Jan. 18. THE NEW ZEALAND GAZETTE. 181

4. Respiration.—Is there any disease of the lungs?
5. Circulation.—Is there any disease of the heart or circulatory system?
6. Digestion.—Is there any disease of stomach, bowels, or liver?
7. Urinary and genital system.—Is there any disease of the kidneys or bladder, or any stricture?

NOTE.—An analysis of urine should be supplied showing appearance, specific gravity, reaction, and whether there is any albumen, sugar, bile, or deposit.

8. Nervous functions—
   (a.) Are there any traces or effects of palsy, convulsion, insanity, or inebriety?
   (b.) Is there any defect in figure, sight, hearing, or speech?
   (c.) Has there been any apoplexy?

9. Surface: Is there any otorrhœa.

10. Is there any circumstance relating to the personal constitution or health, or habits, &c., of the contributor not above specified but known or suspected by you that should, in your opinion, be disclosed to the Superannuation Board?

11. If the contributor is in bad health, do you think his habits of life, past or present, especially in reference to the use of intoxicating liquor, have in any way conduced to his present condition?

NOTE.—The medical examiner will be expected to answer this question fully, as the Superannuation Board requires to be satisfied that the contributor’s condition has not been caused by irregular or intemperate habits.

CERTIFICATE.

I do hereby certify that I have this __ day of __, 19, made a careful physical examination of __, and that the queries above have been answered by me to the best of my knowledge and judgment; and, after careful consideration of the whole evidence before me, I am of opinion that his condition and health are,—

NOTE.—The medical examiner will here give a full description of the contributor’s condition and health.

And I certify,—
(The medical examiner will strike out what does not apply.)

1. Such as will permanently and totally incapacitate him from continuing his present or any occupation in the Public Service.
2. Such as will not permanently incapacitate him from continuing his present occupation, but that with __ rest he will be fit to resume his duties.

NOTE.—Fill in period of rest recommended.

3. Such as will not enable him to continue his present duties, but will enable him to undertake duties of a less responsible or arduous character, such as those of __.

NOTE.—Fill in the nature of the occupation that the medical examiner thinks should be followed.

Dated at __, this __ day of __, 19____.
[Signature of Medical Examiner.]
[Qualifications.]
[Address.]

29. With respect to claims on the Fund arising upon the death of a contributor, the Secretary shall investigate the same and report thereon.

30. The members of the Board shall, at the first quarterly meeting in each year, elect a committee, to consist of three members, two to form a quorum, to consider in detail and to report to the Board upon all claims arising on the Fund. Such committee shall meet on the afternoon of the day before that fixed for each quarterly meeting of the Board.

31. In respect of every contributor who retires medically unfit, and in respect of every claim arising on the Fund in consequence of the death of a contributor, it shall be the duty of the head of the Department to furnish a certificate with particulars (if any) as to whether any compensation has been paid or is payable by the Crown under the provisions of the Workers’ Compensation Act, 1908, or any Act amending or substituted for that Act.

32. The Board shall at its first meeting after receipt of the necessary particulars consider such cases as have been reported upon, and if satisfied as to the correctness of such claim grant allowances or authorize payments, as the case may require, in accordance with the terms of the Act, and determine the date from which the first payment in each case shall be made.

33. In the event of the date of a contributor’s retirement falling on a day other than the last day of a month, then the first instalment of his retiring-allowance shall be payable in respect of the balance of the month, and thereafter at the end of each month.

34. Allowances granted to widows and children under sections 42 and 43 of the Act shall be due and payable on the last day of each month, and, except as to the first and last payment, shall be in equal monthly instalments of £1 10s. for the widow and £1 1s. 8d. for each child.

35. The Secretary shall forthwith after the Board’s decision advise the contributor or beneficiary of the same, and where necessary require him to elect whether he accepts a retiring-allowance or a refund of his contributions in lieu thereof.

36. The receipt of any person to whom the Board may direct any sum accruing in respect to benefits derivable under the Act to be paid shall be an absolute discharge to the Fund of all further liability in respect of the amount so paid.