2484
THE NEW ZEALAND GAZETTE.
[No. 94.

SCHEDULE.
FIRE INSURANCE.—STATISTICAL RETURN FOR THE YEAR
ENDED

Name in full of office :
Address of head office :
Postal address of head office for New Zealand :

PARTICULARS REQUIRED.

A.—As to Position at End of Year.

1. Number of towns in New Zealand in which
   branches are established ..

2. Number of other towns in New Zealand in which
   agencies exist ..

3. Total number of agencies in New Zealand

4. Date of commencement of business in New Zea-
   land ..

5. Total reserve funds (New Zealand and elsewhere) £

6. Total liabilities excluding capital (New Zealand
   and elsewhere) .. £

7. Total assets (New Zealand and elsewhere) .. £

8. Total liabilities to creditors in New Zealand .. £
   New Zealand assets—

9. House and landed property in New
   Zealand owned by the office .. £

10. New Zealand Government Ordinary £

11. securities .. | War Loan £

12. New Zealand local authority securities £

13. Mortgages on freehold and leasehold
    security in New Zealand .. £

14. Other assets in New Zealand (specify
    if possible) :—
    £
    £
    £
    ——— £ ———

15. Total New Zealand assets .. .. .. £ ———

B.—As to Business during Year.

Number of Amount
Policies. underwritten.

16. Total gross amount of New Zealand
    new business underwritten during
    year, excluding reinsurances ac-
    cepted from other offices .. No. £
17. Total gross amount of New Zealand
    business (new and renewal) under-
    written during year, excluding re-
    insurances accepted from other
    offices .. .. No. £
18. Total gross premiums charged for underwriting
    the amount shown under preceding question
    No. 16 .. .. .. .. £
19. Total amount of premiums refunded to insured.. £
20. Number of separate outbreaks of fire with which
    concerned, as per detailed list as required
    under “D” (i.e., not the number of separate
    claims paid, but the number of separate fires
    in respect of which claims paid) .. No.
21. Total gross losses incurred during year, less
    salvage and reinsurance losses, but including
    adjustment and other expenses of settlement £
22. { (a.) Reserve for unexpired risk, being per
    cent. of net premium income for year .. £
    (b.) Additional reserve (if any) .. £

C.—Revenue Account.—New Zealand Business for Financial
Year ended

Expenditure.

Net amount of fire losses incurred during year, in-
cluding adjustment and other expenses of settle-
ment, but less salvage and amounts covered by
reinsurance .. .. .. .. £ s. d.
New Zealand Government taxes .. .. ..
Local authority rates .. .. ..
Fire Board levies .. .. ..
Rents .. .. ..
Allowances and commissions on premiums to agents,
subagents, or others .. .. ..
Salaries and wages, including commissions on profits
or bonuses .. .. ..
Other expenses of management .. .. ..
Reserve to meet unexpired risks as at end of year,
being per cent. of net premium income £
Reserve additional to above (if any) .. £
Other expenditure (specify principal items) :—

Balance for year .. .. .. .. ———
Total .. .. .. .. £ ———

Revenue.

Reserve to meet unexpired risks as at begin-
ing of year, being per cent. of net pre-
mium income .. .. .. £
Reserve additional to above (if any) .. £
Net amount of fire premiums receivable during year
(i.e., gross premiums, including reinsurance pre-
miums receivable, but less reinsurance premiums
payable and less return premiums) .. ..
Interest and dividends on stock, mortgages, &c. ..
Rents .. .. ..
Other revenue (specify principal items) :—

Balance for year .. .. .. .. ———
Total .. .. .. .. £ ———

D.—Statement of Fire Losses incurred during Year.

(1) (2) (3) (4) (5) (6) (7) (8) (9)
Date of Fire. Name of Owner. Locality. Occupation (i.e., prin- Gross Amount in- Probable Gross Rate Per Cent. of Other Offices con- Remarks.
cipal use or character of surred in your Office. Amount of Loss Premium paid by cerned in same Risk
governing rating of payable by your Insured. not as Reinsurers.
the risk). Office, less
Salvage, but
including
Adjustment and
other Expenses
of Settlement.

I certify that the particulars contained in this return are
correct to the best of my knowledge and belief.

Manager, Secretary, or Accountant.

Place and date : , 19 .

As witness the hand of His Excellency the Governor-
General, this twenty-eighth day of July, one thou-
sand nine hundred and nineteen.

G. W. RUSSELL.
Minister of Internal Affairs.

Notice of Change of the Purpose of Portion of a Reserve in
Block XIII. Town of Ormondville, Hawke’s Bay Land
District.

LIVERPOOL, Governor-General.

By his Deputy,
ROBERT STOUT.

WHEREAS by section six of the Public Reserves and
Domains Act, 1908 (hereinafter referred to as “the
said Act”), the Governor-General is empowered in the case of
any public reserve vested in His Majesty or the Governor-
General, for any of the purposes comprised in Class II of the
Second Schedule to the said Act, to change the purpose for
which such reserve was set apart to any other purpose :
And whereas the land described in the Schedule hereto
forms portion of a reserve duly set apart for a site for a
Courthouse, being a purpose within Class II in the Second
Schedule to the said Act, and it is expedient to change, as
hereinafter provided, the purpose of portion of such reserve
so set apart :
Now, therefore, I, Arthur William de Brito Savile, Earl of
Liverpool, the Governor-General of the Dominion of New
Zealand, do hereby, in pursuance of the powers conferred
on me by section six of the said Act as aforesaid, declare
that the purpose of portion of the said reserve is hereby
changed from a site for a Courthouse to an addition to a
site for a post-office. And I do hereby further declare that
this notice is issued subject to the provisions of section seven
of the said Act, and shall take effect according to the pro-
visions of that section.

SCHEDULE.

ALL that area in the Hawke’s Bay Land District, containing
by admeasurement 13 perches, more or less, being Section 3,
Block XIII, Town of Ormondville. Bounded towards the