824

THE NEW ZEALAND GAZETTE.

No. 21

13. These regulations and the forms prescribed thereby shall, with the necessary modifications, extend and apply to united superannuation funds established pursuant to section 15 of the Local Authorities Superannuation Act, 1908; and all references herein to a local authority shall be deemed to include references to the Board in which any such united fund is vested, and references to the employees of a local authority shall include references to the employees of all the local authorities represented by the Board.

SCHEDULE.

Form No. 1.

ELECTION TO BECOME CONTRIBUTOR TO SUPERANNUATION FUND ESTABLISHED BY [Name of local authority] UNDER THE LOCAL AUTHORITIES SUPERANNUATION ACT, 1908.

To the Clerk [or Secretary] of the [Name of local authority],

I, [Name in full, and address], being employed as [State capacity in which employed] by the [Name of local authority], hereby elect to become a contributor to the Superannuation Fund established by the said Council [or Board, or as the case may be].

I hereby declare the following particulars to be correct to the best of my knowledge and belief:—

(1.) Full name:

(2.) Date of birth:

(3.) Date of original appointment:

(4.) Total period of service, with dates of retirement and reappointment in cases of broken service*:

(5.) Rate of salary:

(6.) Condition (whether married or single, or widower or widow):

(7.) Date of birth of wife (if any):

(8.) Date of birth of each child (if any) living and under the age of fourteen years.

Dated at this day of , 19 .

[Signature of applicant.]

The retiring-allowances of contributors are determined by reference to their length of continuous service subsequent to the date of joining the fund; service prior to that date is taken into account only in cases where a local authority acting pursuant to section 2 of the Local Authorities Superannuation Amendment Act, 1912, has agreed to grant out of its ordinary revenues an additional annual allowance in respect of such service.

Form No. 2.

NOTICE BY LOCAL AUTHORITY TO CONTRIBUTOR ON RECEIPT OF ELECTION TO BECOME CONTRIBUTOR TO FUND.

To [Name in full].

I HEREBY acknowledge the receipt of the notice, dated the day of , 19 , of your election to become a contributor to the [Name of Superannuation Fund in full].

In pursuance of section 18 of the Local Authorities Superannuation Act, 1908, a deduction at the rate of per centum per annum will be made from all payments of salary (as defined by section 2 of the said Act) from time to time payable to you in respect of your services on and subsequent to the above-mentioned date.

[Signature of Clerk or Secretary of Local Authority.]

Form No. 3.

REGISTER OF CONTRIBUTORS TO SUPERANNUATION FUND ESTABLISHED BY THE [Name of local authority].

(1.) Registered number:

(2.) Name in full:

(3.) Position in service:

(4.) Date of birth:

(5.) Date of joining fund:

(6.) Length of prior service, with particulars as to dates of appointment, reappointment, &c.:

(7.) Rate of contribution:

(8.) Date of retirement from service:

(9.) Cause of retirement:

(10.) (a.) Amount of annual retiring-allowance:

or

(b.) Amount of contributions refunded:

In case of death of male contributor or annuitant—

(11.) (a.) Date of his death:

(b.) Date of birth of widow (if any), and date of her death or remarriage:

(c.) Amount payable to widow (if any) by way of annuity:

or

(d.) Returned contributions paid by deceased, less sums received by him in his lifetime:

(e.) Amount payable in respect of children under fourteen, setting out also names of children and respective dates of birth; also dates of expiry of allowances by attainment of age of fourteen years, or by death:

(f.) Amount (if any) paid to personal representatives of deceased:

In case of death of female contributor or annuitant—

(12.) (a.) Amount payable in respect of children under fourteen, setting out also names of children and respective dates of birth; also dates of expiry of allowances by attainment of age of fourteen years, or by death:

(b.) Amount paid to personal representatives of deceased:

Form No. 4.

REVENUE ACCOUNT OF SUPERANNUATION FUND FOR THE YEAR ENDED 31ST DECEMBER, 19 .

Income.

Amount of fund at the beginning of the year £ s. d.
Members’ contributions .. .. ..
Subsidy from local authority .. .. ..
Additional amount (if any) paid by local authority under section 11 .. .. ..
Interest (including interest accrued) .. .. ..
Other receipts [To be specified] .. .. ..

£

Expenditure.

Retiring-allowances .. .. ..
Annuities to widows .. .. ..
Allowances in respect of children .. .. ..
Contributions refunded—
(a.) To members .. .. ..
(b.) To widows .. .. ..
(c.) To personal representatives .. .. ..
Other payments [To be specified] .. .. ..
Amount of fund at end of year .. .. ..

£

Form No. 5.

BALANCE-SHEET OF SUPERANNUATION FUND FOR THE YEAR ENDED 31ST DECEMBER, 19 .

Liabilities.

Fund as per Revenue Account .. .. ..
Retiring-allowances due and in course of payment ..
Refunds of contributions due, and in course of payment .. .. ..
Other sums owing [Accounts to be specified] .. .. ..

£

Assets.

Amount in hands of the Public Trustee .. .. ..
Contributions due, in transmission* .. .. ..
Other sums due [Accounts to be specified] .. .. ..

£

*Included in the corresponding items in the Revenue Account.

Form No. 6.

STATEMENT OF MEMBERSHIP OF SUPERANNUATION FUND FOR THE YEAR ENDED 31ST DECEMBER, 19 .