MAY 20.] THE NEW ZEALAND GAZETTE. 1325

Form E.

REGISTER OF ELECTRICAL WIREMEN.

Form F.

ELECTRICAL WIREMEN'S REGISTRATION BOARD OF NEW ZEALAND.

THIS is to certify that , of , having satisfied the Board that he is qualified as an Inspector of electrical wiring, was on the day of , 19 , registered as an INSPECTOR OF ELECTRICAL WIRING under the Electrical Wiremen's Registration Act, 1925.

Registered No. A.
. . . . . . . . . . . . , Chairman.
. . . . . . . . . . , Registrar.

NOTE.—This certificate remains the property of the Board, and must be surrendered on demand.

Form G.

ELECTRICAL WIREMEN'S REGISTRATION BOARD OF NEW ZEALAND.

THIS is to certify that , of , having satisfied the Board that he is qualified as an electrical wireman, was on the day of , 19 , registered as an ELECTRICAL WIREMAN under the Electrical Wiremen's Registration Act, 1925.

Registered No. B.
. . . . . . . . . . . . , Chairman.
. . . . . . . . . . , Registrar.

NOTE.—This certificate remains the property of the Board, and must be surrendered on demand.

Form H.

NEW ZEALAND.

Electrical Wiremen's Registration Act, 1925.

TEMPORARY LICENSE TO INSPECT.

Signature of holder :

THIS is to certify that is hereby licensed to inspect electrical wiring until the 30th day of September, 1926.

License No.
Dated this day of , 19
. . . . . . . . . . . . , Registrar.

This license must be returned to the Registrar not later than the 30th day of September, 1926.

Form J.

NEW ZEALAND.

Electrical Wiremen's Registration Act, 1925.

PROVISIONAL LICENSE.

Signature of holder :

THIS is to certify that is hereby granted a Provisional License to carry out Electrical Wireman's work for a period of months from the date hereof in accordance with section 16 of the Act.

License No.
Dated this day of , 19
. . . . . . . . . . . . , Registrar.

This license must be returned to the Registrar not later than the day of , 19

Form K.

Electrical Wiremen's Registration Act, 1925.

REPORT ON PROVISIONAL LICENSE.

The Registrar,
Electrical Wiremen's Registration Board,
Care of Public Works Department,
Wellington.

SIR,
I, , Engineer to the , hereby certify that has [or has not] satisfactorily carried out the work of an electrical wireman during the currency of the provisional license No.

Signed : . . . . . . . . . . . .

Form L.

NEW ZEALAND.

Electrical Wiremen's Registration Act, 1925.

CERTIFICATE OF REGISTRATION.

Signature of holder :

THIS is to certify that is at this date a registered Inspector of Electrical Wiring, his name having been duly entered in the Register of Inspectors of Electrical Wiring of New Zealand.

Registered No.
Dated this day of , 19
. . . . . . . . . . . . , Chairman.
. . . . . . . . . . . . , Registrar.

NOTE.—This certificate remains the property of the Board and must be surrendered on demand.

Form M.

NEW ZEALAND.

Electrical Wiremen's Registration Act, 1925.

CERTIFICATE OF REGISTRATION.

Signature of holder :

THIS is to certify that is at this date a Registered Electrical Wireman, his name having been duly entered in the Register of Electrical Wiremen of New Zealand.

Registered No.
Dated this day of , 19
. . . . . . . . . . . . , Chairman.
. . . . . . . . . . . . , Registrar.

NOTE.—This certificate remains the property of the Board and must be surrendered on demand.

Form N.

Date of Examination :

Electrical Wiremen's Registration Board of New Zealand.

APPLICATION TO BE EXAMINED.

THIS form is to be filled in and signed by applicant and posted to the Registrar, Electrical Wiremen's Registration Board, care of Public Works Department, Wellington, as soon as possible, and so as to reach the Registrar not later than twenty-eight days before the date of the examination.

1. Name in full :
2. Postal address :
3. Date of Birth :
4. State if you wish to present yourself for—
   (a.) Written part of examination :
   (b.) Practical part of examination :
5. If you previously entered for the Board's examination, state which part you passed, if any :
6. Examination Centre.—State at which of the places in the list below you prefer to attend for examination :—
   Name of place :
   Indicate (by underlining) in the list below the name of another place at which it would be convenient for you to be examined should the number of candidates presenting themselves be insufficient to warrant the Board holding the examination at the place first stated by you.

[List of proposed examination centres to be inserted.]

7. [This information to be furnished where applicant seeks to be registered on passing examination.]—Attach to this form a statement [or statements] written and signed by your employer [or employers], showing you have been employed or engaged in the work of an electrical wireman for at least three years.
   Should you be unable to obtain any statement or statements as required above, attach to this form a written reason therefor.
   State here by whom the statement (or statements) you are forwarding is made and signed. If you have previously forwarded the necessary statement (or statements) write the words "previously forwarded."