Jan. 16.] THE NEW ZEALAND GAZETTE. 81

SCHEDULE.
[Form 1.]
New Zealand Customs.
APPLICATION FOR A TEMPORARY PERMIT TO ENTER NEW ZEALAND.
(Immigration Restriction Amendment Act, 1920.)
[To be filled up in the English Language.]
To the Collector of Customs, , New Zealand.
I [Full name], do hereby make application that a temporary permit to enter New Zealand for a period of [State length of period] be granted to me [and to my wife and/or child(ren)], and submit the following particulars concerning myself [and my wife and/or child(ren)].
[Strike out any words in brackets not required.]

(1) Full name :
(2) Sex :
(3) Nationality :
(4) Race or people to which applicant belongs:
(5) Place and date of birth :
(6) Places of birth and nationality of parents—
(a) Father :
(b) Mother :
(7) Last place of permanent residence :
(8) (a) Whether previously in New Zealand :
(b) If so, when :
(9) Marital state :
(10) If married—
(a) Full name and age of wife :
(b) Full name[s], age[s], and sex[es] of child[ren].
[To be inserted only if accompanying applicant.]

(11) Occupation :
(12) Purpose in coming to New Zealand [Full particulars required] :
(13) (a) Condition of mental and physical health of myself :
(b) Condition of mental and physical health of wife and child[ren] [To be inserted only if accompanying applicant] :
(14) Address in New Zealand to which communications can be sent to me :
(15) Full name[s] and address[es] of any relative[s] or friend[s] in New Zealand :—

(16) Whether or not in possession of passport[s] :
(17) Particulars to aid identification—
(a) Height : ft. in.
(b) Build :
(c) Scars or birthmarks (if any) :
(d) Other particulars :

I, [Full name], do hereby declare that the foregoing particulars are true and correctly stated in every respect, and that I will defray the cost of maintenance, deportation, or any other expenses which may be incurred in New Zealand in respect of myself or of any of the persons herein named, and that I will give such security by bond, deed, or otherwise in this respect as the Collector of Customs may require.

Signature :

Declared before me at , this day of , 19 .

Officer of Customs.

NOTE.—The applicant must produce with his application two unretouched and unmounted half-length recent photographs of a size not exceeding 4½ in. by 3½ in., and not less than 3 in. by 2 in., of himself and of each of the persons named above accompanying him.

B

[Form 2.]
No. .
New Zealand Customs.
TEMPORARY PERMIT TO ENTER NEW ZEALAND.
(Immigration Restriction Amendment Act, 1920.)
PERMISSION is hereby granted to [Full name], of [Last place of permanent residence], of nationality, who was born at on , and whose address in New Zealand to which communications can be sent to him is , to enter New Zealand temporarily, subject to the conditions printed hereunder, as a visitor for the purpose of , accompanied by his wife [Full name of wife] and/or child(ren) [Full name(s) of child(ren)]. [Strike out words in brackets not required.]
This permit is granted for a period of from the date hereof.

Conditions under which this Permit is granted.
(i) That before the issue of the permit a sum of £10 is deposited with the Collector of Customs at the port of arrival by or on behalf of the visitor, to be held by such Collector on the terms that if the visitor, together with his wife and/or children (if accompanying him), shall—
(a) Report personally to the Collector of Customs at the port of departure within a reasonable time before such departure ;
(b) Furnish to the satisfaction of the last-named Collector proof of identity of the visitor, his wife and/or children (if mentioned in the permit) ;
(c) Surrender the permit to the last-named Collector at the time of departure from New Zealand ;
(d) Leave New Zealand within the period for which the permit is granted ;
(e) Comply in all respects with the Immigration Restriction Acts and with every condition imposed on the granting of the permit—
then and in such case the said sum of £10 shall be refunded to the depositor, but otherwise the said sum shall be forfeited and paid to the Public Account.
(ii) That the person to whom the permit is granted will on request at any time by an officer of Customs or a member of the Police Force produce the permit to him for inspection.
(iii) That it shall be sufficient notice to the person to whom this permit is granted as to any matter which the Minister or Collector of Customs desires to communicate to such person (including the revocation, if any, of the permit) if a letter is sent by post to the address shown in his application for a temporary permit or furnished to the Collector of Customs as the address in New Zealand to which communications can be sent to him.
(iv) That the visitor will not, without the special permission in writing of the Collector, engage in any work or occupation, or carry on or assist in carrying on, or accept any employment in or in connection with, any business, calling, or pursuit, other than as stated in this permit.
(v) That the visitor will forthwith on demand, as and when the same become payable, and unless theretofore paid to the Crown or the public body concerned, pay to the Collector, to be received on behalf of the Crown or the public body concerned, all costs, charges, and expenses that may at any time be incurred by the Crown or any public body in or about the maintenance, relief, arrest, or detention in New Zealand of the visitor, his wife and/or children (if accompanying him), or his or their deportation from New Zealand, whether arising from sickness or poverty, or from default by him or them in compliance with any requirements of law, or from any other cause, and whether or not such costs, charges, and expenses may, apart from this condition, be a debt recoverable by the Crown or such public body from the visitor or any other person ; provided always that in the case of any such costs, charges, or expenses as are not actually disbursements by the Crown or a public body, or the amount of which is not fixed by law or contract or otherwise so as to amount to a liquidated sum, the amount thereof shall be such sum as is certified as being reasonable in the circumstances by the Minister of Justice, the Minister in Charge of Prisons, the Minister of Health, the Minister in Charge of the Mental Hospitals Department, the Minister of Customs, the Hospital Board, or other person (including the Permanent Head of a Government Department) or body administering the Department or institution by, through, or in connection with which such costs, charges, and expenses were incurred.