SEPT. 7.] THE NEW ZEALAND GAZETTE. 2377

FIRST SCHEDULE.

Form No. 1.

APPLICATION TO PURCHASE LAND UNDER SECTION 4 OF THE DISCHARGED SOLDIERS SETTLEMENT ACT, 1915.

To the Commissioner of Crown Lands,

I, [Name in full], of [Address], [Occupation (if any)], hereby apply, under the provisions of the Discharged Soldiers Settlement Act, 1915, and the regulations thereunder, to purchase the land hereinafter mentioned, namely:-

For the purposes of this application I make the following replies to the questions hereinafter set forth:

Question.

1. What is your full name and regimental No. ?
2. Of what Naval or Expeditionary Force were you a member?
3. What was-
   (a.) Your length of service in such Force?
   (b.) The date of your discharge?
   (c.) The reason of your discharge?
4. What physical disabilities (if any) do you suffer from by reason of wounds or disease resulting from your naval or military service? State particulars as to loss of limb or faculty or as to condition of health.
5. (1.) Have you applied for a pension under the War Pensions Act, 1915?
   (2.) If so, has your application been (a) granted, or (b) refused, or (c) not finally dealt with?
   (3.) If granted, to what rate of pension are you entitled?
   (4.) If refused, what were the grounds of refusal?
   (5.) In the case of an applicant who is married-
   (a.) To what rate of pension under the War Pensions Act, 1915, is your wife entitled?
   (b.) To what rates of pension are you entitled under the said Act in respect of your children (if any)?
6. What was your occupation prior to your becoming a member of the Forces? State period.
7. For what business or purpose do you intend to use the land for which you are applying?
8. What experience (if any) have you had in such business?
9. What experience have you had (if any) in any kindred business?
10. What is the amount of capital at your disposal for use on the land?-
    (a.) Amount of cash ..
    (b.) Value of stock (if any)
    (c.) Implements or other property ..
11. What financial assistance will you require to enable you to work the land successfully? State particulars.
12. Are you single, married, or a widower? If married or a widower, state number of children (if any) dependent on you.
13. What land (if any) do you at present own or have an interest in? Give particulars.
14. If married, what land (if any) does your wife own or have an interest in? Give particulars.
15. Have you at any time held land or received an advance under the Discharged Soldiers Settlement Act? If so, state particulars.

Dated at this day of , 19 .
[Signature of applicant.]

Form No. 2.

APPLICATION FOR LEASE OF LAND UNDER SECTION 4 OF THE DISCHARGED SOLDIERS SETTLEMENT ACT, 1915.

To the Commissioner of Crown Lands,

I, [Name in full], of [Address], [Occupation (if any)], hereby apply, under the provisions of the Discharged Soldiers Settlement Act, 1915, and the regulations thereunder, for a lease for a term of years, with [or without] right of renewal, of the land hereinafter mentioned, namely:-

For the purposes of this application I make the following replies to the questions hereinafter set forth:-

Question.

1. What is your full name and Regimental No.?
2. Of what Naval or Expeditionary Force were you a member?
3. What was-
   (a.) Your length of service in such Force?
   (b.) The date of your discharge?
   (c.) The reason of your discharge?
4. What physical disabilities (if any) do you suffer from by reason of wounds or disease resulting from your naval or military service? State particulars as to loss of limb or faculty or as to condition of health.
5. (1.) Have you applied for a pension under the War Pensions Act, 1915?
   (2.) If so, has your application been (a) granted, or (b) refused, or (c) not finally dealt with?
   (3.) If granted, to what rate of pension are you entitled?
   (4.) If refused, what were the grounds of refusal?
   (5.) In the case of an applicant who is married,
   (a.) To what rate of pension under the War Pensions Act, 1915, is your wife entitled?
   (b.) To what rates of pension are you entitled under the said Act in respect to your children (if any)?
6. What was your occupation prior to your becoming a member of the Forces? State period.
7. For what business or purpose do you intend to use the land for which you are applying?
8. What experience (if any) have you had in such business?
9. What experience have you had (if any) in any kindred business?
10. What is the amount of capital at your disposal for use on the land?-
    (a.) Amount of cash ..
    (b.) Value of stock (if any)
    (c.) Implements or other property ..
11. What financial assistance will you require to enable you to work the land successfully? State particulars.
12. Are you single, married, or a widower? If married or a widower, state number of children (if any) dependent on you.
13. What land (if any) do you at present own or have an interest in? Give particulars.
14. If married, what land (if any) does your wife own or have an interest in? Give particulars.
15. Have you at any time held land or received an advance under the Discharged Soldiers Settlement Act? If so, state particulars.

Dated at this day of , 19 .
[Signature of applicant.]