[Jan. 16.]

THE NEW ZEALAND GAZETTE.

Whereas application for a permit to enter New Zealand as a
student has been made to the Minister of Customs by or on
behalf of [Full name], (hereinafter called “the student”) of
[Present address], of nationality, who was born
at on [Date], whose father is [Full name], residing
in New Zealand at [Address]: And whereas the student is a
person to whom Part I of the Immigration Restriction
Amendment Act, 1920, applies: And whereas the said
Minister is prepared to grant the student a permit under the
Immigration Restriction Regulations subject to, inter alia,
the condition that these presents shall be entered into:

Now this deed witnesseth that in pursuance of the premises
and of an agreement so to do the said doth hereby
[do hereby jointly and severally] covenant with the Crown
upon and at all times after the granting of any such permit
as aforesaid to pay to the Minister of Customs all costs,
charges, and expenses that may at any time be incurred by
the Crown or any public body in or about the education,
maintenance, relief, arrest, or detention of the student in
New Zealand, or his deportation from New Zealand, whether
arising from sickness or poverty or from default of the
student in compliance with any requirements of law or from
any other cause, and whether or not such costs, charges, and
expenses may, apart from these presents, be a debt recover-
able by the Crown or such public body from the student or
any other person: Provided always that in the case of any
such costs, charges, or expenses as are not actually disbursed
by the Crown or a public body, or the amount of which is not
fixed by law 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 of Education, the Minister in Charge of Mental
Hospitals Department, the Minister of Customs, a 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.

In witness whereof these presents have been executed the
day and year first above written.

Signature[s]:

Signed by the said in the presence of—
Witness—
Name:
Occupation:
Address:

[Form 10.

CONSULAR CERTIFICATE RESPECTING STUDENT.
(The Immigration Restriction Regulations, 1930.)

I [Full name], of [Place of residence], Consul in New Zealand
for [Name of country], hereby certify that the undermentioned
particulars respecting [Full name of student] are correct, and
that he is a fit and proper person to be admitted temporarily
into New Zealand for years as a student.

Particulars respecting Student.

(1) Full name:
(2) Sex:
(3) Present address:
(4) Nationality:
(5) (a) Full names, places of birth, nationality, and full
present addresses of parents—
(i) Father:
(ii) Mother:
(b) Country of domicile of father:
(c) Place and date of birth of student:
(6) Marital state:
(7) Intended place of residence in New Zealand:
(8) (a) School, college, or University to be attended:
(b) Subjects to be studied:
(c) Subjects which have been studied outside New
Zealand.

A photograph of the above-mentioned person is attached
and sealed hereto.

Consul for…

Dated at , this day of, 19 .
[Photograph.]

[F0rm 11.

New Zealand Customs.

LIST OF PROHIBITED OR RESTRICTED IMMIGRANTS (INCLUDING
MEMBERS OF CREW) ON BOARD SHIP ARRIVING IN NEW
ZEALAND.

(Immigration Restriction Acts.)

I, [Full name], master of the [Name of ship], which has arrived
at , in the Dominion of New Zealand, from [Port
from which arriving], do hereby declare that the persons
concerning whom particulars are set forth hereunder [on
page[s] numbered ] are the only persons on board
my ship who are prohibited or restricted immigrants under
the Immigration Restriction Acts or who are in possession of
permits or certificates of registration granted thereunder:—

Dated at this day of , 19 . Master.

NOTES.—The following are the classes of persons particulars
of whom should be inserted in the above list:—

(1) Persons not of British birth and parentage within the
meaning of section 5 of the Immigration Restriction Amend-
ment Act, 1920, whether or not they are in possession of
permits to enter New Zealand or of certificates of registration
entitling them to enter New Zealand on compliance with the
conditions set forth therein.

(2) Persons who are insane, lunatic, idiotic, deaf, dumb,
blind, or infirm.

(3) Persons who are suffering from tuberculosis, syphilis,
leprosy, and any contagious disease which is loathsome or
dangerous.

(4) Any person the date of whose arrival in New Zealand
is earlier than two years after the termination of any imprison-
ment suffered by him in respect of any offence which, if
committed in New Zealand, would be punishable by death or
imprisonment for two years or upwards, not being a mere
political offence, and no pardon having been granted.

The list must include not only passengers, but also members
of crew, who are prohibited or restricted immigrants or in
possession of permits or certificates of registration.

[Form 12.

New Zealand Customs.

APPLICATION FOR CERTIFICATE OF REGISTRATION UNDER THE
IMMIGRATION RESTRICTION ACTS.

To the Collector of Customs.

I, [Full name], of [Place of residence in New Zealand and occupa-
tion], hereby apply for a certificate of registration under the
Immigration Restriction Acts which will entitle me [my
child under the age of fifteen years] to return to New Zealand
within years from the date thereof. I furnish the
following information respecting myself [my child under the
age of fifteen years], and I am aware that if any of the
information furnished herein is incorrect in a material respect
the certificate of registration which may be issued in pursuance
of this application may be or may be deemed to be revoked.

[Words inapplicable to be struck out.]

Full name of person for whom certificate of registration
desired:
Sex:
Nationality:
Place of birth:
Date of birth:
Height: ft. in.
Build:
Scars or birthmarks (if any):
Other particulars to aid identification:
Whether or not can speak English:
Date and port of first arrival in New Zealand, and vessel by
which arrived:
Date when photographs (herewith) taken: