less amounts received (not to include interest on mortgages) .. ..
Printing, stationery, advertising, stamps, and telegrams .. .. ..
Travelling-expenses, incurred in the business only .. .. ..
Repairs or maintenance of business premises (not to include additions or improvements to property, nor depreciation) ..
Petty expenses, incurred in the business only (not to include donations, gratuities, nor subscriptions) .. .. ..
Bad debts (to include those proved to be bad during the year and actually written off the books as bad and irrecoverable) ..
Other items—

Total deductions .. .. ———— ————
Net income .. .. .. £ ====

11. RETURN OF INCOME BY AGENT, CONSIGNEE, OR NON-RESIDENT TRADER.

“The Land and Income Assessment Act, 1900.”

In pursuance of the above Act and of the regulations made thereunder, every agent for a non-resident trader, every consignee, or non-resident trader within the meaning of the said Act, is required to fill up the following return as far as is applicable to his particular case, and deliver the same at, or forward it by post to, the office of the Commissioner of Taxes, Wellington, on or before the day of , 19 .
, Commissioner of Taxes.

Name in full: .
Postal address: .
Occupation: .

Return as Agent for Non-resident Traders (made in pursuance of “The Land and Income Assessment Act, 1900,” and the Regulations thereunder).

Income derived during the year ending 31st March, 19 , from the sale of goods received from abroad and sold in the colony on account of non-resident traders, as per details shown on page 2: £

I, the person making the foregoing return, do solemnly and sincerely declare it to be true and accurate in every particular. And I make this declaration under the provisions of “The Land and Income Assessment Act, 1900.”
Dated this day of , 19 .
[Usual signature.]

Return as Consignee (made in pursuance of “The Land and Income Assessment Act, 1900,” and the Regulations thereunder).

Income derived during the year ending 31st March, 19 , from the sale of goods received from abroad and sold in the colony on consignment account, as per details shown on page 3: £

I, the person making the foregoing return, do solemnly and sincerely declare it to be true and accurate in every particular. And I make this declaration under the provisions of “The Land and Income Assessment Act, 1900.”
Dated this day of , 19 .
[Usual signature.]