114
THE NEW ZEALAND GAZETTE.
No. 4
the Collector of Customs at the port nearest to the place where he is best known, or at the final port of departure. Every such person shall be required to provide two unretouched and unmounted half-length recent photographs of himself, not to exceed in size 4½ in. by 3½ in., and to be not less than 3 in. by 2 in.
(2.) One of the photographs aforesaid shall be securely attached to the certificate, and the other to the duplicate of the same.
(3.) The Collector shall thereupon issue a certificate in the form numbered 5 in the First Schedule hereto, and deliver it to the person applying for the same when the said person is on board the ship by which he is to leave New Zealand. A duplicate of this certificate shall be retained by the Collector and shall be filed in his office.
12. (1.) On the return to New Zealand of a person holding a certificate of registration as herein provided, the Collector at the first port of arrival, if satisfied of the identity of the holder with the person named in the certificate, and that he has returned within four years after the date of registration, shall permit such person to land in New Zealand.
(2.) All such certificates presented by returned persons shall be forwarded by the Collector at the port of arrival to the Collector at the port of issue, and shall be filed with the duplicate.
13. Every person who commits a breach of these regulations shall be liable to a fine of £50.
FIRST SCHEDULE.
[Form No. 1.
PERMIT TO ENTER NEW ZEALAND UNDER THE IMMIGRATION RESTRICTION AMENDMENT ACT, 1920.
(Issued subject to the conditions printed hereon.)
PERMISSION is hereby granted to , of , to enter New Zealand accompanied by (Strike out the words “accompanied by” if not required), provided that he/she can satisfy the Collector of Customs at the port of arrival that the particulars inserted hereunder concerning himself/herself are correct.

1. Full name:
2. Last place of permanent residence:
3. Born at on the day of .
4. Marital state:
5. Nationality:
6. Occupation or business to be undertaken in New Zealand, or purpose in coming to New Zealand:
7. The amount of money in English currency which is possessed by him/her on arrival is not less than
8. That the condition of mental and physical health of himself/herself and the condition of health of those accompanying him/her is
9. That he/she is a person of good character and reputation, who has never been in prison or in a mental hospital or the recipient of charitable aid, and that he/she is not a disaffected or dangerous person or one who advocates the overthrow by force or violence of constitutional Government:
10. That he/she is able to read and write fluently in the following language, namely:
    [Strike out any words not required.]
    [*This declaration is to be made upon arrival at the port of destination.]

• I, , do hereby declare that the foregoing particulars are true and correctly stated in every respect.
  Signature of Immigrant:
  Declared before me at this day of
  Officer of Customs.
  NOTE.—This permit must be delivered up to an Officer of Customs at the first port of arrival in New Zealand.
  . Dated at Wellington, New Zealand, this day of
  Comptroller of Customs.
  [Form No. 2.
  TEMPORARY PERMIT TO ENTER NEW ZEALAND UNDER THE IMMIGRATION RESTRICTION AMENDMENT ACT, 1920.
  (Issued subject to the conditions printed hereon.)
  PERMISSION is hereby granted to , of , to enter New Zealand accompanied by (Strike out the words “accompanied by” if not required), provided that he/she can satisfy the Collector of Customs at the port of arrival that the particulars inserted hereunder concerning himself/herself are correct.
  This permit shall expire at the end of calendar months from the day of arrival in New Zealand.

1. Full name :
2. Last place of permanent residence :
3. Born at on the day of
4. Nationality :
5. Purpose in coming to New Zealand :
6. That the amount of money in English currency possessed by him/her on arrival in New Zealand is not less than
7. That the condition of mental and physical health of himself/ herself, and the condition of health of those accompanying him/her is
8. That he/she is a person of good character and reputation, and that he/she does not advocate the overthrow by force or violence of constitutional Government :
9. That he/she and any persons accompanying him/her of the age of fifteen years or over are/is prepared to swear or affirm that he/she/they will faithfully observe and obey the laws of New Zealand.
   [Strike out any words not required.]
   [* This declaration to be made on arrival at the port of destination.]

• I, , do hereby declare that the foregoing particulars are true and correctly stated in every respect [and that I will defray the cost of maintenance, deportation, or any other expenses incurred on behalf of any of the persons herein named who are accompanying me, and that I will enter into such security by bond or otherwise in this respect as the Collector of Customs may demand]—Strike out all the words within brackets if not required.
  Signature of Immigrant :
  Declared before me at this day of
  Officer of Customs.
  CONDITIONS OF THIS PERMIT.
  This permit is issued subject to the following conditions :—
  (1.) That the immigrant shall deposit with the Collector of Customs at the port of arrival the sum of £10 as security that he/she will report personally and deliver up this permit to the Collector of Customs at the port of departure.
  (2.) The Collector of Customs at the port of departure will refund the amount deposited upon satisfactory identification and upon compliance with these regulations.
  (3.) The amount deposited on account of any person who departs without being identified, or who remains in New Zealand beyond the time permitted, shall be forfeited and paid to the Public Account.
  (4.) Certificates when delivered up at the port of departure shall be forwarded by the Collector to the Comptroller of Customs.
  Dated at Wellington, New Zealand, this day of
  Comptroller of Customs.
  [Form No. 3.
  (Immigration Restriction Amendment Act, 1920.)
  APPLICATION FOR A PERMIT TO ENTER NEW ZEALAND.
  (To be filled up in the English language.)
  To the Honourable the Minister of Customs, Wellington, New Zealand.
  I, [Full name], of [Present address], do hereby make this application to enter New Zealand accompanied by my wife, family, servants, and employees, and in support of the same submit the following particulars concerning myself and my wife, family, servants, and employees.
  [Strike out all words not required, or modify the words to suit the case.]
  (a.) Full name :
  (b.) Nationality :
  (c.) Place of birth and nationality of parents—(1) Father : ; (2) Mother :
  (d.) Last place of permanent residence :
  (e.) I was born at on the day of
  (f.) Marital state :
  (g.) If married; full name and age of wife, and full names and ages and sexes of children; also full names, ages, and sexes of servants or employees : [To be inserted only if accompanying the applicant.]
  (h.) Occupation or business proposed to be undertaken in New Zealand, or purpose in coming to New Zealand :
  (i.) The amount of money in English currency which I undertake to bring to New Zealand :
  (j.) Condition of mental and physical health (including particulars as to height, weight, and chest measurements), and the condition of mental and physical health of the other persons to accompany him/her. (Supported by a certificate from a qualified medical practitioner) :