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

Division 6.—Register of Securities.

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.

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.

158.—(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.

Searches.

160.—(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Extracts from Register not to be published.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.) A person, firm or company shall not 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.

161. 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 X.—Local Committees.

Local Committees.

Local Committee areas, for which Local Committees shall be appointed, shall be the following:—

(a) In the case of metropolitan or city areas, such division thereof as the Commission approves;

(b) In the case of country districts, the Shire areas in New South Wales, Victoria and Queensland, the District Council areas in South Australia, the Road Board Districts in Western Australia, which areas shall also include any Municipal areas, and in Tasmania the Municipal areas:

<table cellspacing="0" cellpadding="0" style="width:97.26%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td rowspan="2" style="width:60.2%; 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">Column 1.in respect of—</td><td colspan="2" 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:middle">Column 2.</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:middle">Column 3.</td></tr><tr style="height:1pt"><td colspan="2" style="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">Allowance per fortnight.</td><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:middle">Additional amount.</td></tr><tr style="height:1pt"><td style="width:60.2%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td style="width:11.36%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">s.</td><td style="width:10.32%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">d.</td><td style="width:10.9%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">s.</td><td style="width:7.22%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">d.</td></tr><tr style="height:1pt"><td style="width:60.2%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Widow.................................</td><td style="width:11.36%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">48</td><td style="width:10.32%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">0</td><td colspan="2" style="border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Nil</td></tr><tr style="height:1pt"><td style="width:60.2%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Widow and one child........................</td><td style="width:11.36%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">60</td><td style="width:10.32%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">0</td><td style="width:10.9%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">30</td><td style="width:7.22%; padding-right:2pt; padding-left:2pt; vertical-align:top">0</td></tr><tr style="height:1pt"><td style="width:60.2%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Widow and two children......................</td><td style="width:11.36%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">66</td><td style="width:10.32%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">0</td><td style="width:10.9%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">45</td><td style="width:7.22%; padding-right:2pt; padding-left:2pt; vertical-align:top">0</td></tr><tr style="height:1pt"><td style="width:60.2%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Widow and three children.....................</td><td style="width:11.36%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">72</td><td style="width:10.32%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">0</td><td style="width:10.9%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">55</td><td style="width:7.22%; padding-right:2pt; padding-left:2pt; vertical-align:top">0</td></tr><tr style="height:1pt"><td style="width:60.2%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Widow and four or more children................</td><td style="width:11.36%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">78</td><td style="width:10.32%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">0</td><td style="width:10.9%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">60</td><td style="width:7.22%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">0</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="5" 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="11" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Person Giving Security.</td><td colspan="2" 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">Amount Secured.</td><td style="vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:4.2%; 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">No.</td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Date.</td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Nature of Security.</td><td style="width:7.24%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Regt. No.</td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Rank.</td><td style="width:8.14%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Unit.</td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Name in Full.</td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Address.</td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Occupation.</td><td style="vertical-align:top"></td></tr><tr style="height:66.1pt"><td style="width:4.2%; 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"></td><td colspan="2" 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 style="width:7.24%; 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 style="width:8.14%; 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 colspan="2" 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="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><td style="vertical-align:top"></td></tr><tr style="height:14.65pt"><td colspan="18" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"></td><td style="border-bottom:0.75pt solid #000000; vertical-align:top"></td></tr><tr style="height:1pt"><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:middle">Rate of Interest Payable.</td><td colspan="8" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Repayment.</td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Property over which Security Given.</td><td colspan="2" rowspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Remarks</td><td colspan="4" 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 colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Instalments due Monthly, &c.</td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Amount.</td><td style="width:8.9%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Repayable by.</td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Extended to.</td><td style="width:11.24%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Description of.</td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Where situated.</td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Date of Discharge.</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">Manner of Discharge.</td></tr><tr style="height:82.3pt"><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="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 style="width:8.9%; 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"></td><td style="width:11.24%; 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="2" 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="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:0pt"><td style="width:19.1pt"></td><td style="width:23.4pt"></td><td style="width:8.95pt"></td><td style="width:39pt"></td><td style="width:15.1pt"></td><td style="width:32.95pt"></td><td style="width:2.75pt"></td><td style="width:40.55pt"></td><td style="width:1.9pt"></td><td style="width:37.05pt"></td><td style="width:51.2pt"></td><td style="width:15.2pt"></td><td style="width:29.9pt"></td><td style="width:22.85pt"></td><td style="width:22.05pt"></td><td style="width:35.45pt"></td><td style="width:10.5pt"></td><td style="width:37.05pt"></td><td style="width:10.5pt"></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:53.3%; 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">Questions.</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">Answers.</td></tr><tr style="height:1pt"><td style="width:23.02%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Information Concerning Pensioner or Applicant.</td><td style="width:23.68%; 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">Information Concerning the Pensioner’s (or Applicant’s) Husband or Wife.</td></tr><tr style="height:1pt"><td style="width:53.3%; 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">1. What is your full name and present postal address?</td><td style="width:23.02%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">1.</td><td style="width:23.68%; 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">1.</td></tr><tr style="height:1pt"><td style="width:53.3%; 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">2. What is your age?.....................</td><td style="width:23.02%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">2.</td><td style="width:23.68%; 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">2.</td></tr><tr style="height:1pt"><td style="width:53.3%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">3. If in receipt of war pension, state—</td><td style="width:23.02%; 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">3.</td><td style="width:23.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">3.</td></tr><tr style="height:1pt"><td style="width:53.3%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(a) At what Post Office payment is being made</td><td style="width:23.02%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(a)</td><td style="width:23.68%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(a)</td></tr><tr style="height:1pt"><td style="width:53.3%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(b) The fortnightly rate ...............</td><td style="width:23.02%; 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:top">(b)</td><td style="width:23.68%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(b)</td></tr><tr style="height:1pt"><td style="width:53.3%; 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">4. Are you single, married, widow, widower, or divorcee? (State which)</td><td style="width:23.02%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">4.</td><td style="width:23.68%; 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">4.</td></tr><tr style="height:1pt"><td style="width:53.3%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">5. If married, state whether—</td><td style="width:23.02%; 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">5.</td><td style="width:23.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">5.</td></tr><tr style="height:1pt"><td style="width:53.3%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(a) your husband or wife is a pensioner</td><td style="width:23.02%; 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:23.68%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:53.3%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(b) you are living together or apart</td><td style="width:23.02%; 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:top"></td><td style="width:23.68%; 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:53.3%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">6. State—</td><td style="width:23.02%; 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">6.</td><td style="width:23.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">6.</td></tr><tr style="height:1pt"><td style="width:53.3%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(a) Number of children under the age of sixteen, and whether or not they are residing with and being maintained by you</td><td style="width:23.02%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(a)</td><td style="width:23.68%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(a)</td></tr><tr style="height:1pt"><td style="width:53.3%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(b) If not, give name and address of guardian</td><td style="width:23.02%; 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:top">(b)</td><td style="width:23.68%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(b)</td></tr><tr style="height:1pt"><td style="width:53.3%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">7. If you are engaged in employment, state—</td><td style="width:23.02%; 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">7.</td><td style="width:23.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">7.</td></tr><tr style="height:1pt"><td style="width:53.3%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(a) Whether on your own account, or</td><td style="width:23.02%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(a)</td><td style="width:23.68%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(a)</td></tr><tr style="height:1pt"><td style="width:53.3%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(b) Whether by an employer............</td><td style="width:23.02%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(b)</td><td style="width:23.68%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(b)</td></tr><tr style="height:1pt"><td style="width:53.3%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(c) Name and address of present employer</td><td style="width:23.02%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(c)</td><td style="width:23.68%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(c)</td></tr><tr style="height:1pt"><td style="width:53.3%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(d) Weekly rate of present remuneration</td><td style="width:23.02%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(d)</td><td style="width:23.68%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(d)</td></tr><tr style="height:1pt"><td style="width:53.3%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(e) Names and addresses of em-employers during the past twelve months</td><td style="width:23.02%; 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:top">(e)</td><td style="width:23.68%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(e)</td></tr><tr style="height:1pt"><td style="width:53.3%; 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">8. How much did your income or earnings (other than war pension or invalid or old-age pension) amount to during the past twelve months? What is the source of such income?</td><td style="width:23.02%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">8.</td><td style="width:23.68%; 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">8.</td></tr><tr style="height:1pt"><td style="width:53.3%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">9. Do you receive—</td><td style="width:23.02%; 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">9.</td><td style="width:23.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">9.</td></tr><tr style="height:1pt"><td style="width:53.3%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(a) Board.........................</td><td style="width:23.02%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(a)</td><td style="width:23.68%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(a)</td></tr><tr style="height:1pt"><td style="width:53.3%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(b) Lodging.......................</td><td style="width:23.02%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(b)</td><td style="width:23.68%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(b)</td></tr><tr style="height:1pt"><td style="width:53.3%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">either free or in return for services ? If so, state from whom, and the relationship of such person to yourself</td><td style="width:23.02%; 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:top"></td><td style="width:23.68%; 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:53.3%; 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">10. Do you receive Invalid or Old-age Pension? If so, state how much per fortnight</td><td style="width:23.02%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">10.</td><td style="width:23.68%; 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">10.</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:53.54%; 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.</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">Answers.</td></tr><tr style="height:1pt"><td style="width:22.56%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Information Concerning Pensioner or Applicant.</td><td style="width:23.9%; 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">Information Concerning the Pensioner’s (or Applicant’s) Husband or Wife.</td></tr><tr style="height:26.05pt"><td style="width:53.54%; 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">11. If not in receipt of Invalid or Old-age Pension, have you at any time lodged a claim therefor?</td><td style="width:22.56%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">11.</td><td style="width:23.9%; 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">11.</td></tr><tr style="height:1pt"><td rowspan="2" style="width:53.54%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">12. Do you own or have you an interest in any house or land property? If so, state in respect of each property—</td><td style="width:22.56%; 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">12.</td><td style="width:23.9%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">12.</td></tr><tr style="height:1pt"><td style="width:22.56%; 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:23.9%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr><tr style="height:1pt"><td style="width:53.54%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(a) Nature........................</td><td style="width:22.56%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(a)</td><td style="width:23.9%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(a)</td></tr><tr style="height:1pt"><td style="width:53.54%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(b) Situation.......................</td><td style="width:22.56%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(b)</td><td style="width:23.9%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(b)</td></tr><tr style="height:1pt"><td style="width:53.54%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(c) Value.........................(Last valuation notice should be produced in support of your statement.)</td><td style="width:22.56%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(c)</td><td style="width:23.9%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(c)</td></tr><tr style="height:1pt"><td style="width:53.54%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(d) Is the property subject to mortgage or any encumbrances?</td><td style="width:22.56%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(d)</td><td style="width:23.9%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(d)</td></tr><tr style="height:1pt"><td style="width:53.54%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(e) If so, state amounts, also names and addresses of mortgagees</td><td style="width:22.56%; 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:top">(e)</td><td style="width:23.9%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(e)</td></tr><tr style="height:1pt"><td style="width:53.54%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">13. If you own more than one house, state—</td><td style="width:22.56%; 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">13</td><td style="width:23.9%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">13.</td></tr><tr style="height:1pt"><td style="width:53.54%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(a) In which house you live.............</td><td style="width:22.56%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(a)</td><td style="width:23.9%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(a)</td></tr><tr style="height:1pt"><td rowspan="2" style="width:53.54%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(b) The actual amounts for rates, taxes, insurance and repairs expended during the past twelve months on the property not used as a home</td><td style="width:22.56%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(b)</td><td style="width:23.9%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(b)</td></tr><tr style="height:1pt"><td style="width:22.56%; 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:top"></td><td style="width:23.9%; 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:53.54%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">14.</td><td style="width:22.56%; 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">14.</td><td style="width:23.9%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">14.</td></tr><tr style="height:1pt"><td style="width:53.54%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(a) Do you sublet any portion of the house in which you live?</td><td style="width:22.56%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(a)</td><td style="width:23.9%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(a)</td></tr><tr style="height:1pt"><td style="width:53.54%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(b) If so, state amount of rent per week received from this source</td><td style="width:22.56%; 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:top">(b)</td><td style="width:23.9%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(b)</td></tr><tr style="height:1pt"><td style="width:53.54%; 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">15. Give particulars of all rents or other income received in respect of property</td><td style="width:22.56%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">15.</td><td style="width:23.9%; 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">15.</td></tr><tr style="height:15pt"><td style="width:53.54%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">16. Do you conduct a business? If so, state-</td><td style="width:22.56%; 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">16.</td><td style="width:23.9%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">16.</td></tr><tr style="height:1pt"><td style="width:53.54%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(a) Value.........................</td><td style="width:22.56%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(a)</td><td style="width:23.9%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(a)</td></tr><tr style="height:1pt"><td style="width:53.54%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(b) Nature........................</td><td style="width:22.56%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(b)</td><td style="width:23.9%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(b)</td></tr><tr style="height:1pt"><td style="width:53.54%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(c) Weekly turnover..................</td><td style="width:22.56%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(c)</td><td style="width:23.9%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(c)</td></tr><tr style="height:1pt"><td style="width:53.54%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(d) Estimated net profit...............</td><td style="width:22.56%; 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:top">(d)</td><td style="width:23.9%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(d)</td></tr><tr style="height:1pt"><td style="width:53.54%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">17. Do you keep lodgers or boarders? If so, state—</td><td style="width:22.56%; 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">17.</td><td style="width:23.9%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">17.</td></tr><tr style="height:1pt"><td style="width:53.54%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(a) Number.......................</td><td style="width:22.56%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">(a)</td><td style="width:23.9%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(a)</td></tr><tr style="height:1pt"><td style="width:53.54%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(b) The amount paid weekly by each</td><td style="width:22.56%; 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:top">(b)</td><td style="width:23.9%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">(b)</td></tr><tr style="height:38.05pt"><td style="width:53.54%; 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">18. State amount of cash in Bank, or in hand. Give name and address of Bank and Pass-book number.</td><td style="width:22.56%; 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">18.</td><td style="width:23.9%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">18.</td></tr><tr style="height:1pt"><td style="width:53.54%; 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">19. Do you own any Bonds, Shares, Interests, or any Securities? Give full particulars</td><td style="width:22.56%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">19.</td><td style="width:23.9%; 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">19.</td></tr><tr style="height:1pt"><td style="width:53.54%; 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">20. Give value of any horses, cattle, sheep, or other live-stock, or any vehicles, implements, &c., owned by you</td><td style="width:22.56%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">20.</td><td style="width:23.9%; 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">20.</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:52.7%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Questions.</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">Answers.</td></tr><tr style="height:1pt"><td style="width:23.28%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Information Concerning Pensioner or Applicant.</td><td style="width:24.02%; 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">Information Concerning the Pensioner’s (or Applicant’s) Husband or Wife.</td></tr><tr style="height:1pt"><td style="width:52.7%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">21. Have you a share or interest in any other property or assets apart from that shown above? Give full particulars</td><td style="width:23.28%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">21.</td><td style="width:24.02%; 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">21.</td></tr><tr style="height:1pt"><td style="width:52.7%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">22. Is your life insured? If so, state name of Company, policy number, amount, and age at which amount is payable. Also state by whom premiums are paid</td><td style="width:23.28%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">22.</td><td style="width:24.02%; 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">22.</td></tr><tr style="height:1pt"><td style="width:52.7%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">23. Are you in receipt of pension, allowance, or the like under any Act, or from any source, such as State Aid, Compensation, Unemployed Sustenance, Provident Fund Payment, Superannuation, Long Service Pension, Civil Pension, &c.? If so, state weekly amount</td><td style="width:23.28%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">23.</td><td style="width:24.02%; 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">23.</td></tr><tr style="height:1pt"><td style="width:52.7%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">24. Have you any interest (including a reversionary interest) under a Will or any other Instrument? If so, give full particulars</td><td style="width:23.28%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">24.</td><td style="width:24.02%; 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">24.</td></tr><tr style="height:1pt"><td style="width:52.7%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">25. Have you any income from property or money otherwise invested not previously disclosed in this statement?</td><td style="width:23.28%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">25.</td><td style="width:24.02%; 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">25.</td></tr><tr style="height:1pt"><td style="width:52.7%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">26. Have you during the past twelve months transferred or otherwise disposed of money or property of any kind? If so, give particulars</td><td style="width:23.28%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">26.</td><td style="width:24.02%; 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">26.</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:50.16%; 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">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; 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:50.16%; 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">2. Regimental No., Rank, Unit or other service particulars</td><td style="width:21.88%; 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">Regimental No.</td><td style="width:14.38%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Rank.</td><td style="width:13.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Unit.</td></tr><tr style="height:1pt"><td style="width:50.16%; 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">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:12.3pt"><td rowspan="3" style="width:50.16%; 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">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:13.5pt"><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:22.5pt"><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.)(&c.)</td></tr><tr style="height:1pt"><td style="width:50.16%; 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">5. Grounds of Appeal (state reasons for considering that the disabilities mentioned in paragraph 4 above are the result of war service)</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:50.16%; 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">6. Person nominated by Appellant to act as Appellant’s Advocate</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:60.45pt"><td style="width:50.68%; 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">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:46.95pt"><td style="width:50.68%; 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">2. Reg. No., Rank, Unit, or other service particulars</td><td style="width:17.74%; 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">Regtl. No.</td><td style="width:12.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Rank.</td><td style="width:19%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Unit.</td></tr><tr style="height:1pt"><td style="width:50.68%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">3. Particulars of Death:—</td><td colspan="3" rowspan="4" 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:50.68%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Date.........................</td></tr><tr style="height:1pt"><td style="width:50.68%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Place........................</td></tr><tr style="height:29.85pt"><td style="width:50.68%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Cause........................</td></tr><tr style="height:36.6pt"><td style="width:50.68%; 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. 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:35.7pt"><td style="width:50.68%; 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. 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><tr style="height:48.75pt"><td style="width:50.68%; 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. Person nominated by Appellant to act as Appellant’s Advocate</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:46.88%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Place of Hearing ..................</td><td rowspan="2" style="width:53.12%; 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:46.88%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Date of Hearing ...................</td></tr><tr style="height:1pt"><td style="width:46.88%; 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">Personnel of Tribunal Hearing Appeal</td><td style="width:53.12%; 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">ChairmanMemberMember</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:51.82%; 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">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; 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:51.82%; 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">2. Regimental No., Rank, Unit, or other service particulars</td><td style="width:14.62%; 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">Regtl. No.</td><td style="width:16.14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Rank.</td><td style="width:17.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Unit.</td></tr><tr style="height:1pt"><td style="width:51.82%; 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">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:51.82%; 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">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:51.82%; 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">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:1pt"><td style="width:51.82%; 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">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 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">Date of Appeal......................</td><td rowspan="3" style="width:50.52%; 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-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Place of Hearing.....................</td></tr><tr style="height:1pt"><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">Date of Hearing.....................</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:middle">Personnel of Tribunal hearing Appeal.......</td><td style="width:50.52%; 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">ChairmanMemberMember</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">Rate of Pension appealed against..........</td><td style="width:50.52%; 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:50.82%; 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">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; 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:50.82%; 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">2. Regimental No., Rank, Unit, or other service particulars</td><td style="width:16.8%; 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">Regtl. No.</td><td style="width:15.8%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Rank.</td><td style="width:16.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Unit.</td></tr><tr style="height:1pt"><td style="width:50.82%; 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">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:50.82%; 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">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:25.35pt"><td style="width:50.82%; 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">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:51.08%; 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">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; 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:51.08%; 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">2. Regimental No., Rank, Unit, or other service particulars</td><td style="width:15.36%; 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">Regtl. No.</td><td style="width:17.22%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Rank.</td><td style="width:16.34%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Unit.</td></tr><tr style="height:1pt"><td style="width:51.08%; 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">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:25.35pt"><td style="width:51.08%; 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">4. Details of 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><tr style="height:1pt"><td style="width:51.08%; 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">5. Person nominated by Appellant to act as Appellant’s advocate</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:50.04%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Date of Appeal.......................</td><td rowspan="3" style="width:49.96%; 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:50.04%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Place of Hearing......................</td></tr><tr style="height:1pt"><td style="width:50.04%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Date of Hearing......................</td></tr><tr style="height:1pt"><td rowspan="3" style="width:50.04%; 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:49.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Chairman</td></tr><tr style="height:1pt"><td style="width:49.96%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Member</td></tr><tr style="height:1pt"><td style="width:49.96%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Member</td></tr><tr style="height:1pt"><td style="width:50.04%; 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">Grounds of Appeal....................</td><td style="width:49.96%; 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:26.05pt"><td style="width:50.04%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Decision of Tribunal—Specify whether appeal is allowed or disallowed</td><td rowspan="2" style="width:49.96%; 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:50.04%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Date from which decision shall operate (if necessary to state)</td></tr></tbody></table> ```

Div 6Register of Securities.

Get a plain-English read of Div 6

Decision of Tribunal—
Specify—
(a) whether appeal is allowed or disallowed	(a)
(b) rate of pension determined upon (show in percentage figures)	(b)
(c) Nature of injury or disease for which this assessment is made	(c)
Date from which decision shall operate (if necessary to state)

Signed by the Borrower at
in
the presence of—

Signed by the Mortgagor at
in
the presence of—

Signed by the Mortgagor at
in
the presence of—

Signed by the Hirer at
In
the presence of—