New Zealand Gazette – 1915 – No. 121

Page 3551

✨ National Register of Men Form



Oct. 21.] THE NEW ZEALAND GAZETTE. 3551

NEW ZEALAND NATIONAL REGISTER OF MEN—continued.

A. State (a) Height: __ ft. __ in.
(b) Weight: __ st. __ lb.

B. State whether your general health is—(a) Very good; (b) Good; (c) Indifferent; (d) Bad:

If health indifferent or bad state cause:

C. If suffering from blindness, deafness, loss of limb, or other physical infirmity, give particulars:

  1. If between ages of NINETEEN and FORTY-FIVE—
    (a) Have you volunteered for military service beyond New Zealand as a member of an Expeditionary Force in connection with the present war? If so, have you been accepted for service or rejected?
    (b) If you have not volunteered for service—
    (i) Are you (being a single man without dependants) willing to become a member of an Expeditionary Force?
    (ii) Are you (being a single man with dependants, or a married man or a widower with dependants) willing to become a member of an Expeditionary Force, if required?
    If so, in what arm of the Service do you prefer to serve?
    (c) If you have not volunteered for military service and are not prepared to volunteer, are you willing to serve in any civil capacity in connection with the present war?
    If so, state in what civil capacity:
    (d) If there are any circumstances or reasons that prevent you from offering your services, state them:—

If you have had military training at any time state—
(a) Arm of the Service:
(b) Rank held:
(c) Total length of service in all capacities:

PARTICULARS OF RELATIVES WHOLLY OR PARTIALLY DEPENDENT ON YOU.

Name and Address. Age. Occupation (if any) or Condition (e.g., retired, Old-age Pensioner, Apprentice, Invalid, or as the case may be). Relationship (e.g., Wife, Son, Mother, or as the case may be). Whether wholly or partially dependent on you. In Case of Partial Dependents, Extent of Dependency per Annum. £ Other Income (if any) of Dependant per Annum £

I CERTIFY that the particulars given in this schedule are correct to the best of my knowledge and belief.

Place and Date: _____

Signature: _____

J. F. ANDREWS,
Clerk of the Executive Council.



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Online Sources for this page:

VUW Te Waharoa — PDF NZ Gazette 1915, No 121


NZLII — PDF NZ Gazette 1915, No 121




✨ LLM interpretation of page content

🏛️ Form of Personal Schedule Prescribed (continued from previous page)

🏛️ Governance & Central Administration
18 October 1915
National Registration Act, Personal Schedule, Government Statistician
  • J. F. Andrews, Clerk of the Executive Council