✨ Marine Department Notices
[SEPT. 3.]
THE NEW ZEALAND GAZETTE.
Marine Department.
NEW ZEALAND.
[Marine—378.
APPLICATION FOR REPLACEMENT OF ENGINE-DRIVER'S CERTIFICATE.
(After completion, this form, together with the prescribed fee of 5s., is to be forwarded to the Secretary, Marine Department, Wellington.)
(A)—Name, &c., of Applicant.
| (1) Christian Names in full. | (2) Surname. | (3) Address. |
|---|---|---|
Date of Birth. Place of Birth.
| (4) Day. | (5) Month. | (6) Year. | (7) Name of Place. | (8) Country in which situated. |
|---|---|---|---|---|
(B)—Particulars of Certificate of which Replacement desired.
| (9) Number. | (10) Description and Class. | (11) Competency or Service. | (12) Date of Issue. | (13) If unable accurately to complete Columns (9) and (12), give here some Information as to when Certificate obtained. |
|---|---|---|---|---|
(C)—Declaration to be made by Applicant.
Caution.—Every person who makes a false representation for the purpose of obtaining a certificate either of competency or service is liable to imprisonment with hard labour for a period not exceeding two years.
I, [Full name] of
, do solemnly and sincerely declare that—
(1) My certificate, particulars of which are given in division (B) of this form, was lost* [destroyed] at
on [Date] under the following circumstances : [Give full details].
- Indicate whether lost or destroyed.
(2) The statements made herein, and in divisions (A) and (B) of this form are correct and true to the best of my knowledge and belief; and I make this solemn declaration conscientiously believing the same to be true, and by virtue of the Justices of the Peace Act, 1927.
Signature: ……………………
Declared at
, in the Dominion of New Zealand, this day of , 19 , before me—
…………………………
Justice of the Peace [or Solicitor].
(D) Certificate as to Receipt of Fee.
(For use by Department.)
The fee of five shillings has been received this day, on Receipt Number £0 5s. 0d.
…………………………, Receiver.
Date: …………………, 19 .
[Front.]
NEW ZEALAND.
No.…………
[The Seal of the Marine
Department, N.Z.]
CERTIFICATE OF COMPETENCY AS EXTRA FIRST-CLASS STATIONARY ENGINEER.
To
WHEREAS it has been reported to me that you have passed an examination and satisfied the Board of Examiners that you are duly qualified to hold a certificate as an Extra First-class Stationary Engineer, I do hereby, in pursuance of the Inspection of Machinery Act, 1928, grant you this Certificate of Competency.
This certificate entitles the holder thereof to drive and have charge of any stationary steam-engine (other than a winding-engine), and of any stationary boiler.
Given under the seal of the Marine Department of New Zealand, at Wellington, this day of , 19 .
Registered:
………………, Secretary.
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VUW Te Waharoa —
NZ Gazette 1931, No 64
NZLII —
NZ Gazette 1931, No 64
✨ LLM interpretation of page content
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Application for Engine-Driver's Certificate
(continued from previous page)
🚂 Transport & CommunicationsMarine Department, Engine-Driver's Certificate, Application Form, Service, Examination, Fees
🚂 Certificate of Competency as Extra First-Class Stationary Engineer
🚂 Transport & CommunicationsMarine Department, Certificate of Competency, Extra First-Class Stationary Engineer, Inspection of Machinery Act, 1928
- Secretary, Marine Department