Feb. 19.] THE NEW ZEALAND GAZETTE. 511

Form 7 (Reg. 19).
DISTRICT OLD-AGE PENSION REGISTER.

Pension-certificate No.:
Name in full:
Address:
Occupation:
District:

No. of Pension-year.
Date of Magistrate’s Certificate.
Date on which Income-year ends.
Date on which Pension-year commences.
Amount of Pension.
Monthly Instalment of Pension, due on the 1st Day of each Month.
Income of Pensioner.
Income of Pensioner’s Husband [or Wife].
Pensioner.
Total Property owned by [Pensioner’s Husband or Wife].
Post-office where payable.
Remarks (see Regulation 20).

Husband’s [or wife’s] pension No.

Form 8 (Reg. 20).

Under “The Old-age Pensions Act, 1898.”

ADVICE OF ENTRY IN PENSION REGISTER.

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 [IMPORTANT—Please give full particulars relating to the entry, and give due date of the instalment affected where necessary].

Dated at , this day of , 19 .
, Deputy Registrar for the Old-age Pension District.

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Form 9 (Reg. 22).

Under “The Old-age Pensions Act, 1898.”

APPLICATION FOR DUPLICATE PENSION-CERTIFICATE.

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.]
   I have made diligent search for the lost certificate, but have been unable to find it.

And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of an Act of the General Assembly of New Zealand intituled “The Justices of the Peace Act, 1882.”

, Applicant.

Declared by the said , at , this day of , 19 , before me—
Justice of the Peace.
Solicitor.
Deputy Registrar for the Old-age Pension District.
Postmaster at .

The Registrar, Wellington.
I have every reason to believe that the statement of the pensioner is correct, and I recommend the issue of a duplicate, which please forward to me for signature and delivery to the pensioner.
, Deputy Registrar.

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Form 10 (Reg. 24).

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 to (Full name of pensioner)], pursuant to pension-certificate No. , hereby apply for a transfer of the pension-certificate from this district to the Old-age Pension District, on the grounds [Set out briefly but clearly the grounds, and give new address of pensioner].
Pension-certificate is herewith attached.
It is desired that the post-office of payment in the new district should be at .
Dated at , this day of , 19 .
, Applicant.

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Form 11 (Reg. 24).

Under “The Old-age Pensions Act, 1898.”

TRANSFER WARRANT.

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

No. of pension-certificate transferred:
Name of pensioner in full:
New address:
Name of payee, and date and currency of the warrant or order under which he is entitled:
Name of district to which transfer is made:
Due date of next instalment:
Date of original grant:
Amount of income in last income-year:
Gross amount of accumulated property:
Date on which income-year ends in each year:
Name of post-office in new district for payment of future instalments:

THIS transfer is recorded in my register as on this date, and the Court papers have been forwarded to the Clerk of Court at . Kindly make the necessary entries in your register, and forward this warrant to the Registrar by first mail.

Dated at , this day of , 19 .
, Deputy Registrar for the Old-age Pension District.

Pension now bears No. in my district, and pension-certificate has been altered accordingly.
, Deputy Registrar at .

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Form 12 (Reg. 25).

Under “The Old-age Pensions Act, 1898.”

APPLICATION FOR CHANGE OF OFFICE OF PAYMENT.

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

I, [Full name, occupation, and address of applicant], being the pensioner [or, as the case may be, the authorised payee of the instalments of the pension payable to (Full name of pensioner)] pursuant to pension-certificate No. , hereby apply that the office of payment may be changed from to , on the grounds [Set out briefly but clearly the grounds].

Dated at , this day of , 19 .
, Applicant.

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Form 13 (Reg. 27).

OLD-AGE PENSION ADVICE.

Instalment .
To the Postmaster of . Pension-district: . Pension-certificate Number: .

PAY the sum of pound shillings and pence, on production of the pensioner’s certificate.

Accountant, G.P.O.

I HEREBY acknowledge the receipt of the above-named sum.

Signature of Pensioner or his Agent.
Signature of witness to marks (if payee unable to write) and to signature of Maoris: .

• Warrant dated produced.
  , Paying Officer.

• To be used only when paid to an agent.

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Form 14 (Reg. 33).

Under the Old-age Pensions Acts, 1898, 1900, 1901, 1902.

APPLICATION FOR PAYMENT OF FORFEITED INSTALMENT.

Pension No. , District.

I, , [Address], being the pensioner [or, as the case may be, the authorised payee], hereby apply for payment of the forfeited instalment which was due on the 1st day of , 19 , and has become forfeited by lapse of time;