22

THE NEW ZEALAND GAZETTE.

[No. 4

27. He shall similarly, so far as the circumstances apply, advise the Board with respect to contributors who retire “medically unfit,” or before becoming entitled to a retiring-allowance, or whose services are dispensed with. And in respect of every person whom it is proposed to retire as “medically unfit” there shall be produced two medical certificates in the form hereinafter following, each signed by a medical practitioner approved of by the Board.

The Public Service Classification and Superannuation Act, 1908.

PHYSICAL EXAMINATION OF CONTRIBUTOR APPLYING TO BE RETIRED AS MEDICALLY UNFIT.

Name of contributor in full:
Residence:

1. Department of Service and position therein:
2. Age last birthday:
3. Weight and height of contributor:
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. That his condition is such as will permanently and totally incapacitate him from continuing his present or any other occupation in the Public Service.

2. That his condition is such as will not permanently incapacitate him from continuing his present occupation, and that, in my opinion, with rest he will be fit to resume his duties.

NOTE.—Fill in period of rest recommended.

3. That his condition is such as will not enable him to continue his present duties, but will not disable him from undertaking duties of a less responsible or arduous character, such as those of .

NOTE.—Fill in the nature of the occupation or occupations that the medical examiner thinks may be followed.

Dated at , this day of , 19 .

[Signature of Medical Examiner.]
[Qualifications.]
[Address.]

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

29. 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 a day before that fixed for each quarterly meeting of the Board.

30. 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 any such claim shall 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.

31. 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 payments shall be made at the end of each month.