JUNE 16.] THE NEW ZEALAND GAZETTE. 2099

FORM 5. [Reg. 18.

The Coal-mines Act, 1925.

UNDERVIEWER’S CERTIFICATE OF COMPETENCY
(BY EXAMINATION).

No. Office of Board of Examiners,
Wellington,
, 19 .

THIS is to certify that [State name in full, address, and occupation of person examined] has produced satisfactory evidence as to his experience, sobriety, and good conduct, and has passed the examination as underviewer of a coal-mine, as required by the Coal-mines Act, 1925, and the regulations made thereunder.

A. B.,
Chairman of Board of Examiners.

Entered, Vol. , folio .
C. D., Secretary.

——

FORM 6. [Reg. 18.

The Coal-mines Act, 1925.

FIREMAN AND DEPUTY’S CERTIFICATE OF COMPETENCY (BY EXAMINATION).

No. . Office of Board of Examiners,
Wellington,
, 19 .

THIS is to certify that [State name in full, address, and occupation of person examined] has produced satisfactory evidence as to his experience, sobriety, and good conduct, and has passed the examination as fireman and deputy of a coal-mine, as required by the Coal-mines Act, 1925, and the regulations made thereunder.

A. B.,
Chairman of Board of Examiners.

Entered, Vol. , folio .
C. D., Secretary.

——

FORM 7. [Regs. 5 and 14.

The Coal-mines Act, 1925.

APPLICATION TO BE EXAMINED FOR CERTIFICATE.

To the Secretary of the Board of Examiners, Wellington.

I, [Full name, occupation, and residence], the undersigned, hereby apply to be examined for a certificate as . I enclose the prescribed fee of* , together with a certificate at date from my employer as to my general good conduct and sobriety, a medical certificate that my senses of sight and hearing are not defective, and hereby declare as follows :—

(1.) My practical experience consists of actual employment as specified in the Schedule hereto ; and in proof thereof I forward with this application evidence in writing from my previous employers, as specified in that Schedule.

(2.)*† I am the holder of a second-class certificate, No. , and desire to be examined for a certificate of the first class.

(3.) I am the holder of a gas-testing certificate, No. .

(4.) The date and place of my birth is .

Dated at this day of , 19 .

SCHEDULE.

Particulars and Proof of Employment.

Signature of Applicant :

• First-class mine-manager, £2 2s. ; second-class mine-manager, £1 10s. ; underviewer, £1 ; fireman and deputy, 15s.

† If the applicant is a candidate for examination for a mine-manager’s certificate, and already holds a certificate of the second class, add this paragraph.

‡ Candidates should give particulars of every mine in which they have been employed, but documentary evidence of more than five years underground employment, or whatever period of practical experience is required by the Act and (or) regulations, is not required, though desirable.

——

FORM 8. Reg. 10.

The Coal-mines Act, 1925.

APPLICATION TO BE EXAMINED FOR CERTIFICATE AS MINE-SURVEYOR.

To the Secretary of the Board of Examiners, Wellington.

I, [Full name, occupation, and residence], the undersigned, hereby apply to be examined for a certificate as mine-surveyor,

I enclose the prescribed fee of £1 10s., together with a certificate at date from my employer as to my general good conduct and sobriety, and hereby declare as follows :—

(1.) My practical experience consists of actual employment in mine-surveying as specified in the Schedule hereto ; and in proof thereof I forward with this application evidence in writing from my previous employers, as specified in that Schedule.

(2.) The date and place of my birth is .

Dated at this day of , 19 .

SCHEDULE.

Particulars and Proof of Employment.

Signature of Applicant :

——

FORM 9. [Reg. 19.

The Coal-mines Act, 1925.

UNDERVIEWER’S OR FIREMAN AND DEPUTY’S CERTIFICATE OF COMPETENCY (BY EXCHANGE).

Office of Board of Examiners,
Wellington,
, 19 .

THIS is to certify [State the name in full, address, and occupation of applicant] has produced an underviewer’s [fireman and deputy’s] certificate granted in [Name of British possession or foreign country], and has satisfied the Board of Examiners that he is entitled to an underviewer’s [fireman and deputy’s] certificate of competency under the provisions of the Coal-mines Act, 1925, and the regulations made thereunder, and this certificate is issued in compliance therewith.

A. B.,
Chairman of Board of Examiners.

Entered, Vol, , folio .
C. D., Secretary.

——

[Reg. 24.

FORM 10.

The Coal-mines Act, 1925.

STATISTICS OF WORKINGS IN COAL-MINES, FIRST HALF-YEAR OF 19 .

• Companies of limited liability only.

I hereby certify that the above particulars are correct.