Dec. 14.] THE NEW ZEALAND GAZETTE. 2875

[Form 6 (Reg. 10).

Pension-claim No. . Pension-certificate No. .

Under the Old-age Pensions Acts, 1898, 1900, 1901, 1902, and 1905.

STIPENDIARY MAGISTRATE’S CERTIFICATE OF ESTABLISHMENT OF CLAIM.

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

I HEREBY certify that the above-numbered pension-claim made by , [Occupation], [Address], has this day been investigated by me, and the following facts have been proved before me:—

1. Age. By (a) .
2. Residence in the colony. By (a) .
3. Character. By (a) .
4. (b) The claimant has fulfilled the conditions set out in “The Old-age Pensions Act, 1898,” section 8, subsections (3), (4), (5), (6), and (9), and amendments thereto.
5. The claimant’s income for last year was .. £
   The claimant’s husband’s [or wife’s] income was £

Deduction on account of income in excess
of £34, or in terms of section 6, 1905 Act £
6. The gross value of claimant’s property is (c) .. £
Less allowance by 1898 Act or 1905 Act .. .. .. .. £
Less mortgage at present date .. £
—— £
Making the net value of property .. .. £

The gross value of husband’s [or wife’s] property is (c) .. .. .. .. £
Less allowance by 1898 Act or by 1905 Act .. .. .. .. £
Less mortgage at present date .. £
—— £
Making the net value of property .. .. £

Deduction on account of property, being £1 for every £10 in net value .. £
[NOTE.—If claimant is married, see section 4, 1905 Act.]

The claimant is granted a pension of £ (pounds).
Dated at , this day of , 190 .
, Stipendiary Magistrate.

(a) State briefly the nature of the proof.
(b) See endorsement below.
(c) State particulars of property hereunder:
...........................................................

Particulars to be supplied by Deputy Registrar.

Date of birth: . Nationality: .
Name of husband [wife]: [If not married, state conjugal condition and sex.]
Husband’s [wife’s] pension No. .
Paying office: .
Pension-certificate No. , issued to D.R., , 190 .
Index card: . Schedule: .
Charge: . P.C.: .
Gen. Reg.: . Dist. card: .
P.C. Reg.: . File: .

“THE OLD-AGE PENSIONS ACT, 1898” (AS AMENDED).

Section 7. Subject to the provisions of this Act, every person of the full age of sixty-five years or upwards shall, whilst in the colony, be entitled to a pension as hereinafter specified.

Section 8. No such person shall be entitled to a pension under this Act unless he fulfils the following conditions, that is to say:—
(1.) That he is residing in the colony on the date when he establishes his claim to the pension.
(2.) That he has so resided continuously for not less than twenty-five years immediately preceding such date:
Provided that continuous residence in the colony shall not be deemed to have been interrupted by occasional absence therefrom unless the total period of all such absences exceeds two years; nor, in the case of a seaman, by absence therefrom whilst serving on board a vessel registered in and trading to and from the colony if he establishes the fact that during such absence his family or home was in the colony.

[NOTE.—A total period of four years’ absence is allowed where the applicant was not absent during the twelve months ended 31st October, 1898, and where the total period of actual residence is not less than twenty-five years.]

(3.) That during the period of twelve years immediately preceding such date he has not been imprisoned for four months, or on four occasions, for any offence punishable by imprisonment for twelve months or upwards, and dishonouring him in the public estimation.

(4.) That during the period of twenty-five years immediately preceding such date he has not been imprisoned for a term of five years with or without hard labour for any offence dishonouring him in the public estimation.

(5.) That the claimant has not during the period of twelve years immediately preceding such date for a period of six months or upwards, if a husband, deserted his wife, or without just cause failed to provide her with adequate means of maintenance, or neglected to maintain such of his children as were under the age of fourteen years; or, if a wife, deserted her husband or such of her children as were under that age:
Provided that, if the pension-certificate is issued, the pensioner’s rights thereunder shall not be affected by any disqualification contained in this subsection, unless the fact of such disqualification is established at any time to the satisfaction of a Stipendiary Magistrate.

(6.) That he is of good moral character, and is, and has for five years immediately preceding such date been, leading a sober and reputable life.

(7.) That his yearly income does not amount to sixty pounds or upwards, computed as hereinafter provided.

[NOTE.—The joint incomes of a husband and wife, with pensions added, must not exceed £90.]

(8.) That the net capital value of his accumulated property does not amount to two hundred and sixty pounds or upwards, computed and assessed as hereinafter provided.

(9.) That he has not directly or indirectly deprived himself of property or income in order to qualify for a pension.

[Form No. 22 (Reg. 45).

District: .
Pension No. .

Under the Old-age Pensions Acts, 1898, 1900, 1901, 1902, and 1905.

STIPENDIARY MAGISTRATE’S CERTIFICATE OF RENEWAL OF PENSION.

The Deputy Registrar for the Old-age Pension District.

I HEREBY certify that I have investigated the income and property statement of [Name], [Occupation], [Address], for the income-year ended the day of , 190 , and am satisfied on the following points:—

(1.) The pensioner’s income was .. .. £
The pensioner’s husband’s [or wife’s] income was .. .. .. .. £

Deduction on account of income in excess of £34, or in terms of section 6, 1905 Act .. .. .. .. £

[NOTE.—Please indicate if pensioner is single, widowed, or married.]

(2.) The gross value of pensioner’s property is* .. £
Less allowance by 1898 Act or 1905 Act .. .. .. .. £
Less mortgage at present date .. £
—— £
Making the net value of property .. .. £

The gross value of pensioner’s husband’s [or wife’s] property is* .. .. .. .. £
Less allowance by 1898 Act or 1905 Act .. .. .. .. £
Less mortgage at present date .. £
—— £
Making the net value of property .. .. £

Deduction on account of property, being £1 for every £10 in net value .. £

[NOTE.—If pensioner married, see section 4, 1905 Act.]

(3.) The conditions of section 8 of the aforesaid Act of 1898 have been complied with [or, as the case may be, have not been complied with in so far as relates to subsection numbered of that section].