Dec. 24.] THE NEW ZEALAND GAZETTE. 3337

(Sec. 17.—A.) [Form I (8).]

NEW ZEALAND.

Under “The Industrial Conciliation and Arbitration Act, 1908,” and its Amendments.

YEARLY LIST.

Yearly List of Unions constituting the Association of , together with the Officers and Trustees, as on the 31st December, 190 .

Full Name. Address.

Officers of Association.
, President ..
, Vice-President ..
, Secretary ..
, Trustee ..
” ..
, Auditor ..
” ..
, Committeeman ..
” ..
” ..
” ..
” ..
” ..

Unions constituting Association.

This is the list, marked “A,” referred to in the annexed declaration of , Chairman [or Secretary], made this day of , 190 , before me,—

Solicitor [or Justice of the Peace].

Address of registered office of association: .

(Sec. 17.) [Form I (9).]

Under “The Industrial Conciliation and Arbitration Act, 1908,” and its Amendments.

STATUTORY DECLARATION AS TO YEARLY LIST OF MEMBERS AND OFFICERS OF INDUSTRIAL UNION [or ASSOCIATION].

I, [Name in full], of [Address and occupation], do solemnly and sincerely declare as follows:—

(1.) That I am the Chairman [or Secretary] of the [Full name of union or association].

(2.) (a.) Union.—That the list hereto annexed and marked “A” is a full and correct list of the members whose subscriptions are not more than twelve months in arrear, and of the officers (including trustees) of such union, as on the 31st day of December, 190 .

Or (2.) (b.) Association.—That the list hereto annexed and marked “A” is a full and correct list of the industrial unions constituting such association, and of the officers (including trustees) of such association, as on the 31st day of December, 190 .

And I make this solemn declaration conscientiously believing the same to be true, and by virtue of “The Justices of the Peace Act, 1908.”

Declared at [Name of town], this day of January, 190 , before me,—

(Signed)

A Justice of the Peace for New Zealand [or a Solicitor of the Supreme Court of New Zealand].

(Sec. 21.) [Form I (10).]

Under “The Industrial Conciliation and Arbitration Act, 1908,” and its Amendments.

APPLICATION FOR CANCELLATION OF REGISTRATION OF INDUSTRIAL UNION [or ASSOCIATION].

To the Registrar of Industrial Unions, Wellington.

We hereby make application for the cancellation of the registration of the [Registered name of the industrial union or association].

We enclose herewith,—

(a.) The certificate of registration.

(b.) Evidence that cancellation is desired by a majority of the members thereof.

1. Total present membership: .
2. Number present at meeting: .
3. Number voting in favour of cancellation: .

Dated at , this day of , 190 .

[Seal.]

[Office held.]

[Office held.]

(Sec. 27.) [Form I (11).]

Under “The Industrial Conciliation and Arbitration Act, 1908,” and its Amendments.

NOTICE OF CONCURRENCE IN AN INDUSTRIAL AGREEMENT.

To the Clerk of Awards at .

TAKE notice that I [we], the undersigned, hereby signify my [our] concurrence in the industrial agreement dated the day of , 190 , made between , and filed at your office as No. .

Dated at , this day of , 190 .

(Signatures.)

(Amend. Act, 1908, sec. 67.) [Form I (12).]

Under “The Industrial Conciliation and Arbitration Act, 1908,” and its Amendments.

APPLICATION FOR ORDER OF THE COURT OF ARBITRATION EXTENDING AN INDUSTRIAL AGREEMENT UNDER SECTION 67 OF THE AMENDMENT ACT, 1908.

To the Clerk of Awards at .

I [or we], the undersigned, party to the Industrial Agreement, dated , 190 , and filed with the Clerk of Awards at , hereby make application for an order extending the operation of that agreement to all employers in the industrial district who are now or may at any time hereafter be engaged in the industry to which the said agreement relates.

Dated at , this day of , 190 .

(Signatures.)

(Amend. Act, 1908, sec. 67.) [Form I (13).]

Under “The Industrial Conciliation and Arbitration Act, 1908,” and its Amendments.

NOTICE OF APPLICATION TO EXTEND INDUSTRIAL AGREEMENT.

In the Industrial District.

TAKE notice that an application to extend the Industrial Agreement, dated , to all employers in the industrial district who are now or may at any time hereafter be engaged in the industry to which the said agreement relates has been made by one of the parties thereto or one of the persons bound thereby.

Dated at , this day of , 190 .

Clerk of Awards.

(Amend. Act, 1908, sec. 30.) [Form I (14).]

Under “The Industrial Conciliation and Arbitration Act, 1908,” and its Amendments.

APPLICATION THAT INDUSTRIAL DISPUTE BE HEARD BY A COUNCIL OF CONCILIATION.

To the Conciliation Commissioner at .

An industrial dispute having arisen between [Name of union, association, or employer, together with any other unions, associations, or employers subsequently joined] and [Name of union, association, or employer, together with any other unions, associations, or employers subsequently joined], and the parties thereto having failed to satisfactorily adjust such dispute, application is hereby made that the dispute be heard by a Council of Conciliation, for which [Not more than three Assessors] persons whose names are given below are recommended for appointment as Assessors. In accordance with section 107 of the Act, I attach certificate of Chairman of the special meeting that the reference has been approved by the members.

Dated at , this day of , 190 .

Signature: [Industrial union, association, or employer.]