13

D.—2

SCHEDULES. Schedules.

FIEST SCHEDULE I [Here insert name and occupation or rank] , in the Department, residing at , do hereby claim to be a permanent employe on the New Zealand Government Eailways, and to have my name registered as a contributor to the Insurance Fund as provided by "The Government Eailway Employes' Insurance Act, 1892." (Signed) In the presence of witness. Eesidence Dated this day of , 18

SECOND SCHEDULE Certificate No. I [We], , being the persons for the time being having charge of the New Zealand Government Eailways, do hereby certify that [Here insert name and occupation or rank] , in the Department, now residing at , is a permanent employe within the meaning of "The Government Eailway Employes' Insurance Act, 1892," and that in pursuance of his claim, dated , his name has been entered on the register as a contributor to the Insurance Fund.