Nov. 23.] THE NEW ZEALAND GAZETTE. 3503

38. All moneys received by way of refund, either with or without Court proceedings, shall be paid into the Public Account at the nearest branch of the Bank of New Zealand, or, in the absence of any such bank, into the Post Office Account at the nearest post-office, and the Registrar shall forward the bank or post-office receipt to the Commissioner without delay, giving particulars of such refund.

RETURNS.

39. The Registrar shall despatch to the Commissioner immediately after the close of each month returns for the said month as under:—
    (a.) A return of all new pensions granted during the month, indicating therein in their respective numerical order the numbers that have been allotted to transferred pensions.
    (b.) A return of all original pension-claims investigated by the Magistrate during the month and not granted, giving the reasons for rejection or adjournment.
    (c.) A return of the applications for renewed pension-certificates refused or adjourned during the month, giving the reasons for such refusal or adjournment.

DUTIES OF GOVERNMENT OFFICERS.

40. It shall be the duty of all Government officers to assist applicants in the preparation of their pension-claims.
41. It shall be the duty of every Registrar of the Supreme Court or Clerk of a Magistrate’s Court, if at the time of the conviction in his Court of any female for any offence he has reason to believe that such female is a widow, to ascertain whether the said female is a pensioner under the said Act, and if so to notify the Commissioner in writing accordingly.
42. It shall be the duty of every Registrar of Deaths to notify the Commissioner in writing of the death of every widow leaving children of the age of fourteen years and under, whose death is reported to him.
43. It shall be the duty of officers of the Police Force, in addition to assisting applicants in the preparation of their pension-claims, to render such service as may be required by the Commissioner, or the Registrar, in connection with the investigation of any claim or any inquiry under the said Act. Authority to incur expenditure by any such officer on any occasion must be obtained beforehand from the Commissioner through the local Registrar.
44. These regulations shall come into force in the 1st day of January, 1912.

—— [Form I (Widows—1).]

[This form is to be issued only to or on behalf of a bona fide applicant for pension.]

Under the Widows’ Pensions Act, 1911.

ORIGINAL PENSION-CLAIM. No.

To the Registrar of Pensions at
I, THE undersigned, being a widow, hereby make claim for a pension under the aforesaid Act.
My present full name is
My former full name was [or names were]
My full address is
My occupation is [or was]
I have lived previously in New Zealand at
I was born at , in the Country of , on the day of , 18
I am a British subject [State if by birth or naturalization] (and produce naturalization papers of self or late husband).
I arrived in New Zealand on the day of , I , at the port of , in the ship
[If absent from New Zealand during the past six months, state when.]
I was married at , on the day of , 1
My late husband’s name was
He died at , on the day of , 1
His death was registered at
The total number of children born to me is [Quote number only].
The following particulars relate to all my children who are under fourteen years of age and are dependent on me for their support:—

The name and address of a person [who must be well known and not a relative] who knows my circumstances are as follows:—

[Registrar to issue Form H.]

The income of myself and of such of my children as are under the age of fourteen years during the past twelve months has been as follows:— £

1. Salary, wages, or other personal earnings ..
2. Profits from business .. ..
3. Superannuation or other pension .. ..
4. Annuity from life assurance company or other source .. .. ..
5. Money left by will or legacy .. ..
6. Dividends from shares, debentures, or investments of any kind .. ..
7. Money from life assurance company—such as loan, bonus, surrender value, or sum assured..
8. Money received as compensation for accident, loss of office, or other cause .. ..
9. Interest on money lent on mortgage, in bank, or other institution .. .. ..
10. Money derived by way of rent from property ..
11. Money derived from sale of milk, grain, or produce of any kind .. .. ..
12. Money withdrawn from bank or obtained by mortgage on property .. .. ..
13. Allowances or valuable consideration received from relatives or other persons .. ..
14. Estimated value of free board and lodging ..

The names and addresses of the persons from whom above income was received are as follows:—

[Registrar to issue Form G1 or G2.]

The following interests in land and house property are owned by me or my children under fourteen years of age:—

[NOTE.—Particulars of Native land to be supplied on separate form.]

[Registrar to issue Form C.]

The above property is mortgaged to [Give full name, address, and occupation of mortgagee].
The amount owing on this mortgage at the present time is £

[Registrar to issue Form I.]

Money owned by me or my children under fourteen years of age is as follows:—

[Registrar to issue Forms B and D.]

Other property owned by me or by my children under fourteen years of age is as follows:— £
Furniture and personal effects [If insured, give insured value] .. .. .. ..
Cash in hand, or lent to, or in hands of [Give name and address] .. .. .. ..
Live-stock [Sheep, cattle, horses, &c.].. .. ..
Value of shares, debentures, or bonds in any company, institution, building, or other society [particulars] ..
Value of interest in business, stock in trade, or venture of any kind [particulars] .. .. .. ..
Any other property (not already specified) [particulars].. .. .. ..

Total .. .. .. .. ..£

Particulars of bill of sale or mortgage on any of this property are as follows:
[If any of this property is insured, state which, and give amount of insurance : .]