168
THE NEW ZEALAND GAZETTE.
[No. 3

Travelling-expenses, incurred in the business only .. .. .. .. £ £
Printing, stationery, advertising, stamps, and telegrams .. .. .. ..
Repairs or maintenance of machinery, plant, or business premises (not to include additions or improvements to property or plant, nor any depreciation) ..
Petty expenses, incurred in the business only (not to include donations, gratuities, nor subscriptions) .. .. .. ..
Bad debts (to include those proved to be bad during the year and actually written off the books as bad and irrecoverable, and no others) .. .. .. ..
Other items (to be specified)—

Total deductions .. .. ————

Net income .. .. .. £ ————

10. RETURN OF INCOME BY INSURANCE OR GUARANTEE COMPANY.

The Land and Income Assessment Act, 1908, and its amendments.

In pursuance of the above Acts and of the regulations made thereunder, every insurance or guarantee company (other than a life-insurance company) in receipt of income within the meaning of the said Acts is required to fill up the following return as far as is applicable to its particular case, and deliver the same at, or forward it by post to, the office of the Commissioner of Taxes, Wellington, on or before the day of , 19 .

, Commissioner of Taxes.

RETURN of the Income of [Name of company in full and postal address], made in pursuance of the Land and Income Assessment Act, 1908, and its amendments, and the Regulations thereunder.

INCOME derived during the year ending , 19 , excluding income derived from business carried on outside New Zealand, as per details shown within : £ .

I, , the duly appointed public officer of the above-named company, do solemnly and sincerely declare that the foregoing return is true and accurate in every particular, and that the copy of the balance-sheet and profit and loss account hereto attached is a true copy of the balance-sheet and profit and loss account of the said company issued to shareholders, or prepared for issue, last prior to the date of this return. And I make this declaration under the provisions of the Land and Income Assessment Act, 1908, and its amendments.

Dated this day of , 19 .
[Usual signature.]

Return as Agent for Debenture-holders [as in Form 9].

I claim to deduct from net income, &c. [as in Form 6].

Return of Persons in the Service or Employ of the Company [as in Form 6].

Return of Directors, Auditors, and Others [as in Form 9].

Statement of Gross Income and Deductions therefrom for the Year ending . 19 . Amount. Total.

Gross premiums received .. .. £ £
Less—
Returns .. .. .. ..
Reinsurances (with companies represented in New Zealand only) .. ————

Deduct losses on risks undertaken in New Zealand, less recoveries .. .. ————

Income from investments .. ..
Other income in New Zealand .. .. ————

Gross income in or from New Zealand .. £

Deductions from Gross Income. £ £
Salaries, wages, and commissions ..
Rent (include only rent of premises or portion of premises used exclusively for the purposes of the business; not to include rental value of premises owned by taxpayer) .. .. .. ..
Rates on business premises or portion of premises used exclusively for purposes of business (not to include payments for land-tax or income-tax) .. ..
Annual license fee .. .. .. ..
Fire insurance (on business premises and stock only) .. .. .. ..
Interest, exchange, and discounts allowed, less amounts received (not to include interest on mortgages) .. ..
Printing, stationery, advertising, stamps, and telegrams .. .. .. ..
Travelling-expenses, incurred in the business only .. .. .. ..
Repairs or maintenance of business premises (not to include additions or improvements to property, nor any depreciation)
Petty expenses, incurred in the business only (not to include donations, gratuities, nor subscriptions) .. .. .. ..
Bad debts (to include those proved to be bad during the year and actually written off the books as bad and irrecoverable, and no others) .. .. .. ..
Other items—

Total deductions .. .. ————

Net income .. .. .. £ ————

11. RETURN OF INCOME BY LIFE-INSURANCE COMPANY.

The Land and Income Assessment Act, 1908, and its amendments.

In pursuance of the above Acts and of the regulations made thereunder, every life-insurance company in receipt of income within the meaning of the said Acts is required to fill up the following return as far as is applicable to its particular case, and deliver the same at, or forward it by post to, the office of the Commissioner of Taxes, Wellington, on or before the day of , 19 .

, Commissioner of Taxes.

RETURN of the Income of [Name of company in full and postal address], made in pursuance of the Land and Income Assessment Act, 1908, and its amendments, and the Regulations thereunder.

INCOME derived during the year ending , 19 , from investments of any kind other than investments in land or upon mortgages of land, as per details shown within :

I, , the duly appointed public officer of the above-named company, do solemnly and sincerely declare that the foregoing return is true and accurate in every particular, and that the copy of the balance-sheet hereto attached is a true copy of the balance-sheet of the said company issued to shareholders, or prepared for issue, last prior to the date of this return. And I make this declaration under the provisions of the Land and Income Assessment Act, 1908, and its amendments.

Dated this day of , 19 .
[Usual signature.]

Return as Agent for Debenture-holders [as in Form 9].

Return of Persons in the Service or Employ of the Company [as in Form 6].

Return of Directors, Auditors, and Others [as in Form 9].

Particulars of Investments.

Nature of Investment. Amount of Investment. Rate of Interest. Amount of Interest.
£ £