JULY 7.] THE NEW ZEALAND GAZETTE. 2211

Form No. 5.
National Provident Fund Act, 1926.
ACCOUNTS.

Dr.

1. Amount of contributions received from each branch for annuity allowances as per return.
2. Received from National Provident fund.
3. Due from National Provident fund.

Cr.

1. Claims paid by branches for maternity.
2. Remitted to National Provident fund.
3. Due to National Provident Fund.

Form No. 6.
National Provident Fund Act, 1926.
ORDER TO PAY TO BANK ACCOUNT.

[Signature of Bank Manager.]

WE hereby authorize the manager of the [Name of bank] (whose signature appears in the margin) to receive all moneys payable out of the National Provident Fund to the , and to sign on our behalf receipts for same.

........................ } Trustees.
........................

Form No. 7.
National Provident Fund Act, 1926.
APPLICATION FOR PENSION (AGE 60).

I, [Name in full], of [Name of society and branch], having attained the age of sixty years on , apply to receive a pension of shillings per week for life.

Since the date of my joining the National Provident Fund, I have not been absent from New Zealand except for the following periods:—
From , to .
From , to .
From , to .
From , to .

[Signature.]
Date:

I HEREBY CERTIFY that [Name in full] is a financial benefit member of the Order.

[Signature.]
Secretary of Branch.
Date:

Countersigned:
Date:
[Secretary of society.]

Form No. 8.
National Provident Fund Act, 1926.
APPROVED FRIENDLY SOCIETIES.—PENSION VOUCHER FORM.

Payable to Schedule No.
Society: Claim No.

CERTIFICATE.

I HEREBY CERTIFY that, to the best of my knowledge and belief, the foregoing account is true and correct in every particular; that payment has been authorized by the National Provident Fund Board; and that the claimant is a financial benefit member of the Order at this date.

Date: , Secretary of Branch.

RECEIVED the sum of , in cash.

[Signature.]
[Date.]

(For Central Body's Use.)
Date:
Noted:
Initials:

SECOND RECEIPT.
(To be retained by Branch Secretary.)

RECEIVED the sum of , in cash.
Date: [Signature.]

Form No. 9.
National Provident Fund Act, 1926.
APPROVED FRIENDLY SOCIETIES.—LIFE CERTIFICATE.

I HEREBY CERTIFY that [Name in full], of , New Zealand, is alive and has appeared before me in person this day.

Date: , 192 .

[Signature]
Justice of the Peace,
[or Medical Practitioner,
or Minister of Religion,
or Postmaster].

Present address in full:

FIFTH SCHEDULE.

1. Regulations under the National Provident Fund Act, 1910, made by Order in Council dated the 9th day of January, 1911, and published in the Gazette of the 19th January, 1911.
2. Regulations under the National Provident Fund Act, 1910, made by Order in Council dated the 27th day of June, 1911, and published in the Gazette of the 29th June, 1911.
3. Regulations under the National Provident Fund Act, 1910, made by Order in Council dated the 28th day of March, 1912, and published in the Gazette of the 4th April, 1912.
4. Regulations under the National Provident Fund Act, 1910, made by Order in Council dated the 21st day of December, 1914, and published in the Gazette of the 14th January, 1915.
5. Regulations under the National Provident Fund Act, 1910, made by Order in Council dated the 4th day of January, 1916, and published in the Gazette of the 13th January, 1916.
6. Regulations under the National Provident Fund Act, 1910, made by Order in Council dated the 22nd day of February, 1916, and published in the Gazette of the 2nd March, 1916.
7. Regulations under the Finance Act, 1916, made by Order in Council dated the 10th day of October, 1916, and published in the Gazette of the 19th October, 1916.
8. Regulations under the National Provident Fund Act, 1910, made by Order in Council dated the 13th day of August, 1917, and published in the Gazette of the 23rd August, 1917.
9. Regulations under the Finance Act, 1916, made by Order in Council dated the 13th day of August, 1917, and published in the Gazette of the 23rd August, 1917.
10. Regulations under the National Provident Fund Act, 1910, made by Order in Council dated the 19th day of November, 1917, and published in the Gazette of the 6th December, 1917.
11. Regulations under the National Provident Fund Act, 1910, made by Order in Council dated the 23rd day of December, 1919, and published in the Gazette of the 8th January, 1920.
12. Regulations under the National Provident Fund Act, 1910, made by Order in Council dated the 21st day of April, 1921, and published in the Gazette of the 28th April, 1921.
13. Regulations under the National Provident Fund Act, 1910, made by Order in Council dated the 27th day of June, 1921, and published in the Gazette of the 30th June, 1921.
14. Regulations under the National Provident Fund Act, 1910, made by Order in Council dated the 27th day of June, 1921, and published in the Gazette of the 30th June, 1921.
15. Regulations under the Finance Act, 1916, made by Order in Council dated the 5th day of October, 1921, and published in the Gazette of the 13th October, 1921.
16. Regulations under the National Provident Fund Act, 1910, made by Order in Council dated the 2nd day of October, 1922, and published in the Gazette of the 12th October, 1922.

F. D. THOMSON,
Clerk of the Executive Council.