Oct. 23.] THE NEW ZEALAND GAZETTE. 3005

Particulars as to Motor-omnibus and Authorized Service.

Name of owner :

Address of owner :

Situation of garage :

Engine number :

Chassis number :

Name of maker of motor-omnibus :

Seating-accommodation : persons (exclusive of driver).

Maximum number of passengers to be carried :

Gross weight of motor-omnibus unladen : tons cwt. qr. lb.

Manufacturer’s rating of weight-carrying capacity : tons cwt. qr. lb.

Routes on which motor-omnibus to be used :

This license, unless sooner revoked or surrendered, will remain in force until the 31st day of May, 19 , and no longer.

Dated at , this day of , 19 .

. . . . . . . Town Clerk [or County Clerk]

[Name of Licensing Authority.]

—

[Form No. 5.

The Motor-omnibus Traffic Act, 1926.

APPLICATION FOR MOTOR-OMNIBUS DRIVER’S LICENSE.

To the Town Clerk [or County Clerk] of [State name of licensing authority].

I HEREBY apply for a motor-omnibus driver’s license to be granted under the above Act and the regulations for the time being in force thereunder, and for the purposes of this application make answer to the several questions hereinafter set forth :—

1. What is your name in full ?

2. (a.) What is your age next birthday ?

(b.) What is the date of your birth ?

3. (a.) Have you ever fainted or been subject to fits of any kind; or have you been invalided from, or rejected after examination for, any public service; or has any proposal made by you for life insurance been declined by any life-insurance company ?

(b.) If so, state particulars.

4. (a.) Are you the holder of a driver’s license issued under the Motor-vehicles Act, 1924 ?

(b.) If so, by what local authority was it issued, and on what date ?

(c.) Has your driver’s license been suspended or endorsed ? If so, give particulars.

5. (a.) Has any motor-omnibus driver’s license ever been issued to you ?

(b.) If so, by whom and when ?

6. (a.) Have you ever been refused a motor-omnibus driver’s license ?

(b.) If so, by whom and when ?

7. (a.) Have you ever been convicted of any offence involving—

(i.) Intoxication ; or

(ii.) The reckless driving of a motor-vehicle ?

(b.) If so, state particulars.

(NOTE : The applicant will be held responsible for the accuracy of the above statement ; and by suppressing any information will be guilty of a breach of the regulations.)

Dated this day of , 19 .

[Signature of applicant.]

Enclosure : Medical certificate.

—

[Form No. 6.

The Motor-omnibus Traffic Act, 1926.

MEDICAL CERTIFICATE (TO ACCOMPANY APPLICATION FOR MOTOR-OMNIBUS DRIVER’S LICENSE).

I HAVE on this date personally examined [Name of applicant], knowing him to be an applicant for a motor-omnibus driver’s license under the above Act, and I hereby certify that in my opinion, having all proper regard to the safety of passengers and of the public generally, the applicant is a fit and proper person to be employed as the driver of a motor-omnibus. I have read the several particulars supplied by him in his application for a motor-omnibus driver’s license, and am not aware of any inaccuracy therein. The results of my examination are as follows :—

1. Eyesight : Right eye, ; left eye, .

2. Colour-vision :

3. Hearing :

4. The respiration is [is not] natural, and the respiratory sounds and the resonance of the chest are normal [abnormal].

5. The pulsations of the heart are [are not] natural in rhythm and force, and its sounds are [are not] those of health.

6. The applicant is free from disease and from any physical defect that would in my opinion interfere with the proper carrying-out of his duties [or The applicant suffers from (State in general terms any disease or physical defect that would in your opinion interfere with the proper carrying-out of his duties as a motor-omnibus driver)].

Date :

. . . . . . . . . . . . .

A Registered Medical Practitioner approved for the purposes of this certificate by the [State name of licensing authority].

—

[Form No. 7.

The Motor-omnibus Traffic Act, 1926.

MOTOR-OMNIBUS DRIVER’S LICENSE.

[Full name and address], is hereby licensed by [State name of licensing authority], (being the licensing authority appointed for the No. Motor-omnibus District) as a motor-omnibus driver for the purposes of the above Act and the regulations thereunder.

This license, unless sooner cancelled, will remain in force until the 31st day of May, 19 , and no longer.

The number of this license is :

Dated at , this day of , 19 .

. . . . . . . Town Clerk [or County Clerk].

[Name of licensing authority.]

—

[Form No. 8.

The Motor-omnibus Traffic Act, 1926.

NOTICE REQUIRING LOCAL OR PUBLIC AUTHORITY TO PURCHASE EXISTING MOTOR-OMNIBUS UNDERTAKING IN TERMS OF SECTION 15 (1) OF THE ABOVE ACT.

To [Name of local or public authority.]

WHEREAS I [Name and description of claimant] was on the 7th day of May, 1926, engaged in carrying on the motor-omnibus service described in Table A hereof, such service being carried on in substantial competition with your tramway [motor-omnibus] service : And whereas by subsection (1) of section 15 of the above Act I am entitled to require you to purchase all motor-omnibuses and other property used by me exclusively for the purposes of the said service, at a price to be agreed on, or in default of agreement, at a price to be fixed by a Compensation Court under the Public Works Act, 1908 :

Now, therefore, in terms of the said section, I do hereby require you, the said [Name of local or public authority] to purchase for the sum of pounds (£ ) the motor-omnibuses and other property referred to in Table B hereof, being property used by me exclusively for the purposes of the motor-omnibus service aforesaid.

As required by the said section, I hereby declare that no other person has any interest in any of the property aforesaid [or, As required by the said section, I have set out in Table C hereof the nature and value of every interest owned by any other person in the above property].

Given under my hand at , this day of , 19 .

[Signature of claimant.]

TABLE A.—DESCRIPTION OF MOTOR-OMNIBUS SERVICE CONDUCTED BY CLAIMANT.

[Here set out particulars in detail as to termini, routes, and time-tables in relation to motor-omnibus service carried on by claimant, and in respect of which claim is made.]

TABLE B.—DESCRIPTION AND VALUATION OF PROPERTY IN RESPECT OF WHICH CLAIM IS MADE.

[Here enumerate the motor-omnibuses and other property in respect of which the claim is made, the nature of the claimant’s interest therein, and the amount claimed for each item in respect of the claimant’s interest.]