37

I.—4a.

the holder of the license specified in the Schedule, hereby applies for a renewal thereof for a term of years, commencing on the expiry of the current term. The address for service is : Dated this day of , 1 [Signature of Applicant, etc.]

THE SCHEDULE ABOVE REFERRED TO. Particulars of Current License.

Form 72 (Eeg. 15). Under "The Mining Act, 1898." Application to be examined for Certificate. To the Board of Examiners, Wellington. I, the undersigned [Full name, occupation, and residence] , hereby apply to be examined for a certificate as mine-manager [or battery superintendent] . I enclose the prescribed fee of £1, and hereby declare as follows : — (1.) My practical experience consists of actual employment as specified in the Schedule hereto ; and in proof thereof I herewith supply evidence in writing from my previous employers, as specified in that Schedule. (2.) [If the applicant is a candidate for examination for a mine-manager's certificate, and already holds a certificate of the second class, add] I am the holder of a second-class certificate, No. , and desire to be examined for a certificate of the first class. Dated at , this day of , 1

SCHEDULE. Particulars and Proof of Employment.

[Signature of applicant.] Form 73 (Eeg. 16). Under "The Mining Act, 1898." Mine - manager's Certificate of First [or Second] Class by Examination. § : This is to certify that [Full name, occupation, ~ : and residence] has by examination duly satisfied * : the Board of Examiners that he is entitled to '"o> : a mine-manager's certificate of the first [or « : second] class, and this first- [or second-] class 3 : certificate is hereby issued to him accordingly. | : Issued at Wellington, this day of .§i • , 1 , by the Board of Examiners. co : CD., A.8., Secretary. Chairman.

Form 74 (Eeg. 16). Under " The Mining Act, 1898." Mine - manager's Certificate of First [or Second] Class without Examination. \ This is to certify that [Full name, occupation, .. \ and residence], having duly satisfied the Board i 5 | of Examiners that he is the holder of a cor--2 : responding certificate of equal status, granted -a: '• after examination by [Name of authority] "Ig. I (being a duly constituted and recognised cb • authority outside New Zealand), this first- [or § [ second-] class certificate as mine-manager is | \ hereby granted to him accordingly without .551 •' examination. : Issued at Wellington, this day of ,1 ,by the Board of Examiners. CD., A.8., Secretary. Chairman.

Form 75 (Eeg. 16). Under "The Mining Act, 1898." Battery Superintendent's Certificate by [or without] Examination. [As in Forms Nos. 73 or 74, or with all necessary modifications.]

Form 76 (Eeg. 18). Under "The Mining Act, 1898." Application for Duplicate of Lost or Destroyed Document. To the Warden of the Mining District, at I, the undersigned [Full name of applicant] , of [Besidence and occupation], being the lawful holder of the miner's right [license, or other document] specified in the Schedule hereto, hereby apply for the issue of a duplicate thereof on the ground that the original has been lost or destroyed ; and in support of this application I do hereby solemnly and sincerely declare as follows :— 1. I am the lawful holder of the document above referred to, and it was lost [or destroyed] under the following circumstances : [Set out as far as known the date on which and the manner in ivhich the loss or destruction occurred]. 2. I have made diligent search for the said document, but have been unable to find it. 3. I have not, nor with my knowledge or consent has any other person, deposited the said document with any person for purposes of security or otherwise, and I verily believe it to be lost [or destroyed] . And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of " The Justices of the Peace Act 1882." THE SCHEDULE ABOVE REFERRED TO. [Set out the name of the document, the Act under which it was issued, the registration or other number and such other particulars as will suffice to identify it.] Declared by the said , at , this day of , 1 before me— J.P. [Solicitor, or other person authorised to take statutory declarations].

Date and Registered Number. Name of Mining Privilege. Date of Expiry of Term.

Period of Employment. Name of of mnl y employer. From i To Nature of Employment. Nature of Evidence in Writing.