1854
THE NEW ZEALAND GAZETTE.
[No. 78

I hereby elect to become a contributor to the Fund under the above-mentioned Act, and authorize the necessary contribution to be deducted from my salary in accordance with section 5 thereof.

Further, I hereby declare that the particulars hereunder are correct to the best of my knowledge and belief.

Dated at __, this __ day of __, 19__.

[Signature.]

PARTICULARS REFERRED TO ABOVE.

Name in full (surname first) :

Sex : __ Date of birth : __

Verified by __ sent herewith.

Present appointment : [Teacher, clerk, &c.] under the [Give the name of the Education Board, or governing body of secondary school, or managers of associated classes].

Present salary : __

Statement of Education service since 1st January, 1906 : __. [Enter Nil if no service since this date.]

CERTIFICATE OF EMPLOYING BODY.

I HEREBY certify that __’s statement that __ is permanently employed for not less than twenty hours a week, the appointment dating from __, is correct.

[Date.]

Secretary (or Director) of Employing Body.

13. Every person who is an applicant for admission to the Fund under the provisions of section 23 (3) of the Act shall make an election in the form prescribed in clause 12 hereof.

Date of Commencement of Contributions.

14. The contributions of every person who elects to join the Fund under the provisions of section 23 (1) of the Act shall begin not later than the first day of the month in which he elects to join; and in the case of a person who joins the Fund under any of the compulsory provisions of the Acts relating to the Fund they shall begin from the date on which his salary begins.

Benefits of the Fund.

15. Every person entitled to benefits from the Fund shall make application accordingly to the Teachers’ Superannuation Board (hereinafter referred to as “the Board”).

16. The Board may decline to consider at any meeting any claim for benefits from the Fund if such claim was not received by the Secretary to the Board in the manner prescribed by (a) or (b) below :—

(a.) In respect of a claim for an allowance (ordinary provisions) : at least fourteen days prior to the date of the meeting of the Board.

(b.) In respect of a claim arising out of the death of a contributor, or a claim for retirement as “medically unfit,” or under the extended provisions of section 12 of the Act, as amended by section 11 of the Public Service Classification and Superannuation Amendment Act, 1909 : at least twenty-one days prior to the date of the meeting of the Board.

17. The Secretary to the Board shall furnish the Board with a report upon the case of every contributor who signifies his intention of retiring from the service and claiming on the Superannuation Fund, and such report shall contain the following information, viz. : Name of contributor; position in the service; age; cause of retirement; date of retirement; length of service; the date to which contributions to the Fund have been paid; where necessary, the total salary received during all the years of contribution to the Fund, and also the total salary received during all the years of service before the commencement of the Teachers’ Superannuation Act, 1905; the average salary for the three years immediately preceding the date of retirement; allowance to which entitled.

18. He shall similarly, so far as the circumstances apply, furnish the Board with all particulars with respect to contributors who apply to be retired as “medically unfit,” or before becoming entitled to a retiring-allowance, or who are dismissed.

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

20. In respect of every contributor who is an applicant for an allowance as “medically unfit” there shall be produced two medical certificates in the form hereafter following, each signed by a medical practitioner approved by the Board :—