JULY 1.] THE NEW ZEALAND GAZETTE. 2191

FORM 2. [Reg. 6.

The Coal-mines Act, 1908.

SECOND-CLASS MINE-MANAGER’S CERTIFICATE.

No. . Office of Board of Examiners,
Wellington, , 19 .

THIS is to certify that [State the name in full, address, and occupation of person examined] has produced a certificate from his previous employers that he has been actually engaged in underground workings in a mine for a period of not less than five years, and has passed a satisfactory examination as a second-class mine-manager of a coal-mine, as required by sections 25 to 27 of the Coal-mines Act, 1908, and the regulations made thereunder.

A. B.,
Chairman of Board of Examiners.

Entered, Vol. , folio .
C. D., Secretary.

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FORM 3. [Reg. 6.

The Coal-mines Act, 1908.

MINE-MANAGER’S CERTIFICATE OF COMPETENCY.

Office of Board of Examiners,
Wellington, , 19 .

THIS is to certify that [State the name in full, address, and occupation of applicant] has produced a mine-manager’s certificate granted in [Name of British possession or foreign country] and has satisfied the Board of Examiners that he is entitled to a first- (or second-) class mine-manager’s certificate of competency under the provisions of section 28 of the Coal-mines Act, 1908 (as set forth in section 5 of the Coal-mines Amendment Act, 1914), and this certificate is issued in compliance therewith.

A. B.,
Chairman of Board of Examiners.

Entered, Vol. , folio .
C. D., Secretary.

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FORM 4.

The Coal-mines Amendment Act, 1909.

UNDERVIEWER’S CERTIFICATE OF COMPETENCY (BY EXAMINATION).

THIS is to certify that [State name in full, address, and occupation of person examined] has produced satisfactory evidence as to his experience, sobriety, and good conduct, and has passed the examination as underviewer of a coal-mine, as required by section 9 of the Coal-mines Amendment Act, 1909, and the regulations thereunder.

A. B.,
Chairman of Board of Examiners.

Entered, Vol. , folio .
C. D., Secretary.

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FORM 5.

The Coal-mines Amendment Act, 1909.

FIREMAN AND DEPUTY’S CERTIFICATE OF COMPETENCY (BY EXAMINATION).

THIS is to certify that [State name in full, address, and occupation of person examined] has produced satisfactory evidence as to his experience, sobriety, and good conduct, and has passed the examination as fireman and deputy of a coal-mine, as required by section 9 of the Coal-mines Amendment Act, 1909, and the regulations thereunder.

A. B.,
Chairman of Board of Examiners.

Entered, Vol. , folio .
C. D., Secretary.

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FORM 6.

The Coal-mines Act, 1908.

APPLICATION TO BE EXAMINED FOR CERTIFICATE.

To the Secretary of the Board of Examiners, Wellington.

I [Full name, occupation, and residence], the undersigned, hereby apply to be examined for a certificate as . I enclose the prescribed fee of* , and hereby declare as follows:—

(1.) My practical experience consists of actual employment as specified in the Schedule hereto; and in proof thereof I forward with this application evidence in writing from my previous employers, as specified in that Schedule.

(2.)† I am the holder of a second-class certificate, No. , and desire to be examined for a certificate of the first class.

Dated at this day of , 19 .

SCHEDULE.

Particulars and Proof of Employment.

Signature of Applicant: .

• First-class mine-manager, £1; second-class mine-manager, £1; underviewer, 5s.; fireman and deputy, 2s. 6d.

† If the applicant is a candidate for examination for a mine-manager’s certificate, and already holds a certificate of the second class, add this paragraph.

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FORM 7.

The Coal-mines Act, 1908.

UNDERVIEWER’S OR FIREMAN AND DEPUTY’S CERTIFICATE OF COMPETENCY.

Office of Board of Examiners,
Wellington, , 19 .

THIS is to certify that [State the name in full, address, and occupation of applicant] has produced an underviewer’s [fireman and deputy’s] certificate granted in [Name of British possession or foreign country], and has satisfied the Board of Examiners that he is entitled to an underviewer’s [fireman and deputy’s] certificate of competency under the provisions of section 28 of the Coal-mines Act, 1908 (as set forth in section 5 of the Coal-mines Amendment Act, 1914), and this certificate is issued in compliance therewith.

A. B.,
Chairman of Board of Examiners.

Entered, Vol. , folio .
C. D., Secretary.

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FORM 8. [Reg. 17.

The Coal-mines Act, 1908.

STATISTICS OF WORKINGS IN COAL-MINES, 19 .

Dividends.

Declared. Paid.