Child Endowment Regulations

STATUTORY RULES.

1941. No. 180.

REGULATIONS UNDER THE CHILD ENDOWMENT ACT 1941.*

I, THE GOVERNOR-GENERAL in and over the Commonwealth of Australia, acting with the advice of the Federal Executive Council, hereby make the following Regulations under the Child Endowment Act 1941.

Dated this twenty-Ninth day of July, 1941.

Signature.

Governor-General.

By His Excellency’s Command,

Signature of Frederick Stewart.

Minister of State for Social Services.

CHILD ENDOWMENT REGULATIONS.

Part I.—Preliminary.

Citation.

1. These Regulations may be cited as the Child Endowment Regulations.

Parts.

2. These Regulations are divided into Parts, as follows:—

Part I.—Preliminary.

Part II.—Lodgment, Investigation and Determination of Claims.

Part III.—Payment of Endowments.

Part IV.—Miscellaneous.

Definitions.

3.—(1.) In these Regulations, unless the contrary intention appears—

“aboriginal native of Australia” means a person born in Australia whose parentage is predominantly aboriginal;

“approved” means approved by the Secretary, Department of Social Services;

“bank manager” includes an officer of the bank authorized by the bank manager;

“Deputy Commissioner”, in relation to an endowment, means the Deputy Commissioner for the State in which the endowment is paid;

“endowee” means a person entitled to receive payment of an endowment;

“postmaster” includes an officer of the post office authorized by the postmaster;

“the Act” means the Child Endowment Act 1941.

(2.) For the purposes of these Regulations, unless the contrary intention appears, the Australian Capital Territory shall be deemed to be part of the State of New South Wales, and the Northern Territory shall be deemed to be part of the State of South Australia.

(3.) In these Regulations, any reference to a Form by number shall be read as a reference to the Form in the Schedule to these Regulations bearing that number.

* Notified in the Commonwealth Gazette on 1941.

4049.—21/28.7.1941.—Price 1s.

Part II.—Lodgment, Investigation and Determination of Claims.

Claims for endowment other than claims by institutions.

4.—(1.) Any person (other than an institution) claiming an endowment shall deliver or send to the Deputy Commissioner for the State in which payment is desired—

(a) when the claimant has not previously been granted an endowment which is still being paid—a claim in accordance with Form 1; or

(b) in any other case—a claim in accordance with Form 2, together with a certificate of registration of birth in accordance with the approved form.

(2.) A claim for endowment by a person who is an aboriginal native of Australia—

(a) may be made by the person himself, or, on his behalf, by—

(i) a member of a Board or other authority of the State or Territory in which the person resides charged with the welfare of aborigines, or an officer of any such Board or authority thereunto authorized by the Board or authority, or the Officer in Charge of the Aborigines Department, or other Department administering aboriginal affairs, of that State or Territory; or

(ii) by the Senior Protector of Aboriginals in the district, or by the person, if of European origin or descent, in charge of the mission or Government settlement where the person resides; and

(b) shall be accompanied by a certificate furnished by the Aborigines Department, or other Department administering aboriginal affairs, of the State or Territory in which the child or children in respect of whom the claim is made, or whose maintenance is relevant to the claim, was or were born, as to the date, or approximate date, of birth of the child or children.

(3.) A Deputy Commissioner may, where he is of opinion that, by reason of special circumstances, it is necessary to do so, accept a claim made by a person approved by him on behalf of another person.

Validation of claim forms issued before commencement of Regulations.

5. Where a claim has been made, or is made, in a form issued by the Commissioner before the date of commencement of these Regulations, the claim shall be deemed to have been, or to be, duly made in the prescribed form.

Application by institution.

6.—(1.) Any charitable institution or organization (not being a charitable institution or organization maintained by the Commonwealth or a State or mainly dependent upon financial assistance from the Commonwealth or a State) may make application, in accordance with Form 3, for the approval of the Minister in pursuance of section 4 of the Act, which application shall be accompanied by a declaration in accordance with the declaration contained in that Form.

(2.) Where it appears to the Minister at any time that the approval of an institution should be withdrawn, the Minister may revoke the approval accordingly, and any endowment granted to that institution shall thereupon cease to be payable.

(3.) Any institution claiming endowment shall deliver or send to the Deputy Commissioner for the State in which the institution is located—

(a) where the institution has not previously been granted an endowment which is still being paid—a claim in accordance with Form 4; or

(b) in any other case—a claim in accordance with Form 5.

(4.) Every institution to which an endowment has been granted shall, except where otherwise permitted by the Deputy Commissioner, on the Monday of every week, deliver or post to the Deputy Commissioner a statement in the approved form of the children admitted to, or discharged from, the institution during the week ended on the last preceding Saturday.

Person by whom child is deemed to be maintained.

7.—(1.) For the purposes of section 13 of the Act, a child shall be deemed to be maintained—

(a) by the mother of the child, if the child is living with the mother:

Provided that, where the parents are permanently living apart and the father is, by his contributions, wholly or substantially maintaining the child, this paragraph shall not in any way affect the question by whom the child is maintained:

Provided further that, where the child is not, in fact, maintained by the mother or father of the child, and the child and its mother are both living with a person, or with the wife of a person, who would, if the child were his or her child, for the purposes of section 13 of the Act, be maintaining or deemed to be maintaining the child, the child shall be deemed to be maintained by that person; or

(b) by the father of the child, if the mother is dead, or if the mother and father are living apart, and the child is living with the father:

Provided that, where the parents are not permanently living apart, and the mother is maintaining, or is deemed to be maintaining, any other child, the child so living with the father shall be deemed to be maintained by the mother.

(2.) Where a child is an inmate of an approved institution, the child shall, for the purposes of section 13 of the Act, be deemed to be maintained by that institution:

Provided that a child who is an inmate of a hospital shall be deemed to be maintained by the person who ordinarily maintains, or is deemed to maintain, the child.

(3.) Where the mother and father are both dead, or the child is not living with either of them, and the child is not deemed to be maintained by an approved institution, the child shall, for the purposes of section 13 of the Act, be deemed to be maintained by the guardian or other person having the custody, care and control of the child:

Provided that, where that guardian or other person is receiving payment from the mother or the father of the child, or from any other

person, towards the cost of the maintenance of the child, this sub-regulation shall not in any way affect the question by whom the child is maintained.

Investigation of claims.

8.—(1.) On receipt of a claim the Deputy Commissioner, or an officer thereto authorized by him, shall examine the claim together with any other relevant papers or documents. If it appears to him that the evidence on any material point is insufficient for a just determination of the claim, he shall cause to be made such further investigations as appear to him desirable.

(2.) The Deputy Commissioner or a Registrar may require any person, whom he believes to be in a position to do so, to furnish to him, in accordance with the approved form, a confidential report on such matters relating to any claimant for an endowment or any child as to him appear relevant for the purposes of the Act.

(3.) A person who has been required, in pursuance of the last preceding sub-regulation, to furnish a report shall not fail to furnish the report within a reasonable time.

Penalty: Twenty-five pounds.

When date of birth of child uncertain.

9. When the date of birth of a child cannot be exactly determined, the Deputy Commissioner may specify a date which is, in his opinion, as nearly as can be ascertained, the date of birth of the child, and that date shall be deemed, for the purposes of the Act and of these Regulations, to be the date of birth of the child.

Inquiries by Magistrates and Registrars.

10. The Commissioner or a Deputy Commissioner may authorize a Magistrate or a Registrar to conduct such inquiries in any case or class of case as he thinks fit, and to furnish a report on every such inquiry.

Determination of claims.

11. Upon completion of the investigation of the claim the Deputy Commissioner, or an officer thereto authorized by him pursuant to section 7 of the Act, shall determine the claim and, if the determination is in the claimant’s favour, determine the amount of the endowment or endowments, and fix the date as from which each endowment is payable.

Advice of determination.

12. The determination in relation to any claim shall be notified to the claimant in accordance with the approved form applicable to the case.

Part III.—Payment of Endowments.

Person to whom endowment payable.

13. Subject to section 22 of the Act and to these Regulations, in any case in which an endowment is granted to a person other than the mother of the child in respect of whom it is granted, the endowment shall be paid to the person to whom it is granted.

Methods of payment.

14.—(1.) An endowment may be paid, at the option of the endowee, either in cash at a post office or bank selected by him with the approval of the Deputy Commissioner or of an officer thereto authorized by him, at intervals of four weeks, or by credit to a bank account specified by the endowee at intervals of twelve weeks:

Provided that, in the case of an institution entitled to receive endowment, payment may be made at intervals of twelve weeks, or at such other intervals (not being less than four weeks) as are approved by the Commissioner.

(2.) Any instalment of endowment or portion thereof may, if the Deputy Commissioner thinks fit, be paid by cheque.

Endowment period.

15.—(1.) The periods in respect of which instalments of an endowment are payable shall be divided into periods of four weeks, which shall in every case commence on a Tuesday and end on a Monday. Every such period of four weeks shall be known as an “endowment period”. The first of such periods shall be deemed to have commenced on Tuesday, the first day of July, 1941, and shall end on Monday, the twenty-eighth day of July, 1941. The due date of the first instalment of endowments payable in cash at a post office or bank shall be the twenty-ninth day of July, 1941, on which date payment for the period from the first day of July, 1941, to the twenty-eighth day of July, 1941, inclusive, may be made.

(2.) The intervals at which an endowment payable to a bank account shall be payable shall each coincide with the end of an endowment period.

(3.) The Deputy Commissioner may make such adjustment as regards the first payment of an endowment or otherwise as is necessary to give effect to this regulation.

Payment of endowments granted to aboriginal natives.

16.—(1.) Where the Deputy Commissioner is satisfied that it is necessary, in order to ensure the proper application of an endowment granted to an aboriginal native of Australia, that the endowment shall be paid to some other person, the endowment may be paid to a person approved by the Deputy Commissioner.

(2.) Where endowments are granted in respect of aboriginal children living in a reserve, settlement or mission supervised by a Protector of Aborigines, the endowments may, subject to the approval of the Commissioner, be applied to the general maintenance, training and advancement of the children residing on that reserve, settlement or mission.

Endowment order book.

17.—(1.) On the grant of an endowment which is to be paid in cash at a post office or a bank, an endowment order book in accordance with the approved form, which shall contain orders bearing the dates on which instalments of endowment are payable, shall be forwarded by the Deputy Commissioner to the postmaster in charge of the post office, or bank manager in charge of the bank, at which the endowment is to be payable.

(2.) Subject to any directions of the Commissioner or the Deputy Commissioner, the postmaster or bank manager shall deliver the order book to the endowee after the endowee has signed in his presence the receipt form endorsed on the notice of grant of endowment, and has surrendered that notice to him.

(3.) From time to time, as occasion requires, the Deputy Commissioner may forward further endowment order books to the postmaster or bank manager, who shall issue them in accordance with the instructions of the Commissioner or the Deputy Commissioner.

(4.) Where, prior to the commencement of these Regulations, a book in a form approved by the Secretary, Department of Social Services, and purporting to be an endowment order book has been issued to any person, that book shall be deemed, for the purposes of these Regulations, to be an endowment order book in accordance with the approved form duly issued to that person in pursuance of these Regulations.

Order book to be returned when required by Deputy Commissioner.

18.—(1.) The Deputy Commissioner may, whenever he considers it necessary to do so, require an endowee, or a person in possession of an endowment order book, to return the endowment order book to him.

(2.) The endowee or other person so required in pursuance of the last preceding sub-regulation, or by any provision of these Regulations, to return an endowment order book shall not fail to return the book within a reasonable time.

Penalty: Twenty-five pounds.

Change of place of payment.

19. When an endowment is payable in cash at a post office or bank, if the endowee desires to change the place of payment of the endowment, he shall advise the Deputy Commissioner accordingly, and at the same time return his endowment order book. The Deputy Commissioner may thereupon, if he thinks fit, make the arrangements necessary for change of place of payment, and shall forward an order book to the postmaster or bank manager at the altered place of payment, who shall deliver the order book to the endowee in accordance with the instructions of the Commissioner or the Deputy Commissioner.

Loss of endowment order book.

20.—(1.) In the event of the loss of an endowment order book, the endowee may inform the postmaster or bank manager by whom the endowment is payable in writing of the loss, and the postmaster or bank manager shall thereupon not make any further payments under the order book unless he receives instructions to the contrary from the Deputy Commissioner.

(2.) In the event of the loss or destruction of an endowment order book, the endowee shall inform the Deputy Commissioner in writing of the loss or destruction, and may make application in writing for a substitute older book.

(3.) If the Deputy Commissioner is satisfied that the original order book has been lost or destroyed, he shall notify the postmaster or bank manager of the loss or destruction, and shall instruct him not to make any further payment under the original order book, and may, upon such conditions as he thinks fit, order the issue of a substituted order book, which shall be forwarded to the postmaster or bank manager, who shall deliver it to the endowee in accordance with the instructions of the Commissioner or the Deputy Commissioner.

(4.) Where an endowment order book has passed from the possession of the endowee into the possession of another person, and that person has obtained payment of any instalment of endowment which he was not entitled to receive, upon surrender of an order from that endowment order book at a bank or post office—

(a) before the endowee has informed the manager of the bank, or postmaster in charge of the post office, at which the endowment is payable, of the loss of the order book; or

(b) where the endowee has informed the Deputy Commissioner of the loss—before the Deputy Commissioner has notified that bank manager or postmaster of the loss of the order book,

the instalment of endowment represented by the order so presented by the unauthorized person shall not be payable, and, in the event of the issue of a substitute order book, the Deputy Commissioner may omit from that book the order corresponding to that order:

Provided that, if the amount received by the unauthorized person or any part thereof is recovered by the Commonwealth, the Deputy Commissioner may, if, having regard to the circumstances existing at the time of the recovery, he thinks fit, pay the amount so recovered or any part thereof to the person who, in his opinion, is best entitled to receive it.

Instructions for payment of endowment.

21. Subject to these Regulations, a postmaster or hank manager shall follow such instructions in regard to the payment or non-payment of endowment as are from time to time issued by the Commissioner or the Deputy Commissioner.

Suspension of endowment.

22. Where the Commissioner or the Deputy Commissioner is satisfied that it is expedient so to do, he may suspend payment of an endowment. On the removal of the suspension, the amount of the endowment accrued during the period of suspension may be paid to such person as the Commissioner or the Deputy Commissioner directs.

Order book to be produced and order surrendered.

23.—(1.) Subject to any directions of the Commissioner or the Deputy Commissioner, a postmaster or bank manager shall not pay an instalment of an endowment except upon production to him of the endowment order book and surrender to him of the relevant order bearing the signature of the endowee to the form of declaration and receipt printed thereon.

(2.) A postmaster or bank manager shall not pay any instalment of an endowment if he has reason to doubt that the person presenting the order is the endowee, or a person authorized by the endowee in pursuance of the next succeeding regulation to receive payment on his behalf.

Payment to agent of endowee.

24. Where an endowee is unable, through ill-health or mental or bodily infirmity, to collect personally any instalment of an endowment, he may, by completing the authority, and obtaining the certificate, endorsed on the order relating to that instalment, authorize some other person to collect the instalment on his behalf.

Orders to be presented within six months after due date.

25. Where an order contained in an endowment order book is not presented for payment within six months after the due date shown on the order, the instalment of endowment in respect of which the order was issued shall cease to be payable, unless the Commissioner or the Deputy Commissioner directs, by reason of special circumstances in any particular case, that payment be made after that period, in which event payment shall be made by cheque to the person who, in the opinion of the Deputy Commissioner, is best entitled to receive it.

Endowment paid to the credit of endowee’s bank account.

26. Upon the grant of an endowment which is to be payable by credit to a bank account, the Deputy Commissioner shall forward to the endowee a notice of grant of endowment in accordance with the approved form.

Alteration in amount of endowments.

27. Whenever the total amount payable to an endowee in respect of endowments is reduced or increased, the Deputy Commissioner shall forward a notice in accordance with the approved form to the endowee, and shall make the arrangements necessary for payment of the reduced or increased amount, as the case requires.

When grant deemed to be revoked.

28. Whenever a child in respect of whom an endowment is being paid, or whose maintenance is being taken into account for the purposes of endowment, ceases to be maintained, or deemed to be maintained, by

the person by whom that child was maintained, or deemed to be maintained, at the time of the grant of the endowment, or a child whose maintenance is being so taken into account dies before reaching the age of sixteen years, the grant of the endowment—

(a) in the case of a child in respect of whom endowment is being-paid—in respect of that child; and

(b) in the case of any other child whose maintenance is being so taken into account—in respect of the youngest child in respect of whom endowment is being paid to the endowee,

shall, as from the happening of that event, be deemed to be revoked, and any instalment of the endowment paid in respect of any period after that event may be recovered in pursuance of section 24 of the Act.

Cancellation of endowment.

29.—(1.) Where, in the opinion of the Deputy Commissioner, or of an officer thereto authorized by him, an endowment has ceased to be payable, he shall record the cancellation of the endowment and the date on which the endowment ceased to be payable.

(2.) Upon the cancellation of an endowment which is being paid at a post office or bank, the Deputy Commissioner shall—

(a) forward a notice in accordance with the approved form to the postmaster or bank manager, who shall thereupon cease to make any further payment in respect of that endowment; and

(b) forward a notice in accordance with the approved form to the endowee, who shall return, if he has not already done so, the endowment order book to the Deputy Commissioner forthwith.

Part IV.—Miscellaneous.

Strict compliance with forms not necessary.

30.—(1.) Strict compliance by the Commissioner, the Assistant Commissioner, a Deputy Commissioner, or an officer doing duty under the Act or these Regulations, with the forms contained in the Schedule to these Regulations, or with the approved forms, shall not be necessary, and substantial compliance therewith shall be sufficient.

(2.) Where a form substantially in accordance with a form contained in the Schedule to these Regulations has been or is made available by the Commissioner or a Deputy Commissioner, the form so made available may be used by any person for the same purposes as the prescribed form, and the form so used shall he deemed for all purposes to be in accordance with the prescribed form.

Declaration by officers.

31. The declaration to be made in pursuance of sub-section (1.) of section 12 of the Act, if the Minister so directs, by the Commissioner, the Assistant Commissioner, a Deputy Commissioner, a Registrar and other officers performing duties under the Act, shall be in accordance with Form 6.

Declarations.

32.—(1.) A declaration for the purposes of the Act or of these Regulations (other than a statutory declaration or a declaration referred to in sub-section (1.) of section 12 of the Act)—

(a) shall be in writing and shall declare that, to the best of the knowledge and belief of the declarant, the contents of the declaration are true and correct in every particular:

Provided that, in relation to any claim, the form of declaration set out in the prescribed claim form shall be the prescribed declaration for the purposes of section 16 of the Act; and

(b) shall be signed in the presence of, and attested by, one of the following persons:—

A minister of religion; a legally qualified medical practitioner; a bank manager; a railway station master; a railway road-master; a State school head-teacher; a member of the police force of the Commonwealth or of a State; a police, stipendiary or special magistrate of the Commonwealth or of a State; a justice of the peace; a barrister or solicitor; a notary public; an adult permanent officer of the Commonwealth Public Service; a non-official postmaster; a superintendent of an aboriginal mission or settlement; a commissioner for affidavits; a commissioner for declarations; a Registrar of Pensions; a councillor of any municipality or shire; a town clerk; a shire clerk; a member or secretary of a road board; a member of the Parliament of the Commonwealth or of any State.

(2.) A person shall not wilfully make any false or misleading statement in any declaration made in pursuance of the Act or of these Regulations.

Penalty: Twenty-five pounds or imprisonment for three months, or both.

Endowee to report change in circumstances.

33. Whenever—

(a) any child in respect of whom an endowment is being paid, or whose maintenance has been taken into account in the grant of an endowment—

(i) ceases to be maintained, or to be deemed to be maintained, by the person by whom the child was maintained, or was deemed to be maintained, at the time when the endowment was granted; or

(ii) dies before reaching the age of sixteen years;

(b) any child in respect of whom an endowment is being paid-

(i) ceases to be resident in Australia; or

(ii) if the child is a female child, marries; or

(c) an endowee—

(i) is about to leave Australia; or

(ii) marries,

the endowee shall forthwith report the fact to the Deputy Commissioner in the State in which the endowment is paid, and return to him any endowment order book held in respect of the endowment.

Penalty: Twenty-five pounds.

Death of endowee.

34. Upon the death of an endowee any person into whose possession an endowment order book in respect of the endowment comes shall forthwith report the fact of the death to the Deputy Commissioner, and return to him the endowment order book.

Penalty: Twenty-five pounds.

Dealings with endowments prohibited.

35.—(1.) A person shall not—

(a) advance money or goods, or offer or promise to advance money or goods, to any person on the security (whether sole or collateral) of an endowment or any instalment thereof; or

(b) purport to accept any transfer or assignment of, or any charge on, any endowment or instalment thereof.

Penalty: Twenty-five pounds or imprisonment for three months, or both.

(2.) An endowee shall not—

(a) obtain an advance of money or goods upon the security of an endowment, or any instalment thereof; or

(b) purport to transfer or assign or create any charge on an endowment or any instalment thereof.

Penalty: Twenty-five pounds or imprisonment for three months, or both.

Registration of births and deaths.

36.—(1.) Whenever the birth of a child (other than the first child of the mother) is reported to a Registrar of Births for registration, the Registrar of Births shall issue to the person reporting the birth a certificate of registration of birth in accordance with the approved form. In the event of a claim for an endowment being made in respect of that child, the certificate so issued shall be attached to the claim.

(2.) Whenever the death of any person is reported to a Registrar of Deaths for registration he shall inquire whether the deceased was in receipt of any endowment. If it appears to the Registrar that the deceased was in receipt of endowment, he shall forward to the Deputy Commissioner a notice in accordance with the approved form.

(3.) Whenever the death of any child under the age of sixteen years is reported to a Registrar of Deaths for registration, the Registrar shall forward to the Deputy Commissioner in the State in which the child died a notice in accordance with the approved form.

(4.) Any person now or hereafter authorized to record or register births and deaths under the law of a State or Territory of the Commonwealth shall be a Commonwealth Registrar for the purposes of the issue of certificates of registration of births and notices of deaths in pursuance of this regulation.

Consent to prosecutions.

37. An offence against these Regulations shall not be prosecuted without the written consent of the Minister.

THE SCHEDULE.

Form 1.

Reg. 4 (1.).

Commonwealth of Australia.

Child Endowment Act 1941.

CLAIM FOR CHILD ENDOWMENT.

I, [full name in block letters] of [full postal address] hereby claim endowment under the Child Endowment Act 1941 in respect of the children in excess of one, named hereunder I declare that to the best of my knowledge and belief the information given in reply to the questions hereinafter set out is true and correct in every particular.

The names, dates and places of birth, &c., of all children under sixteen years of age, now living, and maintained by me are as follows:—

Note.—If available, attach birth certificates or extracts of birth entries. These will be returned by post.

The Schedule—continued.

<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-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Full Names of Children in order of age, the eldest child being named first.</span></p></td><td colspan="4" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Date of Birth.</span></p></td><td rowspan="2" style="width:20.92%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Place of Birth. (Suburb or Town, and State, Territory or Country.</span></p></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"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Relationship of Claimant to each Child.</span></p></td></tr><tr style="height:1pt"><td style="width:19.94%; 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"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Surname.</span></p></td><td style="width:20.94%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Christian Names.</span></p></td><td style="width:8.18%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Day.</span></p></td><td style="width:8.32%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Month.</span></p></td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Year.</span></p></td></tr><tr style="height:1pt"><td style="width:19.94%; 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"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:6.3pt; line-height:normal"><span style="font-family:'Times New Roman', serif">1</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:6.3pt; line-height:normal"><span style="font-family:'Times New Roman', serif">2</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:6.3pt; line-height:normal"><span style="font-family:'Times New Roman', serif">3</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:6.3pt; line-height:normal"><span style="font-family:'Times New Roman', serif">4</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:6.3pt; line-height:normal"><span style="font-family:'Times New Roman', serif">5</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:6.3pt; line-height:normal"><span style="font-family:'Times New Roman', serif">6</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:6.3pt; line-height:normal"><span style="font-family:'Times New Roman', serif">7</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:6.3pt; line-height:normal"><span style="font-family:'Times New Roman', serif">8</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:6.3pt; line-height:normal"><span style="font-family:'Times New Roman', serif">9</span></p><p style="margin-left:4.5pt; margin-bottom:0pt; text-indent:2.7pt; line-height:normal"><span style="font-family:'Times New Roman', serif">10</span></p><p style="margin-left:4.5pt; margin-bottom:0pt; text-indent:2.7pt; line-height:normal"><span style="font-family:'Times New Roman', serif">11</span></p><p style="margin-left:4.5pt; margin-bottom:0pt; text-indent:2.7pt; line-height:normal"><span style="font-family:'Times New Roman', serif">12</span></p></td><td style="width:20.94%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.18%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.32%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:20.92%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><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:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Questions and Requests for Information.</span></p></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"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Answers.</span></p></td><td style="border-top:0.75pt solid #000000; vertical-align:top"></td></tr><tr style="height:37.35pt"><td colspan="5" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-36pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">1. (i) Have you or has your husband at any time previously applied for Child Endowment under this Act? (If so, give full particulars.)</span></p></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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">1. (i)</span></p></td><td style="vertical-align:top"></td></tr><tr style="height:38.2pt"><td colspan="5" style="border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(ii) Have you or has your husband at any time applied for State Family Endowment in New South Wales? (If so, give full particulars.)</span></p></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"><p style="margin-left:7.2pt; margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(ii)</span></p></td><td style="vertical-align:top"></td></tr><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:top"><p style="margin-left:28.8pt; margin-bottom:0pt; text-indent:-28.8pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">2. Are all the children named herein being maintained by you or your husband? (If this question cannot be answered “Yes” or “No” a full explanation should be made in a separate letter.)</span></p></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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">2.</span></p></td><td style="vertical-align:top"></td></tr><tr style="height:33.75pt"><td colspan="5" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">3. State—</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(i) The names of any of the children who are </span><span style="font-family:'Times New Roman', serif; font-style:italic">not </span><span style="font-family:'Times New Roman', serif">now living with you</span></p></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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">3. (i)</span></p></td><td style="vertical-align:top"></td></tr><tr style="height:24pt"><td colspan="5" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(ii) The reason for the absence of such children from home.</span></p></td><td colspan="3" style="border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:14.4pt; margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(ii)</span></p></td><td style="vertical-align:top"></td></tr><tr style="height:34.2pt"><td colspan="5" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(iii) The names and addresses of the persons (or institutions) with whom (or in which) such children are residing.</span></p></td><td colspan="3" style="border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:14.4pt; margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(iii)</span></p></td><td style="vertical-align:top"></td></tr><tr style="height:33.8pt"><td colspan="5" style="border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(iv) To what extent (if any) do you or your husband contribute towards the maintenance of such children?</span></p></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"><p style="margin-left:14.4pt; margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(iv)</span></p></td><td style="vertical-align:top"></td></tr><tr style="height:35.1pt"><td colspan="5" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-36pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">4. (i) What are the names of any children included in this claim who are </span><span style="font-family:'Times New Roman', serif; font-style:italic">not </span><span style="font-family:'Times New Roman', serif">children of yourself or your husband?</span></p></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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">4. (i)</span></p></td><td style="vertical-align:top"></td></tr><tr style="height:27.55pt"><td colspan="5" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(ii) State the full name of the father and the maiden name of the mother of each such child.</span></p></td><td colspan="3" style="border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:14.4pt; margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(ii)</span></p></td><td style="vertical-align:top"></td></tr><tr style="height:26.65pt"><td colspan="5" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(iii) (</span><span style="font-family:'Times New Roman', serif; font-style:italic">a</span><span style="font-family:'Times New Roman', serif">)</span><span style="font-family:'Times New Roman', serif; font-style:italic"> </span><span style="font-family:'Times New Roman', serif">What weekly payment do you receive towards the maintenance of each such child, and</span></p></td><td colspan="3" style="border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:14.4pt; margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(iii) (</span><span style="font-family:'Times New Roman', serif; font-style:italic">a</span><span style="font-family:'Times New Roman', serif">)</span></p></td><td style="vertical-align:top"></td></tr><tr style="height:12.45pt"><td colspan="5" style="border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:36pt; margin-bottom:3pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">b</span><span style="font-family:'Times New Roman', serif">)</span><span style="font-family:'Times New Roman', serif; font-style:italic"> </span><span style="font-family:'Times New Roman', serif">from what source?</span></p></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"><p style="margin-left:36pt; margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">b</span><span style="font-family:'Times New Roman', serif">)</span></p></td><td style="vertical-align:top"></td></tr><tr style="height:0pt"><td style="width:90.85pt"></td><td style="width:95.35pt"></td><td style="width:37.25pt"></td><td style="width:37.9pt"></td><td style="width:16.3pt"></td><td style="width:21.2pt"></td><td style="width:95.3pt"></td><td style="width:57.1pt"></td><td style="width:4.2pt"></td></tr></tbody></table>

The Schedule—continued.

<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:60.76%; 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"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Questions and Requests for Information.</span></p></td><td style="width:39.24%; 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"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Answers.</span></p></td></tr><tr style="height:63.55pt"><td rowspan="2" style="width:60.76%; 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"><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-36pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">5. (i) Have all the children named herein, who were </span><span style="font-family:'Times New Roman', serif; font-style:italic">not born in Australia, </span><span style="font-family:'Times New Roman', serif">been resident in Australia for the period of twelve months immediately preceding the date of this claim?</span></p><p style="margin-left:28.8pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">If not, state the facts.</span></p><p style="margin-left:14.4pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(ii) Is any such child the child of an alien father?</span></p></td><td style="width:39.24%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">5. (i)</span></p><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:12pt"><td style="width:39.24%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:14.4pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(ii)</span></p></td></tr><tr style="height:14.2pt"><td rowspan="5" style="width:60.76%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">6. State—</span></p><p style="margin-left:14.4pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(i) (</span><span style="font-family:'Times New Roman', serif; font-style:italic">a</span><span style="font-family:'Times New Roman', serif">)</span><span style="font-family:'Times New Roman', serif; font-style:italic"> </span><span style="font-family:'Times New Roman', serif">Date and (</span><span style="font-family:'Times New Roman', serif; font-style:italic">b</span><span style="font-family:'Times New Roman', serif">) place of your birth.</span></p><p style="margin-left:14.4pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(ii) Your full maiden name.</span></p><p style="margin-left:14.4pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(iii) (</span><span style="font-family:'Times New Roman', serif; font-style:italic">a</span><span style="font-family:'Times New Roman', serif">)</span><span style="font-family:'Times New Roman', serif; font-style:italic"> </span><span style="font-family:'Times New Roman', serif">Date and (</span><span style="font-family:'Times New Roman', serif; font-style:italic">b</span><span style="font-family:'Times New Roman', serif">) place of your marriage.</span></p><p style="margin-left:14.4pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(iv) Full name of your husband.</span></p></td><td style="width:39.24%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">6.</span></p></td></tr><tr style="height:13.35pt"><td style="width:39.24%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:14.4pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(i) (</span><span style="font-family:'Times New Roman', serif; font-style:italic">a</span><span style="font-family:'Times New Roman', serif">)</span><span style="font-family:'Times New Roman', serif; font-style:italic"> </span><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">b</span><span style="font-family:'Times New Roman', serif">)</span></p></td></tr><tr style="height:12.9pt"><td style="width:39.24%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:14.4pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(ii)</span></p></td></tr><tr style="height:15.55pt"><td style="width:39.24%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:14.4pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(iii) (</span><span style="font-family:'Times New Roman', serif; font-style:italic">a</span><span style="font-family:'Times New Roman', serif">)</span><span style="font-family:'Times New Roman', serif; font-style:italic"> </span><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">b</span><span style="font-family:'Times New Roman', serif">)</span></p></td></tr><tr style="height:9.35pt"><td style="width:39.24%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:14.4pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(iv)</span></p></td></tr><tr style="height:11.55pt"><td rowspan="4" style="width:60.76%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">7. (i) Are you a natural born British subject?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(ii) Is (or was) your husband a natural born British subject?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(iii) If your husband is (or was) not a natural born British subject, has he been (or was he) naturalized?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(iv) If so, state date and place of naturalization.</span></p></td><td style="width:39.24%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">7. (i)</span></p></td></tr><tr style="height:13.75pt"><td style="width:39.24%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(ii)</span></p></td></tr><tr style="height:13.35pt"><td style="width:39.24%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(iii)</span></p></td></tr><tr style="height:36.45pt"><td style="width:39.24%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom"><p style="margin-left:7.2pt; margin-bottom:0pt; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(iv)</span></p></td></tr><tr style="height:1pt"><td style="width:60.76%; 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"><p style="margin-left:28.8pt; margin-bottom:0pt; text-indent:-28.8pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">8. If you were not born in Australia has your usual place of residence for the period of twelve months immediately preceding the date of this claim been in Australia?</span></p><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">If not, state the facts.</span></p></td><td style="width:39.24%; 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"><p style="margin-bottom:0pt; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">8.</span></p></td></tr><tr style="height:12pt"><td rowspan="4" style="width:60.76%; 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"><p style="margin-left:28.8pt; margin-bottom:0pt; text-indent:-28.8pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">9. (i) Are you an aboriginal native of Australia? </span><span style="font-family:'Times New Roman', serif; font-variant:small-caps">(Note</span><span style="font-family:'Times New Roman', serif">.—An “aboriginal native” is a person whose parentage is predominantly aboriginal.)</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(ii) Are any of the children named herein aboriginal natives of Australia?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(iii) Is any contribution made towards their support by the Commonwealth or a State?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(If so, give particulars.)</span></p></td><td style="width:39.24%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">9. (i)</span></p></td></tr><tr style="height:11.1pt"><td style="width:39.24%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:20.9pt"><td style="width:39.24%; 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"><p style="margin-left:7.2pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(ii)</span></p></td></tr><tr style="height:28.9pt"><td style="width:39.24%; 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"><p style="margin-left:7.2pt; margin-bottom:0pt; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(iii)</span></p></td></tr></tbody></table>

If your claim for Child Endowment is granted, you may choose one of two methods of receiving payment. They are—

(1) In cash at a bank or post office, each 28 days.

(2) By payment every twelve weeks to the credit of an account with a bank.

If you choose method (1), name both the post office and also the branch of the bank in the order you prefer, on the following two lines—

.......................................................................................................................................................

.......................................................................................................................................................

If you choose method (2), state the bank and branch, also the title or number of your account—

Bank Branch

Title of Account Account Number

View image in the official sourceEvery question should be fully answered before the claim is signed.

† The person before whom this declaration is made to sign here and add the title by which he takes the declaration, such as “Minister of Religion”, &c.

‡ The declaration may be made before any of the following persons:— A minister of religion; a legally qualified medical practitioner; a bank manager; a railway station-master; a railway road-master; a State school head-teacher; a member of the police force of the Commonwealth or of a State: a police, stipendiary or special magistrate of the Commonwealth or of a State; a justice of the peace; a barrister or solicitor: a notary public: an adult permanent officer of the Commonwealth Public Service; a non-official postmaster; a superintendent of an aboriginal mission or settlement; a commissioner for affidavits: a commissioner for declarations; a Registrar of Pensions; a councillor of any municipality or shire; a town clerk; a shire clerk; a member or secretary of a road board; a member of the Parliament of the Commonwealth or of any State.

The Schedule—continued.

Declaration by Person other than a Relative who has known Claimant

for at least Twelve Months.

I, [name of declarant] [address and occupation of declarant] do solemnly and sincerely declare that the information given hereunder in respect of the above-named claimant is based upon my own knowledge and observation and not upon information supplied by any other person.

<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"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Please read each question carefully before answering.</span></p></td></tr><tr style="height:1pt"><td style="width:62%; 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"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Questions.</span></p></td><td style="width:38%; 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"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Answers.</span></p></td></tr><tr style="height:1pt"><td style="width:62%; 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"><p style="margin-left:28.8pt; margin-bottom:0pt; text-indent:-28.8pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">1. </span><span style="font-family:'Times New Roman', serif">For what period and in what places have you been well acquainted with the claimant?</span></p></td><td style="width:38%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="width:36pt; display:inline-block"></span><span style="width:36pt; display:inline-block"></span><span style="font-family:'Times New Roman', serif">years at</span></p></td></tr><tr style="height:1pt"><td style="width:62%; 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"><p style="margin-left:28.8pt; margin-bottom:0pt; text-indent:-28.8pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">2.</span><span style="font-family:'Times New Roman', serif; font-style:italic"> </span><span style="font-family:'Times New Roman', serif">Has the claimant’s usual place of residence been in Australia for the twelve months immediately preceding the date of this claim?</span></p></td><td style="width:38%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:62%; 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"><p style="margin-left:28.8pt; margin-bottom:0pt; text-indent:-28.8pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">3. </span><span style="font-family:'Times New Roman', serif">(i) Are all the children under sixteen years of age mentioned in this claim living with or being maintained by claimant?</span></p><p style="margin-left:28.8pt; margin-bottom:0pt; text-indent:-14.4pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(ii) State names of any of the children who are </span><span style="font-family:'Times New Roman', serif; font-style:italic">not </span><span style="font-family:'Times New Roman', serif">living with or being maintained by claimant.</span></p></td><td style="width:38%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(i) (ii)</span></p></td></tr><tr style="height:1pt"><td style="width:62%; 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"><p style="margin-left:28.8pt; margin-bottom:0pt; text-indent:-28.8pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">4. </span><span style="font-family:'Times New Roman', serif">Have all the children been resident in Australia for the twelve months immediately preceding the date of this claim? If not, state the facts.</span></p></td><td style="width:38%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>

Signature of Declarant.

Date

Form 2. Reg. 4 (1.).

Commonwealth of Australia.

Child Endowment Act 1941.

ADDITIONAL CLAIM.

In Respect of Child of Children Born or Admitted to the Family after the Date of Original Claim for Child Endowment.

I, [full name in block letters] of [full postal address] being the recipient of Endowment number [here insert number shown on face of Order book immediately under name of payee] hereby claim additional endowment under the Child Endowment Act 1941 in respect of the child (or children) named hereunder who has (or have) been born or admitted to my family since the date of last claim.

<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-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Full Name of Additional Child (or Children).</span></p></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Date of Birth.</span></p></td><td rowspan="2" style="width:20.94%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Place of Birth. (Suburb or Town, and State, Territory or Country.)</span></p></td><td rowspan="2" style="width:13.6%; 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"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Relationship of Claimant to each Child.</span></p></td></tr><tr style="height:1pt"><td style="width:19.66%; 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"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Surname.</span></p></td><td style="width:21.1%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Christian Names.</span></p></td><td style="width:8.1%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Day.</span></p></td><td style="width:8.34%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Month.</span></p></td><td style="width:8.26%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Year.</span></p></td></tr><tr style="height:38.85pt"><td style="width:19.66%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:21.1%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.1%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.34%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.26%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:20.94%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:13.6%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>

The Schedule—continued.

I declare that to the best of my knowledge and belief the information given above and in reply to the following questions is true and correct in every particular:—

I attach certificate of registration of birth obtained from the Registrar of Births.

* The person before whom this declaration is made to sign here and add the title by which he takes the declaration, such as “Minister of Religion”, &c.

† The declaration may be made before any of the following persons:—A minister of religion; a legally qualified medical practitioner; a bank manager; a railway station-master; a railway road-master; a State school head-teacher; a member of the police force of the Commonwealth or of a State; a police, stipendiary or special magistrate of the Commonwealth or of a State; a justice of the peace; a barrister or solicitor; a notary public; an adult permanent officer of the Commonwealth Public Service; a non-official postmaster; a superintendent of an aboriginal mission or settlement; a commissioner for affidavits; a commissioner for declarations; a Registrar of Pensions; a councillor of any municipality or shire; a town clerk; a shire clerk; a member or secretary of a road board; a member of the Parliament of the Commonwealth or of any State.

Form 3.

Reg. 6 (1.).

Commonwealth of Australia.

Child Endowment Act 1941.

APPLICATION BY INSTITUTION OR ORGANIZATION FOR APPROVAL OF MINISTER.

Attention is directed to the following definition of “institution” in Section 4 of the Act:—

“Institution” means a charitable institution or organization (not being a charitable institution or organization maintained by the Commonwealth or a State or mainly dependent upon financial assistance from the Commonwealth or a State) approved by the Minister.

I, [full name in block letters] of [full postal address] being the [insert “Manager”, “Superintendent” or other title] of the [full name of institution] situated at [full address of institution] hereby apply for the Minister’s approval of the above-named institution (or organization) as an institution for the purposes of the Child Endowment Act 1941.

I declare that, to the best of my knowledge and belief, the information given in reply to the questions and requests hereinafter set out is true and correct in every particular.

The Schedule—continued.

<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:61.56%; 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"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Questions and Requests for Information.</span></p></td><td style="width:38.44%; 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"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Answers.</span></p></td></tr><tr style="height:1pt"><td style="width:61.56%; 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"><p style="margin-left:28.8pt; margin-bottom:0pt; text-indent:-28.8pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">1. What was the total gross income of the institution from all sources during the twelve months ended on 30th June last?</span></p></td><td style="width:38.44%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">£</span></p></td></tr><tr style="height:15.55pt"><td rowspan="2" style="width:61.56%; 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"><p style="margin-left:28.8pt; margin-bottom:0pt; text-indent:-28.8pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">2. What amount of financial assistance, if any, was received from (</span><span style="font-family:'Times New Roman', serif; font-style:italic">a</span><span style="font-family:'Times New Roman', serif">)</span><span style="font-family:'Times New Roman', serif; font-style:italic"> </span><span style="font-family:'Times New Roman', serif">the Commonwealth, or (</span><span style="font-family:'Times New Roman', serif; font-style:italic">b</span><span style="font-family:'Times New Roman', serif">) a State, during the same period (included in the amount shown in answer to the previous question)?</span></p></td><td style="width:38.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">a</span><span style="font-family:'Times New Roman', serif">)</span><span style="font-family:'Times New Roman', serif; font-style:italic"> </span><span style="font-family:'Times New Roman', serif">Commonwealth</span><span style="width:22.15pt; display:inline-block"> </span><span style="font-family:'Times New Roman', serif">£</span></p></td></tr><tr style="height:34.65pt"><td style="width:38.44%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-top:5pt; margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">b</span><span style="font-family:'Times New Roman', serif">) State</span><span style="width:69.03pt; display:inline-block"> </span><span style="font-family:'Times New Roman', serif">£</span></p></td></tr><tr style="height:1pt"><td style="width:61.56%; 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"><p style="margin-left:28.8pt; margin-bottom:0pt; text-indent:-28.8pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">3. What is the estimated total gross income of the institution from all sources during the twelve months ending on 30th June next?</span></p></td><td style="width:38.44%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">£</span></p></td></tr><tr style="height:14.65pt"><td rowspan="2" style="width:61.56%; 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"><p style="margin-left:28.8pt; margin-bottom:0pt; text-indent:-28.8pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">4. What is the estimated amount of financial assistance, if any, to be received from (</span><span style="font-family:'Times New Roman', serif; font-style:italic">a</span><span style="font-family:'Times New Roman', serif">)</span><span style="font-family:'Times New Roman', serif; font-style:italic"> </span><span style="font-family:'Times New Roman', serif">the Commonwealth, or (</span><span style="font-family:'Times New Roman', serif; font-style:italic">b</span><span style="font-family:'Times New Roman', serif">) a State, during the same period (included in the amount shown in answer to the previous question)?</span></p></td><td style="width:38.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">a</span><span style="font-family:'Times New Roman', serif">)</span><span style="font-family:'Times New Roman', serif; font-style:italic"> </span><span style="font-family:'Times New Roman', serif">Commonwealth</span><span style="width:22.15pt; display:inline-block"> </span><span style="font-family:'Times New Roman', serif">£</span></p></td></tr><tr style="height:36pt"><td style="width:38.44%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">b</span><span style="font-family:'Times New Roman', serif">) State</span><span style="width:69.03pt; display:inline-block"> </span><span style="font-family:'Times New Roman', serif">£</span></p></td></tr><tr style="height:1pt"><td style="width:61.56%; 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"><p style="margin-left:28.8pt; margin-bottom:0pt; text-indent:-28.8pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">5. What is the total number of children under sixteen years of age at present resident in the institution?</span></p></td><td style="width:38.44%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>

View image in the official sourceNote.—Please attach a copy of the Constitution or Objects of the Institution (or Organization) also a copy of the last annual statement of receipts and expenditure of the Institution. Any explanatory comments on the matters appearing in such statements should be furnished on the back hereof.

* The person before whom this declaration is made to sign here and add the title by which he takes the declaration, such as “Justice of the Peace”, &c.

† The declaration may be made before any of the following persons:—A minister of religion; a legally qualified medical practitioner; a bank manager; a railway station-master; a railway road-master; a State school head-teacher; a member of the police force of the Commonwealth or of a State; a police, stipendiary or special magistrate of the Commonwealth or of a State; a justice of the peace; a barrister or solicitor; a notary public; an adult permanent officer of the Commonwealth Public Service; a non-official postmaster; a superintendent of an aboriginal mission or settlement; a commissioner for affidavits; a commissioner for declarations; a Registrar of Pensions; a councillor of any municipality or shire; a town clerk; a shire clerk; a member or secretary of a road board; a member of the Parliament of the Commonwealth or of any State.

Form 4. Reg. 6 (3.).

Commonwealth of Australia.

Child Endowment Act 1941.

CLAIM FOR CHILD ENDOWMENT IN RESPECT OF INMATES OF AN INSTITUTION.

I, [full name in block letters] of [full postal address] being the* of the [full name of institution] situated at [full address of institution] hereby claim, on behalf of the said institution, endowment under the Child Endowment Act 1941 in respect of the children named in the Schedule herein, all of whom are under the age of sixteen years and are being maintained in and by the abovenamed institution.

I declare that, to the best of my knowledge and belief, the information given in reply to the questions and requests hereinafter set out is true and correct in every particular.

* Insert “Manager”, “Superintendent” or other title.

The Schedule—continued.

SCHEDULE OF CHILDREN IN RESPECT OF WHOM ENDOWMENT IS CLAIMED.

<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:5.38%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">* Full Name of Child.</span></p></td><td colspan="3" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Date of Birth,</span></p></td><td rowspan="2" style="width:8.1%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Place of Birth.</span></p></td><td rowspan="2" style="width:10.98%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Father’s Full Name.</span></p></td><td rowspan="2" style="width:10.08%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Mother’s Maiden Surname.</span></p></td><td rowspan="2" style="width:11.92%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Mother’s Christian Names.</span></p></td><td rowspan="2" style="width:12.88%; 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:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Additional information. (See Questions 1 and 4 on the back of this form.)</span></p></td></tr><tr style="height:1pt"><td style="width:5.38%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">No.</span></p></td><td style="width:9.14%; 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"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Surname.</span></p></td><td style="width:12.6%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Christian Names.</span></p></td><td style="width:4.8%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Day.</span></p></td><td style="width:7.92%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Month.</span></p></td><td style="width:6.2%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Year.</span></p></td></tr><tr style="height:1pt"><td style="width:5.38%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">1</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">2</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">3</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">4</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">5</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">6</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">7</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">8</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">9</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">10</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">11</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">12</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">13</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">14</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">15</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">16</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">17</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">18</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">19</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">20</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">21</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">22</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">23</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">24</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">25</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">26</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">27</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">28</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">29</span></p><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">30</span></p></td><td style="width:9.14%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.6%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.8%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.92%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.2%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.1%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.98%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.08%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.92%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.88%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>

* The names should be shown in order of age—eldest first, and so on. The Christian names of each child should be shown in their correct order If available, attach birth certificates, or extracts of birth entries. These will be returned by post.

The Schedule—continued.

<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-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Questions and Requests for Information.</span></p></td><td style="width:39.1%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Answers.</span></p></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"><p style="margin-left:28.8pt; margin-bottom:0pt; text-indent:-28.8pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">4. Are any of the children named herein aboriginal natives of Australia?</span></p><p style="margin-left:28.8pt; margin-bottom:0pt; text-indent:14.4pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">(Note</span><span style="font-family:'Times New Roman', serif">.—Any person whose parentage is predominantly aboriginal is deemed to be an aboriginal native.)</span></p><p style="margin-left:28.8pt; margin-bottom:3pt; text-indent:14.4pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(If so, show in the last column of the Schedule, opposite the name of the child, the weekly amount now being received from the Commonwealth or State towards the support of the child.)</span></p></td><td style="width:39.1%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:52.8%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:3pt; margin-left:36pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Declared at</span></p><p style="margin-left:43.2pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">the</span><span style="width:16.58pt; display:inline-block"> </span><span style="width:36pt; display:inline-block"></span><span style="font-family:'Times New Roman', serif">day of</span><span style="width:10.73pt; display:inline-block"> </span><span style="width:36pt; display:inline-block"></span><span style="width:36pt; display:inline-block"></span><span style="font-family:'Times New Roman', serif">19</span></p><p style="margin-left:50.4pt; margin-bottom:3pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Before me*†</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:middle"><div style="width:100%; height:1pt; display:inline-block; overflow:visible"><p style="margin-right:14.4pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="height:0pt; text-align:left; display:block; position:relative; z-index:3"><img src="image.006.png" width="8" height="44" alt="" style="margin-top:0.76pt; margin-left:2.88pt; position:absolute"></span><span style="font-family:'Times New Roman', serif; font-style:italic">Signature of Claimant.</span></p></div></td></tr><tr style="height:0pt"><td style="width:240.45pt"></td><td style="width:36.9pt"></td><td style="width:178.1pt"></td></tr></tbody></table>

* The person before whom this declaration is made to sign here and add the title by which he takes the declaration, such as “Justice of the Peace”, &c.

† The declaration may be made before any of the following persons:—A minister of religion; a legally qualified medical practitioner; a bank manager; a railway station-master; a railway road-master; a State school head-teacher; a member of the police force of the Commonwealth or of a State; a police, stipendiary or special magistrate of the Commonwealth or of a State; a justice of the peace; a barrister or solicitor; a notary public; an adult permanent officer of the Commonwealth Public Service; a non-official postmaster; a superintendent of an aboriginal mission or settlement; a commissioner for affidavits; a commissioner for declarations; a Registrar of Pensions; a councillor of any municipality or shire; a town clerk; a shire clerk; a member or secretary of a road board; a member of the Parliament of the Commonwealth or of any State.

Form 5.

Reg. 6 (3.).

Commonwealth of Australia.

Child Endowment Act 1941.

ADDITIONAL CLAIM BY INSTITUTION IN RESPECT OF CHILD OR CHILDREN ADMITTED TO THE INSTITUTION SUBSEQUENT TO THE DATE OF ORIGINAL CLAIM FOR CHILD ENDOWMENT.

I, [full name in block letters] of [full postal address] being the‡

of the [full name of institution] hereby claim, on behalf of the said institution, additional endowment under the Child Endowment Act 1941 in respect of the child (or children) named hereunder who has (or have) been admitted to the abovenamed institution since the date of the last claim, and particulars of whom are included in schedule of Admissions and Discharges for the week ended

<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-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Full Name of Child (or Children).</span></p></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:middle"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Date of Admission.</span></p></td></tr><tr style="height:1pt"><td style="width:20.94%; 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"><p style="margin-top:3pt; margin-bottom:3pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">Surname.</span></p></td><td style="width:33.8%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Christian Names.</span></p></td><td style="width:18.26%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Day.</span></p></td><td style="width:13.96%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Month.</span></p></td><td style="width:13.02%; 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"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Year.</span></p></td></tr><tr style="height:80.25pt"><td style="width:20.94%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:33.8%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:18.26%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:13.96%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:13.02%; 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"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>

‡ Insert “Manager”, “Superintendent” or other title.

I declare that to the best of my knowledge and belief the information given above is true and correct in every particular:—

* The person before whom this declaration is made to sign here and add the title by which he takes the declaration, such as “Justice of the Peace”, &c.

† The declaration may be made before any of the following persons:—A minister of religion; a legally qualified medical practitioner; a bank manager; a railway station-master; a railway road-master; a State school head-teacher; a member of the police force of the Commonwealth or of a State; a police, stipendiary or special magistrate of the Commonwealth or of a State; a justice of the peace; a barrister or solicitor; a notary public; an adult permanent officer of the Commonwealth Public Service; a non-official postmaster; a superintendent of an aboriginal mission or settlement; a commissioner for affidavits: a commissioner for declarations; a Registrar of Pensions; a councillor of any municipality or shire; a town clerk; a shire clerk; a member or secretary of a road board; a member of the Parliament of the Commonwealth or of any State.

Form 6.

Reg. 31.

Commonwealth of Australia.

Child Endowment Act 1941.

DECLARATION BY OFFICERS.

I, [name in full] of [residence] do solemnly and sincerely declare that—

(1) I have been appointed to the office of under the Child Endowment Act 1941.

(2) I will not make a record of, or divulge or communicate to any unauthorized person, any information acquired by me in the performance or exercise of my duties, powers or functions, respecting the affairs of any other person.

(3) I shall at all times well and faithfully to the best of my ability exercise, discharge, and fulfil the powers, duties, functions, and obligations of or appertaining to my said office.

By Authority: L. F. Johnston, Commonwealth Government Printer, Canberra.