Division Div 6 - Australian Soldiers' Repatriation Regulations - Register of Securities.

Division 6.—Register of Securities.

169. To assist in the protection of the public against possible frauds, the Commission shall establish and keep in each State a Register of the Securities accepted in that State.

170. The Register in each State shall be kept in the office of the Deputy Commissioner for the State.

Particulars of securities to be entered in Register.

171.—(1.) As soon as practicable but not later than fourteen days after a security has been accepted, particulars of that security shall be entered in the Register.

(2.) As soon as practicable but not later than fourteen days after a security has ceased to be in force an entry of that fact shall be made in the Register.

Form and contents of entries in Register.

The form and contents of entries to be made in the Register shall be determined from time to time by the Commission, but until otherwise determined by the Commission entries shall be made in accordance with Form E in the Schedule.

Searches.

173.—(1.) Any person shall be entitled to search the Register and make extracts therefrom on payment of a search fee of One shilling for each period of five minutes occupied in the search, or such search fee as is from time to time determined by the Commission.

Extracts from Register not to be published.

(2.) No person, firm or company shall print, publish, sell or expose for sale, any book, periodical, pamphlet, circular, handbill, poster, or newspaper, containing any extract made from the Register.

Liability for entry in, or omission from, Register.

No liability shall be incurred by the Commonwealth or by the Commission, or by any officer of the Commonwealth by reason of any entry having been made in or omitted from the Register, or by reason of anything having been inserted in or omitted from any entry in the Register.

Inspection of documents.

Nothing in these Regulations shall entitle any person to inspect any security or any other document in the possession or under the control of the Commission.

Part IX.—Miscellaneous.

Power of Commission to enter into contracts.

The Commission may enter into contracts for any purpose connected with or incidental to the administration of the Act or of these Regulations including contracts for the purchase or sale of any commodities.

Establishment of Institutions.

The Commission may maintain, erect, equips and conduct homes, hostels, hospitals, sanatoria, and artificial limb factories for the benefit of soldiers.

<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">Securities.</td><td colspan="6" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Person Giving Security.</td><td rowspan="2" style="width:8.9%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle">Amount Secured.</td></tr><tr style="height:1pt"><td style="width:6.34%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">No.</td><td style="width:7.92%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Date.</td><td style="width:12.82%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Nature of Security.</td><td style="width:10.84%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Regtl. No.</td><td style="width:11.32%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Rank.</td><td style="width:8.9%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Unit.</td><td style="width:11.24%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Name in Full.</td><td style="width:9.68%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Address.</td><td style="width:12.04%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Occupation.</td></tr><tr style="height:1pt"><td style="width:6.34%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td style="width:7.92%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:12.82%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:10.84%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:11.32%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:8.9%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:11.24%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:9.68%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:12.04%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:8.9%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td rowspan="2" style="width:11.3%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">Rate of Interest Payable.</td><td colspan="4" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Repayment.</td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Property over which Security Given.</td><td rowspan="2" style="width:10.86%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Remarks.</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle">Security Discharged.</td></tr><tr style="height:1pt"><td style="width:13.84%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Instalments due Monthly, &c.</td><td style="width:9.9%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Amount.</td><td style="width:10.86%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Repayable by.</td><td style="width:8.92%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Extended to.</td><td style="width:9.88%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Description of.</td><td style="width:8.9%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Where situated.</td><td style="width:7.92%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Date of Discharge.</td><td style="width:7.62%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle">Manner of Discharge</td></tr><tr style="height:37.5pt"><td style="width:11.3%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td style="width:13.84%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:9.9%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:10.86%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:8.92%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:9.88%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:8.9%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:10.86%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:7.92%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:7.62%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:52.42%; padding-right:2pt; padding-left:2pt; vertical-align:top">Declared by the said</td><td rowspan="4" style="width:3.78%; padding-right:2pt; padding-left:2pt; vertical-align:middle"><img src="image.005.png" width="12" height="64" alt="Brace grouping details of the Applicant's declaration"></td><td rowspan="4" style="width:43.8%; padding-right:2pt; padding-left:2pt; vertical-align:middle">Applicant.</td></tr><tr style="height:1pt"><td style="width:52.42%; padding-right:2pt; padding-left:2pt; vertical-align:top">at this</td></tr><tr style="height:1pt"><td style="width:52.42%; padding-right:2pt; padding-left:2pt; vertical-align:top">day of , 19 before me—</td></tr><tr style="height:1pt"><td style="width:52.42%; padding-right:2pt; padding-left:2pt; vertical-align:top">‡§</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:101.1%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:31.44%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Member of Forces in respectof whom Pension payable</td><td style="width:2.76%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><img src="image.006.png" width="12" height="39" alt="Brace grouping details of Member of Forces in respect of whom Pension payable"></td><td style="width:44.84%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td rowspan="2" style="width:19.88%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">War Pension Certificate No.</td><td style="vertical-align:top"></td></tr><tr style="height:1pt"><td colspan="3" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">No. Rank Unit</td><td style="border-bottom:0.75pt solid #000000; vertical-align:top"></td></tr><tr style="height:1pt"><td colspan="3" style="padding-right:2pt; padding-left:2pt; vertical-align:top">Instalments of Pension are payable to as</td><td colspan="2" style="border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">*Pensioner.*Trustee.</td></tr><tr style="height:0pt"><td style="width:144.75pt"></td><td style="width:12.7pt"></td><td style="width:206.55pt"></td><td style="width:91.55pt"></td><td style="width:4.9pt"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:30.6%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">Full Name of each Pensioner.</td><td style="width:13.14%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Fortnightly Amount Payable.</td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Altered as from/ / 19</td><td style="width:12.82%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Altered as from/ / 19</td><td style="width:15.18%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Altered as from/ / 19</td><td style="width:12.98%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle">Altered as from/ / 19</td><td style="vertical-align:top"></td></tr><tr style="height:62.25pt"><td style="width:30.6%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td style="width:13.14%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:12.82%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:15.18%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:12.98%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td><td style="vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:30.6%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Total..........</td><td style="width:13.14%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:12.82%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:15.18%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:12.98%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td><td style="vertical-align:top"></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Postmaster’s Signature to each Alteration...</td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:12.82%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:15.18%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:12.98%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td><td style="border-bottom:0.75pt solid #000000; vertical-align:top"></td></tr><tr style="height:66.75pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Pension at the rate of fortnightly has been granted from Payable in advance atDeputy Commissioner.</td><td colspan="5" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">I hereby acknowledge receipt of War Pension Certificate numbered as above.*Pensioner.*Trustee.(Signature)</td></tr><tr style="height:0pt"><td style="width:139.35pt"></td><td style="width:59.85pt"></td><td style="width:31.6pt"></td><td style="width:23.25pt"></td><td style="width:58.4pt"></td><td style="width:69.15pt"></td><td style="width:59.1pt"></td><td style="width:14.75pt"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border:0.75pt solid #000000; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:34.12%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Payment to be made in future at—</td><td style="width:22.22%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">The Last Payment made at this office was due on Thursday, the—</td><td style="width:43.66%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Signature of Postmaster and Office Stamp.</td></tr><tr style="height:34.6pt"><td style="width:34.12%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:22.22%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">/ / 19</td><td style="width:43.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><img src="image.007.png" width="39" height="40" alt="Office Stamp"></td></tr><tr style="height:35.5pt"><td style="width:34.12%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:22.22%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">/ / 19</td><td style="width:43.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><img src="image.007.png" width="39" height="40" alt="Office Stamp"></td></tr><tr style="height:35.5pt"><td style="width:34.12%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:22.22%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">/ / 19</td><td style="width:43.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><img src="image.007.png" width="39" height="40" alt="Office Stamp"></td></tr><tr style="height:40pt"><td style="width:34.12%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:22.22%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">/ / 19</td><td style="width:43.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><img src="image.007.png" width="39" height="40" alt="Office Stamp"></td></tr><tr style="height:35.5pt"><td style="width:34.12%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:22.22%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">/ / 19</td><td style="width:43.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><img src="image.007.png" width="39" height="40" alt="Office Stamp"></td></tr><tr style="height:35.5pt"><td style="width:34.12%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:22.22%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">/ / 19</td><td style="width:43.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><img src="image.007.png" width="39" height="40" alt="Office Stamp"></td></tr><tr style="height:35.5pt"><td style="width:34.12%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:22.22%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">/ / 19</td><td style="width:43.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><img src="image.007.png" width="39" height="40" alt="Office Stamp"></td></tr><tr style="height:17.25pt"><td style="width:34.12%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td rowspan="2" style="width:22.22%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">/ / 19</td><td rowspan="2" style="width:43.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><img src="image.007.png" width="39" height="40" alt="Office Stamp"></td></tr><tr style="height:26.25pt"><td style="width:34.12%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">No.</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="margin-left:30.6pt; margin-bottom:0pt; border-collapse:collapse"><tbody><tr><td style="width:234.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Odd days, from / / 19 to / / 19</td><td style="width:114.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">.................</td><td style="width:45.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">£</td></tr><tr><td style="width:234.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Fortnight in Advance, from / / 19</td><td style="width:114.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">.................</td><td style="width:45.55pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">£</td></tr><tr><td colspan="2" style="width:359.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Total....................</td><td style="width:45.55pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">£</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:57.75pt"><td style="width:20.74%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td rowspan="7" style="width:79.26%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><table cellspacing="0" cellpadding="0" style="margin-left:94.05pt; margin-bottom:0pt; border:0.75pt solid #000000; border-collapse:collapse"><tbody><tr style="height:382.45pt"><td style="width:117.95pt; height:382.45pt; margin-left:auto; writing-mode:tb-rl; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:382.45pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden">IMPORTANT NOTICE.This pension is absolutely inalienable.If the pensioner cannot attend in person to collect instalments of pension as they become due he may on Form “O”, obtainable at any Post Office, give an Order to another person. The person to whom such order is given must certify that he or she is not receiving the pension by way or in consequence of sale, assignment, charge, execution, or insolvency.Penalty for false or misleading statements—£50 or imprisonment for six months.</div></td></tr></tbody></table></td></tr><tr style="height:53.5pt"><td style="width:20.74%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td></tr><tr style="height:62.95pt"><td style="width:20.74%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td></tr><tr style="height:62.5pt"><td style="width:20.74%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td></tr><tr style="height:62.05pt"><td style="width:20.74%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td></tr><tr style="height:58pt"><td style="width:20.74%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td></tr><tr style="height:62.5pt"><td style="width:20.74%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">This Instalment to be collected on due date.</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td colspan="23" style="padding-right:2pt; padding-left:2pt; vertical-align:top">[Inside of Card]</td></tr><tr style="height:11.1pt"><td style="width:9.04%; padding-right:2pt; padding-left:2pt; vertical-align:top">Pensioner’s</td><td rowspan="2" style="width:0.72%; padding-right:2pt; padding-left:2pt; vertical-align:top"><img src="image.008.png" width="12" height="34" alt="Brace grouping details of Pensioner's Name"></td><td colspan="4" style="padding-right:2pt; padding-left:2pt; vertical-align:top"></td><td colspan="8" style="padding-right:2pt; padding-left:2pt; vertical-align:top">Certificate</td><td colspan="3" rowspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><img src="image.009.png" width="12" height="30" alt="Brace grouping Certificate Number"></td><td colspan="4" style="padding-right:2pt; padding-left:2pt; vertical-align:top">Payable</td><td rowspan="2" style="width:4.38%; padding-right:2pt; padding-left:2pt; vertical-align:top"><img src="image.008.png" width="12" height="34" alt="Brace grouping details of Payable At"></td><td style="width:15.88%; padding-right:2pt; padding-left:2pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:9.04%; padding-right:2pt; padding-left:2pt; vertical-align:top">Name</td><td colspan="4" style="padding-right:2pt; padding-left:2pt; vertical-align:top"></td><td colspan="8" style="padding-right:2pt; padding-left:2pt; vertical-align:top">Number</td><td colspan="4" style="padding-right:2pt; padding-left:2pt; vertical-align:top">At</td><td style="width:15.88%; padding-right:2pt; padding-left:2pt; vertical-align:top"></td></tr><tr style="height:1pt"><td colspan="3" style="padding-right:2pt; padding-left:2pt; vertical-align:top">Pensioner’s Signature</td><td rowspan="2" style="width:5.04%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><img src="image.008.png" width="12" height="34" alt="Brace grouping Pensioner's Signature (or witnessed Mark)"></td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"></td><td colspan="11" style="padding-right:2pt; padding-left:2pt; vertical-align:top"></td><td colspan="4" style="padding-right:2pt; padding-left:2pt; vertical-align:top">Witness to mark</td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"></td></tr><tr style="height:1pt"><td colspan="3" style="border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(or witnessed Mark)</td><td colspan="2" style="border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"></td><td colspan="11" style="border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"></td><td colspan="6" style="border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"></td></tr><tr style="height:1pt"><td colspan="7" rowspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">Date of Commencement or Alteration.</td><td colspan="4" rowspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Fortnightly Rate.</td><td colspan="7" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Fortnightly Rate (in Words).</td><td colspan="5" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle">Postmaster’s Signature to each Alteration.</td></tr><tr style="height:1pt"><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Pounds.</td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Shillings.</td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Pence.</td></tr><tr style="height:1pt"><td colspan="7" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Commenced as from / / 19.....Altered as from / / 19.....Altered as from / / 19.....Altered as from / / 19.....</td><td style="width:3.9%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">£</td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">s.</td><td style="width:2.56%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">d.</td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="5" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Granted by Repatriation Board.</td></tr><tr style="height:26.7pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="4" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="4" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:12.24%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:26.5pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="4" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="4" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:12.24%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:26.5pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="4" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="4" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:12.24%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:22pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="4" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="4" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:12.24%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:22pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="4" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="4" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:12.24%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:22pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td colspan="3" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="4" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="4" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:12.24%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:0pt"><td style="width:63.45pt"></td><td style="width:5.05pt"></td><td style="width:39.85pt"></td><td style="width:35.35pt"></td><td style="width:7.7pt"></td><td style="width:18.65pt"></td><td style="width:5.45pt"></td><td style="width:27.35pt"></td><td style="width:6.75pt"></td><td style="width:15.6pt"></td><td style="width:17.95pt"></td><td style="width:28.35pt"></td><td style="width:16.55pt"></td><td style="width:46.85pt"></td><td style="width:13.45pt"></td><td style="width:19.25pt"></td><td style="width:45.05pt"></td><td style="width:35.1pt"></td><td style="width:16.3pt"></td><td style="width:85.9pt"></td><td style="width:9.55pt"></td><td style="width:30.75pt"></td><td style="width:111.45pt"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td colspan="2" style="border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">*I /*We have this day examined the above-named person for War Pension purpose in respect of the above-mentioned disability or disabilities, and the following report is submitted:—</td></tr><tr style="height:1pt"><td style="width:49.68%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">1. States he is suffering from.............</td><td style="width:50.32%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:49.68%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">2. Age............................</td><td style="width:50.32%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Weight st. lb. (Coat and vest off)</td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">3. Describe in detail the present condition of the disability or disabilities recorded under (a), (b), or (c) above. (Heart and lungs must be examined in all cases).(a)</td></tr><tr style="height:1pt"><td style="width:49.68%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">4 The above condition is the result of .......</td><td style="width:50.32%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:49.68%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">5. In my opinion the improvement during the past six months has been</td><td style="width:50.32%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:55.95pt"><td style="width:49.68%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">6 State any other disabilities not recorded in 3 above, indicating whether</td><td style="width:50.32%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(a) Due to war service(b) Due to post-war causes</td></tr><tr style="height:66.3pt"><td style="width:49.68%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">7. Period of incapacity.................(Indicate if condition permanent)</td><td style="width:50.32%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">The condition is such as to render him *totally/*partially incapacitated for a period of months from this date.</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:18pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">8. Percentage of incapacity..............</td><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">He is at present incapacitated to the extent of % of total incapacity, made up as follows:—</td></tr><tr style="height:22.5pt"><td rowspan="7" style="width:47.76%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">These may be combined under one percentage if thought desirable by medical examiner</td><td rowspan="7" style="width:2.16%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><img src="image.010.png" width="12" height="51" alt="Brace grouping items 1 through 4 which may be combined under one percentage if thought desirable by medical examiner"></td></tr><tr style="height:15.45pt"><td style="width:42.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(1) Disability existing, prewar (if any)</td><td style="width:7.68%; padding-right:2pt; padding-left:2pt; vertical-align:top">%</td></tr><tr style="height:32.75pt"><td style="width:42.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(2) Disability caused through war service</td><td style="width:7.68%; padding-right:2pt; padding-left:2pt; vertical-align:top">%</td></tr><tr style="height:28.05pt"><td style="width:42.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(3) Disability — aggravation caused by war service</td><td style="width:7.68%; padding-right:2pt; padding-left:2pt; vertical-align:top">%</td></tr><tr style="height:39.3pt"><td style="width:42.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(4) Present disability (if any) due to post-war causes, but not contributed to by service</td><td style="width:7.68%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">%</td></tr><tr style="height:11.8pt"><td style="width:42.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Total, as above......</td><td style="width:7.68%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">%</td></tr><tr style="height:38.35pt"><td colspan="2" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">N.B.—Any degree of incapacity due to the default or wilful act of the ex-member is not a pension liability.</td></tr><tr style="height:1pt"><td style="width:47.76%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">9. Nature of employment since discharge and time lost during past 12 months through war disabilities</td><td style="width:2.16%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">For office use (G.O.P.25).</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">To the Deputy Commissioner of Repatriation,Signature:Medical Examiner.AddressDate</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="margin-left:63pt; margin-bottom:0pt; border-collapse:collapse"><tbody><tr><td style="width:286.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Form O</td><td style="width:86.05pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Post Office Date Stamp to</td></tr><tr style="height:16.6pt"><td style="width:286.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">———</td><td rowspan="6" style="width:86.05pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><img src="image.011.png" width="75" height="92" alt="Post Office Date Stamp to be placed in this square"></td></tr><tr><td style="width:286.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Commonwealth of Australia.</td></tr><tr><td style="width:286.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">———</td></tr><tr><td style="width:286.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Australian Soldiers’ Repatriation Act 1920-1931.</td></tr><tr><td style="width:286.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">———</td></tr><tr><td style="width:286.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">WAR PENSION ORDER, RECEIPT AND DECLARATION.</td></tr><tr><td style="width:286.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">———</td><td style="width:86.05pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">be placed in this square</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="margin-left:27pt; margin-bottom:0pt; border-collapse:collapse"><tbody><tr><td style="width:220.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Signature of Pensioner or Trustee</td><td rowspan="3" style="width:112.95pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"></td><td rowspan="3" style="width:16.2pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:middle">£</td><td rowspan="3" style="width:11.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:middle">s.</td><td rowspan="3" style="width:14.05pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:middle">d.</td></tr><tr><td style="width:220.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Postal Address Date</td></tr><tr><td style="width:220.95pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Receipt and Declaration.</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="margin-bottom:0pt; border-collapse:collapse"><tbody><tr><td rowspan="3" style="width:341.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Note.—Whenever payment of a pension instalment is made, the paying officer will hand to the person who is paid a blank form of receipt, which must be brought back on the next pension pay day, already filled in and signed.</td><td style="width:99.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Signature</td></tr><tr><td style="width:99.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Address</td></tr><tr><td style="width:99.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Date</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="margin-left:27pt; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:274.05pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Form P.</td><td style="width:134.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Post Office Date Stamp to be</td></tr><tr style="height:1pt"><td style="width:274.05pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">———</td><td rowspan="5" style="width:134.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:middle"><img src="image.012.png" width="61" height="61" alt="Post Office Date Stamp to be placed in this square"></td></tr><tr style="height:1pt"><td style="width:274.05pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Commonwealth of Australia.</td></tr><tr style="height:1pt"><td style="width:274.05pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">———</td></tr><tr style="height:1pt"><td style="width:274.05pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Australian Soldiers’ Repatriation Act 1920-1931.</td></tr><tr style="height:1pt"><td style="width:274.05pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">———</td></tr><tr style="height:1pt"><td style="width:274.05pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">WAR PENSION RECEIPT.</td><td style="width:134.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">placed in this square.</td></tr><tr style="height:1pt"><td style="width:274.05pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">———</td><td style="width:134.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:12.65pt"><td rowspan="3" style="width:49.36%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">1. Name—Surname (in block letters)........Christian names..................</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">.................................</td></tr><tr style="height:11.25pt"><td colspan="3" style="border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">.................................</td></tr><tr style="height:7pt"><td colspan="3" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:10.3pt"><td rowspan="2" style="width:49.36%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">2. Regimental No., Rank, Unit or other service particulars</td><td style="width:21.76%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Regimental No.</td><td style="width:12.42%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Rank.</td><td style="width:16.46%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Unit.</td></tr><tr style="height:20.55pt"><td style="width:21.76%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">…………………..</td><td style="width:12.42%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">………….</td><td style="width:16.46%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">………………</td></tr><tr style="height:1pt"><td style="width:49.36%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">3. Present address in full...............</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:15pt"><td rowspan="4" style="width:49.36%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">4. Nature of disability which I claim to be result of war service and which claim has been rejected by the Repatriation Commission (if more than one disability specify each distinctly)</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(a)</td></tr><tr style="height:13.6pt"><td colspan="3" style="border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(b)</td></tr><tr style="height:13.1pt"><td colspan="3" style="border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(c)</td></tr><tr style="height:26.65pt"><td colspan="3" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(&c.)</td></tr><tr style="height:98.7pt"><td style="width:49.36%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">5. Grounds of Appeal.................</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:15.45pt"><td rowspan="3" style="width:49.88%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">1. Name of deceased soldier:—Surname (in block letters)..........Christian Names.................</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:13.1pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">.................................</td></tr><tr style="height:9.35pt"><td colspan="3" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">.................................</td></tr><tr style="height:16.4pt"><td rowspan="2" style="width:49.88%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">2. Regtl. No., Rank, Unit, or other service particulars</td><td style="width:16.42%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Regtl. No.</td><td style="width:12.52%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Rank:</td><td style="width:21.18%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Unit:</td></tr><tr style="height:14.5pt"><td style="width:16.42%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">…………….</td><td style="width:12.52%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">………….</td><td style="width:21.18%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">……………….</td></tr><tr style="height:12.75pt"><td rowspan="4" style="width:49.88%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">3. Particulars of Death:—Date..................Place.................Cause.................</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:8.25pt"><td colspan="3" style="border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">................................</td></tr><tr style="height:7.8pt"><td colspan="3" style="border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">................................</td></tr><tr style="height:10.3pt"><td colspan="3" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">................................</td></tr><tr style="height:1pt"><td style="width:49.88%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">4. Present address of Appellant...........</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:74.4pt"><td style="width:49.88%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">5. Grounds of Appeal..................</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:19.5pt"><td rowspan="3" style="width:49.66%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Place of Hearing.....................Date of Hearing......................</td><td style="width:50.34%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">................................</td></tr><tr style="height:9.85pt"><td style="width:50.34%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">................................</td></tr><tr style="height:11.2pt"><td style="width:50.34%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:49.66%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">Personnel of Tribunal hearing Appeal.......</td><td style="width:50.34%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Chairman:...........................Member:............................Member:............................</td></tr><tr style="height:1pt"><td style="width:49.66%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Injury or disease in respect of which appeal is allowed.Injury or disease in respect of which appeal is disallowed.If the injury or disease in respect of which the appeal is allowed existed prior to enlistment state whether at present the aggravation is—material, ornon-material.State whether death is due to war service or not due to war service.Date from which decision shall operate (if necessary to state).</td><td style="width:50.34%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Decision of Tribunal:</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:11.7pt"><td rowspan="2" style="width:49.4%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">1. Name—Surname (in block letters)........Christian names..............</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">.................................</td></tr><tr style="height:13.55pt"><td colspan="3" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">.................................</td></tr><tr style="height:16.85pt"><td rowspan="2" style="width:49.4%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">2. Regimental No., Rank, Unit, or other service particulars.</td><td style="width:16.24%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Regtl. No.:</td><td style="width:14.8%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Rank:</td><td style="width:19.54%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Unit:</td></tr><tr style="height:8.4pt"><td style="width:16.24%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">…………</td><td style="width:14.8%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">………...</td><td style="width:19.54%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">……………</td></tr><tr style="height:1pt"><td style="width:49.4%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">3. Present address in full ...............</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:49.4%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">4. Present rate of Pension (self only)........</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:49.4%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">5. Nature of war disability in respect of which pension is being received</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:94.65pt"><td style="width:49.4%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">6. Grounds of appeal..................</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Name of Appellant: Surname........................................ Christian Names...................................Regimental Particulars: Regtl. No................................. Rank............................ Unit.............................</td></tr><tr style="height:1pt"><td style="width:49.44%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Date appeal lodged.......................Place of Hearing........................Date of Hearing.........................</td><td style="width:50.56%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:49.44%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">Personnel of Tribunal hearing appeal.</td><td style="width:50.56%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Chairman..............................Member..............................Member ..............................</td></tr><tr style="height:1pt"><td style="width:49.44%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Rate of Pension appealed against.</td><td style="width:50.56%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:38.85pt"><td rowspan="3" style="width:49.44%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Decision of Tribunal—Specify—(a) whether appeal is allowed or disallowed.(b) rate of pension determined upon (show in percentage figures).(c) Nature of injury or disease for which this assessment is made.Date from which decision shall operate (if necessary to state).</td><td style="width:50.56%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">(a)</td></tr><tr style="height:38.65pt"><td style="width:50.56%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(b)</td></tr><tr style="height:37.8pt"><td style="width:50.56%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(c)</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:11.3pt"><td style="width:49.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">1. Name—Surname (in block letters).......</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">……………………………………………………</td></tr><tr style="height:13.55pt"><td style="width:49.48%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Christian names............</td><td colspan="3" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">……………………………………………………</td></tr><tr style="height:19.2pt"><td rowspan="3" style="width:49.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">2. Regimental No., Rank, Unit, or other service particulars</td><td style="width:18.14%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Regtl. No.:</td><td style="width:14.8%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Rank:</td><td style="width:17.56%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Unit:</td></tr><tr style="height:6.1pt"><td style="width:18.14%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">……………....</td><td style="width:14.8%; padding-right:2pt; padding-left:2pt; vertical-align:top">…………</td><td style="width:17.56%; padding-right:2pt; padding-left:2pt; vertical-align:top">…………..</td></tr><tr style="height:6.1pt"><td colspan="3" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">……………………………………………………</td></tr><tr style="height:1pt"><td style="width:49.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">3. Present address in full...............</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:49.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">4. Nature of war disability in respect of which pension has been refused</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:49.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">5. Grounds of appeal..................</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:49.82%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">Questions and requests for information.</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle">Replies.</td></tr><tr style="height:1pt"><td style="width:49.82%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Give the full name of the member of the Forces on whose death or incapacity the claim is based</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:27.6pt"><td rowspan="2" style="width:49.82%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">State his rank, his number (if known), and the regiment or branch of the Forces in which he served</td><td style="width:16.74%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">No.</td><td rowspan="2" style="width:33.44%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Rank</td></tr><tr style="height:15.9pt"><td style="width:16.74%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Regiment, &c.</td></tr><tr style="height:1pt"><td style="width:49.82%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">State whether he is dead, or is alive but incapacitated</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:49.82%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">State in respect of his first marriage:—Full maiden name of wife...........Date of marriage.................Place of marriage................</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:49.82%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Give similar details in relation to his other marriages (if any)</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:49.82%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">State in respect of the first dependant for whom pension is claimed:—Full name of dependant............Date of birth of dependant..........Place of birth of dependant..........Where living at present............Full name of father of dependant......Full maiden name of mother of dependantRelationship of dependant to the deceased or incapacitated member of Forces who is named above*</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:49.82%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">State in respect of the second dependant for whom pension is claimed:—Full name of dependant............Date of birth of dependant..........Place of birth of dependant..........Where living at present............Full name of father of dependant......Full maiden name of mother of dependantRelationship of dependant to the deceased or incapacitated member of Forces who is named above*</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="margin-left:45pt; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:15.7pt"><td style="width:169.9pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Registrar of Pensions</td><td rowspan="2" style="width:2.7pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><img src="image.013.png" width="12" height="41" alt="Brace grouping details of Registrar of Pensions and Deputy Commissioner of Repatriation at"></td><td rowspan="2" style="width:206.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">at</td></tr><tr><td style="width:169.9pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Deputy Commissioner of Repatriation</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:50.08%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">Questions and requests for information.</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle">Replies.</td></tr><tr style="height:1pt"><td style="width:50.08%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Give the full name of the member of the Forces on whose death or incapacity the claim is based</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:13.1pt"><td rowspan="2" style="width:50.08%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">State his rank, his number (if known), and the regiment or branch of the Forces in which he served</td><td style="width:16.84%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">No.</td><td rowspan="2" style="width:33.08%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Rank</td></tr><tr style="height:30.85pt"><td style="width:16.84%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Regiment, &c.</td></tr><tr style="height:1pt"><td style="width:50.08%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Where was he born? (Give name of town and country, if known)</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:50.08%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">When was he born? (Give exact date, if known)</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:50.08%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Was he single, married, or a widower? (State which)</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:50.08%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">State whether he is dead, or is alive but incapacitated</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:50.08%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">What is your relationship to him?...........</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:50.08%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Where were you born ? (Give name of town and country, if known)</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:49.2%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">Questions and requests for information.</td><td colspan="5" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle">Replies.</td></tr><tr style="height:11.7pt"><td rowspan="2" style="width:49.2%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">State your number, rank, and the regiment or branch of the Forces in which you served</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">No.</td><td colspan="3" rowspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Rank</td></tr><tr style="height:13.55pt"><td colspan="2" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Regiment, &c.</td></tr><tr style="height:1pt"><td style="width:49.2%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">State the nature of your disability, and how, where and when caused</td><td colspan="5" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Nature of disabilityHow causedWhereWhen</td></tr><tr style="height:1pt"><td style="width:49.2%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Where and when were you born ? (Give name of town and country, also exact date, if known)</td><td colspan="5" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">PlaceDate</td></tr><tr style="height:1pt"><td style="width:49.2%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">What was your occupation before the outbreak of war? (Give full particulars)</td><td colspan="5" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:49.2%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">If you are or have been married, state, in respect of your first marriage:—</td><td style="width:12.32%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Full Maiden Name of Wife.</td><td style="width:10.34%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Place of Marriage.</td><td style="width:10.34%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Date of Marriage.</td><td style="width:8.38%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">If wife still living.</td><td style="width:9.42%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle">Present Address.</td></tr><tr style="height:24.9pt"><td style="width:49.2%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Give particulars of any subsequent marriage or marriages</td><td style="width:12.32%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:10.34%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:10.34%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:41.44%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">Full Names of Children.</td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Date of Birth.</td><td style="width:21.9%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Place of Birth.</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle">Where Living at Present.</td></tr><tr style="height:47.2pt"><td style="width:41.44%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:21.9%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Questions and requests for information.</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Replies.</td><td style="border-top:0.75pt solid #000000; vertical-align:top"></td></tr><tr style="height:14.5pt"><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Give full name and address of person to whom children’s pensions, if granted, are to be paid</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Name</td><td style="vertical-align:top"></td></tr><tr style="height:10.75pt"><td colspan="3" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">Address</td><td style="vertical-align:top"></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Give full particulars of your employment since your service as a member of the Forces ended</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td><td style="vertical-align:top"></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Are you or your wife or your children receiving or entitled to receive any payment under any Commonwealth Act other than the Australian Soldiers’ Repatriation Act 1920-1931, or under any Imperial Act or State Act ? If so, give full particulars</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td><td style="vertical-align:top"></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">At what Post Office should your pension, if granted, be paid?</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td><td style="vertical-align:top"></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">At what Post Office should the pensions of your wife and children, if granted, be paid?</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td><td style="vertical-align:top"></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">If there has been a delay of more than six months in lodging claim since you became eligible for a war pension the reason for such delay must be stated fully</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td><td style="vertical-align:top"></td></tr><tr style="height:0pt"><td style="width:188.75pt"></td><td style="width:38.55pt"></td><td style="width:33.5pt"></td><td style="width:99.75pt"></td><td style="width:93.1pt"></td><td style="width:1.8pt"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:427.55pt; margin-left:30.6pt; margin-bottom:0pt; border-collapse:collapse"><tbody><tr><td style="width:179.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Registrar of Pensions</td><td rowspan="2" style="width:1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><img src="image.014.png" width="12" height="42" alt="Brace grouping details of Registrar of Pensions and Deputy Commissioner of Repatriation at"></td><td rowspan="2" style="width:215.05pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">at</td></tr><tr style="height:8.55pt"><td style="width:179.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Deputy Commissioner of Repatriation</td></tr></tbody></table> ```

Questions and requests for information.	Replies.
State in respect of the third dependant for whom pension is claimed:—Full name of dependant............Date of birth of dependant..........Place of birth of dependant..........Where living at present............Full name of father of dependant......Full maiden name of mother of dependantRelationship of dependant to the deceased or incapacitated member of Forces who is named above*
Give similar details in respect of each other dependant for whom pension is claimed
If any of the persons named in this claim is a child of the aforesaid member of the Forces, state whether its mother is dead, and give the date and place of her death
Was every one of the persons named in this claim dependent upon the earnings of the aforesaid member of the Forces during the period of twelve months prior to his enlistment or appointment?
Do you consider yourself well qualified to speak of the sources of maintenance of the dependants referred to in this claim ?
Give your reasons for considering yourself to be so qualified
What is your relationship to the dependants?...
In the twelve months prior to the enlistment or appointment of the aforesaid member of the Forces did any other person maintain or contribute towards the maintenance of any of the dependants referred to in this claim?
If so, give full particulars...............
Give the name and address of some: person over the age of sixteen years who is able and willing to receive and economically disburse the pensions which may be granted in pursuance of this claim*
What relationship does such person bear to the dependants?

Questions and requests for information.	Replies.
Are any of the dependants named in this claim receiving or are they entitled to receive any payment under any Commonwealth Act other than the Australian Soldiers’ Repatriation Act 1920-1931, or under any Imperial Act or State Act?
If so, give full particulars................
At what Post Office should pensions, if granted, be paid?
Give the names and addresses of all persons known to you (other than those named in this claim) who were dependent upon the earnings of the aforesaid member of the Forces at any time within the twelve months prior to his enlistment or appointment
If there has been a delay of more than six months in lodging claim since the dependant became eligible for a war pension, the reason for such delay must be stated fully

Questions and requests for information.	Replies.
When were you born? (Give exact date, if known)
What is your occupation?................
Are you single, married, widow, or widower? (State which)
If you are a widow, state the date and place of your husband’s death
If you are, or have been married, state, in respect of your first marriage: —Full name of husband..............Full maiden name of wife...........Place of marriage................Date of marriage.................
Give similar particulars of your other marriage or marriages (if any)
Were you dependent upon the earnings of the aforesaid member of the Forces at any time during the period of twelve months prior to his enlistment or appointment ?
If you were dependent, give full particulars....
In the twelve months prior to the enlistment or appointment of the aforesaid member of the Forces did any other person contribute towards your maintenance?
If so, give full particulars................
Did you earn any money in the said period of twelve months?
If so, give full particulars................
Did you, during the said period of twelve months, have any means of support other than means of support shown on this page?
If so, give full particulars................
Are you in receipt of an Invalid or Old-age Pension?
If so, state the fortnightly rate and where you receive payment
Have you at any time applied for an Invalid or Old-age Pension?
If so, state when and where...............

Questions and requests for information.	Replies.
Is your husband (or wife) in receipt of an Invalid or Old-age Pension, or has he (or she) at any time applied?
Are you receiving or entitled to receive, any payment under any Commonwealth Act other than the Australian Soldiers’ Repatriation Act 1920-1931 or under any Imperial Act or State Act?
If so, give full particulars................
At what Post Office should pension, if granted, be paid?
Give the names and addresses of all persons known to you who were dependent upon the earnings of the aforesaid member of the Forces at any time within the twelve months prior to his enlistment or appointment
If there has been a delay of more than six months in lodging claim since you became eligible for a war pension, the reason for such delay must be stated fully

	Regulation No.	Statutory Rules, 1934, No.
	3	150
	62a	150
	65	55, 150
	66, 68, 76, 79	55
	80, 81	150
	85	96

Div 6Register of Securities.

Get a plain-English read of Div 6