2854

PART G.
Return as Agent for Debenture-holders.
(To be filled in by companies and other corporate bodies which have issued debentures.)
Return of the income of the debenture-holders received or receivable for the year ended the , 19 £

PART H.
Return of Directors, Auditors, and others.
(This part applies to registered companies only).
(All amounts should be included in this list.)

• The figures in these columns should represent the actual salary or emolument for the year ended 31st March, 19 , and not for the period covered by the taxpayer's balance-sheet, if made up to another date.
  If there should not be sufficient space in either of the above Parts, a sheet giving the required information may be attached.

PART I.
Statement of Assets and Liabilities as at 31st March, 19 , for the Purpose of determining the Amount of Capital employed in the Production of the Income.

A copy of the taxpayer's annual balance-sheet at the above date will be accepted in lieu of the above particulars.

Declaration.
I, of do hereby solemnly and sincerely declare that this return includes the whole of the assessable income derived during the period indicated, and that all the statements contained therein are true, accurate, and complete in every particular.
Dated at , this day of , 19 .
[Usual signature.]

Capacity in which I make this return : [If not made by the taxpayer, state whether as trustee, attorney, agent, secretary, director, or executor.]

Schedules to Form No. 3.

SCHEDULE A.—RETURN TO BE SUPPLIED BY BANKING COMPANIES.

(a.) Total assets and liabilities of the banking company for the four quarters ending on— £
30th June, 19 .. .. ..
30th September, 19 .. .. ..
31st December, 19 .. .. ..
31st March, 19 .. .. ..
(b.) Average of total assets and liabilities for the four quarters .. .. .. .. ..
(c.) Income derived by banking company during income-year as interest on debentures issued under the New Zealand Loans Amendment Act, 1915, prior to 11th November, 1920 ..

THE NEW ZEALAND GAZETTE. [No. 82

SCHEDULE B.—RETURN OF INCOME BY INSURANCE OR GUARANTEE COMPANY.
Statement of Gross Income from Business and Deductions therefrom.
(NOTE.—This may be taken for TWELVE MONTHS ended at date of stocktaking or annual balance nearest to 31st March.)
For the Year ended , 19

Gross premiums received .. ..
Less : Returns .. .. ..
Reinsurances (with companies represented in New Zealand only)
Deduct losses on risks undertaken in New Zealand, less recoveries .. ..
Income from rents .. .. ..
Income from investments .. ..
Other income in New Zealand ..

Gross income in or from New Zealand .. £

DEDUCTIONS FROM GROSS INCOME.
Salaries, wages, and commissions ..
Rent (include only rent of premises or portion of premises used exclusively for the purposes of the business), not to include rental value of premises owned by taxpayer
Rates on business premises or portion of premises used exclusively for the purposes of the business (not to include payments for land-tax or income-tax)
Annual license fees .. .. ..
Fire insurance premiums (on business premises and stock only)
Exchange and discounts allowed, less amounts received
Repairs or maintenance of business premises (not to include additions or improvements to property, or any depreciation)
Travelling-expenses incurred in the business only
Printing, stationery, advertising, stamps, and telegrams
Petty expenses incurred in the business only (not to include donations, gratuities, or subscriptions)
Bad debts (to include those proved to be bad during the year and actually written off the books, and no others)
Interest on registered mortgages [State names and addresses of mortgagees and amounts paid to each]
Other interest : [State name and address of, and amount paid to, each person]
Other items (to be specified) .. ..

Total deductions .. .. £

Net income .. .. .. £

Care should be taken to fill in the above items as correctly as possible. No averages or estimates will be accepted.

SCHEDULE C.—RETURN OF INCOME BY FOREIGN LIFE-INSURANCE COMPANY.
Part A.—Statement of Income and Expenditure in respect of Properties let during the Year ended on 31st March, 19.