Old-age Pensions Regulations 1909 (Provisional)

STATUTORY RULES.

1909 No. 47.

PROVISIONAL REGULATIONS UNDER THE INVALID AND OLD-AGE PENSIONS ACT 1908.

I, THE GOVERNOR-GENERAL in and over the Commonwealth of Australia, acting with the advice of the Federal Executive Council, hereby certify that, on account of urgency, the following Regulations under the Invalid and Old-age Pensions Act 1908 should come into immediate operation, and make the Regulations to come into operation forthwith as Provisional Regulations.

Dated this fourteenth day of May, One thousand nine hundred and nine.

DUDLEY,

Governor-Genera1.

By His Excellency’s Command,

W. M. HUGHES,

For Treasurer.

———

OLD-AGE PENSIONS REGULATIONS.

1. These Regulations may be cited as the Old-age Pensions Regulations 1909.

2. The declaration to be made by the Commissioner, Deputy Commissioners, and Registrars, under section 13 of the Act, shall be in accordance with Form 1. The declarations made by Registrars shall be forwarded to the Deputy Commissioner.

3. Every person claiming a pension shall deliver or send to the Registrar of the district in which he resides:—

(1) A pension claim in accordance with Form 2.

(2) Declarations, in accordance with Form 3, made by two persons acquainted with the claimant.

(3) Identification card in accordance with Form 4.

All officers in the Public Service of the Commonwealth shall, so far as is consistent with their duties, give all reasonable assistance to claimants in the preparation of pension claims.
(1) Declarations under the Act or these Regulations may be made before any of the following persons:—

A postmaster or postmistress, or person in charge of a post-office, a police, stipendiary or special magistrate of the Commonwealth or a State, a justice of the peace, a barrister or solicitor, a State school head-teacher, an officer of the Department of Trade and Customs, a member of the police force of the Commonwealth or of a State, a legally qualified medical practitioner, a notary public, a commissioner for affidavits, a registrar, a minister of religion, or an officer of the Commonwealth Department of the Treasury.

C.6232.—Price 8d.

(2) If any person wilfully makes any false statement in any declaration provided for under these Regulations he shall, if subject to no higher penalty under the Act, be liable to a penalty not exceeding One hundred pounds.

6. Unless otherwise directed by the Commissioner, every Registrar shall keep a record, in accordance with Form 5, of pension claims received by him.

7. As soon as possible after the receipt of a claim the Registrar shall request the police to make a report in accordance with Form 6.

8. On receipt from the police of a report in accordance with Form 6, the Registrar shall examine the claim together with the police report, and other papers in the case. If it appears to him that on any material point the evidence is insufficient for a just determination of the claim, he shall, in accordance with Form 7 or 8 or 9, or in ordinary letter-form, cause to be made such further investigations as appear to him desirable. Provided that in any case in which it appears that no documentary evidence as to age is in the possession of the claimant, it shall not be necessary for the Registrar to make further inquiries on the point if he believes that the age qualification will be obvious when the claimant appears before the Magistrate.

9. The Registrar shall ascertain the time and place at which a Magistrate will investigate the claim, and shall send to the claimant and to the Magistrate notices in accordance with Forms 10 and 11 respectively. Notice in accordance with Form 11 need not be sent if the Registrar is aware that the Magistrate does not require such notice. If the Registrar is aware that, by reason of physical disability, or the distance of the claimant’s residence from the place of investigation, or other sufficient cause, the claimant cannot reasonably be expected to attend, the notice in accordance with Form 10 need not be sent, and in that case a note shall be made on Form 12. If the Registrar will not be in attendance at the place of investigation when claims are to be investigated by the Magistrate, he shall take steps to place the claims and all the papers connected therewith in the hands of the Magistrate before the time for the investigation.

10. If for any reason no Magistrate can investigate any claim within a reasonable time the Registrar shall inform the Deputy Commissioner. The information shall be conveyed to the Deputy Commissioner by telegraph if the Registrar deems it advisable.

11. The Registrar shall refer the claim to the Magistrate in accordance with Form 12.

12. In calculating the maximum pension which may be recommended, there shall be deducted from fifty-two pounds the amount of claimant’s income, including income from accumulated property, and from the balance remaining, or from twenty-six pounds, whichever is lower in amount, there shall be deducted an amount, calculated as directed in section 24 sub-section 2 of the Act, in respect of the net capital value of the claimant’s accumulated property.

13. The Magistrate shall make his recommendation in accordance with Form 13 (indorsed on Form 2), and, in any case in which he postpones an investigation, he shall, in accordance with Form 14, record as proved all matters as to which he is satisfied.

14. (1) When a Magistrate has recommended the admission or rejection of a pension claim, he shall forward to the Registrar all the papers in the case together with the notes of evidence taken at the investigation of the case.

(2) Subject to paragraph (3) of this regulation, the Registrar shall send the papers and the evidence received from the Magistrate and the identification card to the Deputy Commissioner.

(3) In cases where the Magistrate’s recommendation for the rejection of the claim shows that no material point has been disproved, but that some material points have not been proved or have not been sufficiently proved, the Registrar shall retain the papers for one month, or until he has received from the claimant a notice in accordance with Form 15 of intention to adduce fresh evidence, in which case the matter shall be dealt with as prescribed by section 32 of the Act. If no notice in accordance with Form 15 has been received, or if the notice has been received and the case has been dealt with as directed, the Registrar shall forthwith forward the papers, evidence, and identification card to the Deputy Commissioner.

15. A claimant may, within thirty days after the date of the Magistrate’s recommendation for the rejection of his claim, appeal to the Minister in respect of matters found by the Magistrate to be disproved. The appeal shall be in accordance with Form 16.

Any request of the Commissioner or a Deputy Commissioner for a re-hearing of a pension claim, previously admitted or rejected, shall be addressed to a Registrar, who shall, in accordance with Forms 10 and 11, notify the claimant or pensioner and the Magistrate. For this purpose verbal alterations in those forms may be made. In connexion with the re-hearing the Registrar shall have the same powers as in connexion with the original claim.

17. The determination of the Commissioner or Deputy Commissioner in relation to any claim shall be communicated to the claimant in accordance with Form 17 or 18.

18. The pension certificate in accordance with Form 19 and the identification card in accordance with Form 4 shall be forwarded to a postmaster or other officer, who shall, subject to the following provisions, retain the identification card, and deliver the certificate to the pensioner. Before delivery of the pension certificate the postmaster or other officer shall require the pensioner to sign his name thereon, or, if he cannot write, to make his mark thereon. Such mark in every case shall be witnessed by the postmaster or other officer. Provided that, if the signature of pensioner then made is not the same as that on the identification card, or, in the case of a marksman, if the pensioner cannot repeat the information shown on the identification card, the postmaster or other officer shall not deliver the pension certificate unless specially directed so to do by the Deputy Commissioner.

19. The possession of any identification card shall be regarded as the authority of the postmaster or other officer to make payment of the pension thereon described as it falls due. Provided that, as regards the method of accounting, he shall follow such instructions as are from time to time issued by the Commissioner. Provided also that, if so instructed by the Commissioner or Deputy Commissioner, the postmaster or other officer shall not make payment of the pension.

20. If a pensioner loses his pension certificate, he may make application, in accordance with Form 20, to the Deputy Commissioner for a duplicate certificate; and if the Deputy Commissioner issues a duplicate, he shall notify the postmaster or other officer who is authorized to pay the pension. The duplicate shall bear across its face the word “duplicate,” together with a note in writing, under the hand of the Deputy Commissioner, stating the date on which the duplicate is issued.

21. If a pensioner desires to permanently leave the place at which he resides to reside in another place, he may make application in Form 21 to the postmaster or other officer authorized to pay his pension, and if such postmaster or other officer is satisfied that the request is a reasonable one, he shall make a note on the pensioner’s identification card and on the pension certificate, as follows:—“Payment to be made in future at ” Also he shall make a note on the identification card as follows:—“Payment made at this office up to .” To such notes he shall add his signature, and shall forward the identification card by post to the office to which payment is to be transferred. After the receipt of the identification card at that office, the postmaster or other officer there shall, subject to any instructions issued by the Commissioner or Deputy Commissioner, make payment of the pension as it falls due.

22. No pensioner shall be allowed to change the office of payment more than twice in any calendar year without the permission of the Deputy Commissioner.

23. The application in accordance with Form 21 shall, if approved by the postmaster or other officer be transmitted to the Deputy Commissioner.

24. The receipt given by a pensioner shall be in accordance with Form 22. If the payee is other than the pensioner, the payee shall give a receipt in accordance with Form 23.

25. No payment shall be made to any person other than the pensioner unless such person is the holder of a warrant under sections 43 or 44 of the Act, and certifies that he has seen the pensioner within the preceding three months.

26. In the event of any instalment being forfeited under section 40 of the Act, the pensioner, or other person the holder of a warrant, may make application, in accordance with Form 24, to the Registrar of the district in which the pension is payable, for payment of the forfeited instalment. The waiver of forfeiture shall be in accordance with Form 25, and shall not be granted in any case in which the application has not been made within sixty days after the expiration of the period during which the instalment was payable.

27. Any undrawn instalment of a pension due at the date of a pensioner’s decease, if applied for within twenty-one days after such decease, may be paid to such person as in the opinion of the Deputy Commissioner has an equitable claim thereto. Provided that no payment shall be made of any amount of pension accrued after the last pay-day preceding the pensioner’s decease.

28. With respect to warrants under sections 43 and 44 of the Act, authorizing payment of instalments of a pension to any benevolent or charitable society, minister of religion, justice of the peace, or other person, for the benefit of the pensioner, the following provisions shall apply:—

(1) The application for the warrant shall be in accordance with Form 26.

(2) The applicant may be the pensioner, the proposed payee, or any other reputable person competent to speak to the facts.

(3) The application shall bear the proposed payee’s consent in writing, and shall disclose the names of pensioners on whose behalf the proposed payee already holds warrants.

(4) The warrant shall be in accordance with Form 27, and shall continue in force until a date to be therein named or until otherwise ordered by the Deputy Commissioner.

29. Whenever any instalment is payable under a warrant or waiver of forfeiture, the pension certificate shall be produced, at the time of payment, by the pensioner or other payee, together with the warrant or waiver.

30. When any pensioner enters any Benevolent Asylum, Hospital, or Asylum for the Insane, the Secretary or other officer of the Benevolent Asylum, Hospital, or Asylum for the Insane, should forthwith send a notification in accordance with Form 28 to the Postmaster or other officer authorized to pay the pension. Upon receipt of the notification the Postmaster or other officer shall suspend payment of the pension.

31. On receipt of notice of discharge, in accordance with Form 29, the Postmaster or other officer may resume payment of the pension, and, in a case in which the pensioner has been an inmate of the institution for a period of less than four weeks, he shall be entitled to payment of his pension for the whole of such period; but, in a case in which the pensioner has been an inmate for a longer period, he shall be entitled to payment of his pension for only twenty-eight days of such period.

32 (1) Whenever the death of any person is reported to a Registrar of Deaths for registration, the Registrar may inquire whether the deceased was a pensioner, and the person reporting the death shall state, to the best of his knowledge, whether the deceased was a pensioner or not. If the deceased was a pensioner, the Registrar should send to the Deputy Commissioner a notice of the death in accordance with Form 30.

(2) In this Regulation Registrar of Deaths means any Commonwealth or State officer charged with the duty of registering deaths.

33. Every Registrar, postmaster, and other officer charged with duties under the Act or Regulations, shall requisition the Deputy Commissioner for all the forms under these regulations which are required in connexion with his duties. Such requisition, in accordance with Form 31 or in ordinary letter form, shall be made early enough in every case to secure a new supply of forms before the old stock becomes exhausted. The forms kept by Registrars shall include those required for the use of Magistrates. If from any cause printed forms are not in the hands of any Registrar, postmaster, or other officer, when required, the forms may be prepared wholly in manuscript.

34. As regards postage and telegrams, the following arrangements, made with the Postmaster-General’s Department, shall be observed:—

(1) Letters, &c., addressed to Registrars in connexion with Old-age Pensions, to be transmitted without prepayment, if inclosed in the official envelopes of any Commonwealth or State Department, and indorsed “Old-age Pensions,” the postage thereon at prepaid rates to be paid by the Commissioner.

(2) The Letter-carrier delivering the correspondence to be supplied by the Postmaster with a docket showing the amount of postage due, such docket to be signed by the Registrar to whom the matter is addressed, or by his representative. Dockets to be supplied to Postmasters by the Treasury in book form, with counterfoils, and numbered consecutively.

(3) Letters, &c, sent by Registrars, except those addressed to other Registrars, which are covered by the arrangement set out in paragraph (1) to be handed in at Post Offices, with dockets, to be supplied by the Registrars.

(4) Telegrams from Registrars and Magistrates on Old-age Pension business to be transmitted, without prepayment, on production by the transmitter of a signed docket.

(5) The Postmaster to transmit the dockets to the Deputy Postmaster General, who will claim payment from the Commissioner in the usual way.

(6) The dockets to be in accordance with Form 32.

Form 1 (Reg. 2)

COMMONWEALTH OF AUSTRALIA.

——

The Invalid and Old-age Pensions Act 1908.

Section 13.

——

DECLARATION.

I, do solemnly and sincerely promise and declare that I will, according to law and to the best of my knowledge and ability, discharge the duties of the office of* under the above-named Act.

Declared at this day of 19 ,
before me †Justice of the Peace, or

Commissioner for Affidavits.

* Fill in nature of Office.

† Strike out what is inapplicable.

Form 2 (Reg. 3).

COMMONWEALTH OF AUSTRALIA.

——

The Invalid and Old-age Pensions Act 1908

——

PENSION CLAIM.

Attention is directed to the following:—

(a) Information for claimants is shown on pages 8 and 9.

(b) Section 27, sub-section 4 of the Act reads:—

Every claimant shall, by declaration to be indorsed thereon, declare that the contents of his pension claim are true and correct in every particular, and if in the declaration or claim he wilfully makes any statement which is untrue in any particular, he shall be guilty of an indictable offence. Penalty: Five years’ imprisonment.

* Name of Claimant in full.	I,*
* Residence (Postal Address).	of*
* Occupation.	*
Where 2 is not applicable strike it out.Where 2 is applicable strike out 1.	hereby claim an Old-age Pension under the above Act.1. I have attained the age of sixty-five years.2. I have attained the age of sixty years and am permanently incapacitated for work.3. I am qualified to receive an Old-age Pension by reason of being a natural born British subject, or a naturalized subject of the King, having been naturalized for a period of three years next preceding the date of this claim, and I am not disqualified from receiving an Old-age Pension by reason of any of the disqualifications set forth in the above-named Act.
* For meaning of continuous residence see page 9 of this document.	4. I am on this date residing in Australia, and I have on this date so resided continuously* for twenty-five years within the meaning of the Act. My place of abode is at
* Here set out names of places.	wherein I have resided for a period of and my place or places of abode during the last twelve months have been*5. I am of good character.
* Where a husband is the claimant 7 should be struck out, and where a wife is the claimant 6 should be struck out.	6. Being a husband, I have not for twelve months or upwards during five years immediately preceding this date without just cause deserted my wife or without just cause failed to provide her with adequate means of maintenance or neglected to maintain any of my children under the age of fourteen years.7. Being a wife, I have not for twelve months during, five years immediately preceding this date without just cause deserted my husband or deserted any of my children under the age of fourteen years.8. The net capital value of my accumulated property, whether in or out of Australia, does not exceed Three hundred and ten pounds.9. I have not directly or indirectly deprived myself of property or income in order to qualify for or obtain a pension.
* Where not applicable the paragraph in brackets should be struck out	10. I have not at any time within six months been refused a pension certificate under the above-named Act (*except for the reason that I was disqualified on account of my age, or for reasons which are not now in existence).11. The information given in answer to the questions hereunder set out is true and correct.

Questions—	Answers—
Where were you born?(Name the place and country)When were you born?(Give exact date if possible)When did you first arrive in Australia?From what port did you sail for Australia?What was the name of the ship?At what port did you land?Were you a passenger or immigrant or member of the crew?(State which)Since you first arrived in Australia have you visited New Zealand or any other country?If so, how long altogether were you away from Australia?Are you single, married, widow, or widower?If you are married, what is the full name of your husband or wife?Where and when were you married?(Give exact date if possible)If you are a widow or married woman, what was your maiden name?

Questions—

Answers—

Where were you born?(Name the place and country)When were you born?(Give exact date if possible)When did you first arrive in Australia?From what port did you sail for Australia?What was the name of the ship?At what port did you land?Were you a passenger or immigrant or member of the crew?(State which)Since you first arrived in Australia have you visited New Zealand or any other country?If so, how long altogether were you away from Australia?Are you single, married, widow, or widower?If you are married, what is the full name of your husband or wife?Where and when were you married?(Give exact date if possible)If you are a widow or married woman, what was your maiden name?

What are the names, dates of birth, places of birth, &c., of all your children?

<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:36.96%; 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; font-size:10pt"><span style="font-family:'Times New Roman', serif">Names of Children.</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:10pt"><span style="font-family:'Times New Roman', serif">Dates of Birth.</span></p></td><td style="width:21.48%; 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:10pt"><span style="font-family:'Times New Roman', serif">Places of Birth. (Show name of State as well as Place.)</span></p></td><td style="width:20.54%; 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:10pt"><span style="font-family:'Times New Roman', serif">Places where Births Registered.</span></p></td></tr><tr style="height:56.4pt"><td style="width:36.96%; 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; line-height:normal; font-size:10pt"><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; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:21.48%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:20.54%; 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:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:21.55pt"><td colspan="2" style="border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Questions—</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Answers—</span></p></td></tr><tr style="height:56.4pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">What are the names and addresses of your children now living?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Have you within the last six months been refused an Old-age Pension?—If so, when and where?</span></p><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Were you born a British subject?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Are you a naturalized British subject? If so, when and where were you naturalized?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(Papers or other evidence must be produced to the Magistrate.)</span></p></td><td colspan="3" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps"></span></p></td></tr><tr style="height:0pt"><td style="width:168.35pt"></td><td style="width:58.55pt"></td><td style="width:37.15pt"></td><td style="width:97.85pt"></td><td style="width:93.55pt"></td></tr></tbody></table>

<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td rowspan="2" style="width:47.3%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle"><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.</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:middle"><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; font-variant:small-caps">Answers</span><span style="font-family:'Times New Roman', serif">.</span></p><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">(In the case of married persons, information is required concerning both husband and wife.)</span></p></td></tr><tr style="height:1pt"><td style="width:28.26%; 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; font-size:9pt"><span style="font-family:'Times New Roman', serif">Information concerning Claimant.</span></p></td><td style="width:24.44%; 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:middle"><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">Information concerning Claimant’s Wife or Husband.</span></p></td></tr><tr style="height:1pt"><td style="width:47.3%; 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:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">By</span><span style="font-family:'Times New Roman', serif; font-style:italic"> </span><span style="font-family:'Times New Roman', serif">whom were you employed during the last twelve months?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">How much did you earn during the last twelve months?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Did you receive board or lodging besides money wages?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-14.4pt; text-align:justify; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">(If not received during the whole of the last twelve months, state how long received.)</span></p></td><td style="width:28.26%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:24.44%; 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; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>

<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td rowspan="2" style="width:47.06%; 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; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Questions</span><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:middle"><p style="margin-top:6pt; margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Answers.</span></p><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(In the case of married persons, information is required concerning both husband and wife.)</span></p></td></tr><tr style="height:1pt"><td style="width:28.36%; 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; font-size:10pt"><span style="font-family:'Times New Roman', serif">Information concerning Claimant.</span></p></td><td style="width:24.58%; 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; font-size:10pt"><span style="font-family:'Times New Roman', serif">Information concerning Claimant’s Wife or Husband.</span></p></td></tr><tr style="height:1pt"><td style="width:47.06%; 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:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">How much did each of your children </span><span style="font-family:'Times New Roman', serif; font-style:italic">not living with you </span><span style="font-family:'Times New Roman', serif">contribute to your support during the last twelve months?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">How much did each of your children </span><span style="font-family:'Times New Roman', serif; font-style:italic">living with you </span><span style="font-family:'Times New Roman', serif">contribute towards the maintenance of the home during the last twelve months?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Do you keep a shop or lodging-house or boarding-house or conduct a business of any kind, or have you an interest in any shop or business?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">What is the nature of the same, and what profit did you make during the last twelve months?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Has any one agreed to maintain you in whole or in part or to make any payments to you in consideration of property you have transferred?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">During the last twelve months did you receive free board or free lodging or both?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-14.4pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(State which received, and for how long received.)</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">What other income have you received during the last twelve months?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-14.4pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(Reply should include rents, after deduction of repairs, &amp;c., dividends from banks or companies, interest on money lent or in banks, and any other income. The nature and amount of the income in each case should be stated.)</span></p><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">What house or land property do you own?</span></p><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Where is it situated?</span></p><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">What is the nature of the title?</span></p><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">What is the full capital value?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-14.4pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(Where a valuation of the property has been made for any local authority, the last notice of assessment or a letter from an official of such local authority, stating the capital value as assessed, must be sent to the Registrar of Pensions, pinned to this page.)</span></p><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">If you own only one house, do you live in it?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">If you own more than one house, which of those mentioned above do you live in?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Is any of the property mortgaged or otherwise encumbered?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-14.4pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(If so, state amounts, also names, and addresses of the persons to whom the mortgages or encumbrances have been granted.)</span></p><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Have you a share or interest in any other property?</span></p></td><td style="width:28.36%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:24.58%; 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; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>

<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td rowspan="2" style="width:47.14%; 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; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Questions,</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:middle"><p style="margin-top:3pt; margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Answers.</span></p><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(In the case of married persons, information is required concerning both husband and wife.)</span></p></td></tr><tr style="height:1pt"><td style="width:28.34%; 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; font-size:10pt"><span style="font-family:'Times New Roman', serif">Information concerning Claimant.</span></p></td><td style="width:24.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Information concerning Claimant’s Wife or Husband.</span></p></td></tr><tr style="height:1pt"><td style="width:47.14%; 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:6pt; margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">What is the nature and value of such property?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Do you own any horses, cattle, sheep, or other live stock?</span></p><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(Give particulars and value.)</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Do you own any furniture, vehicles, &amp;c.?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-14.4pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(State nature and value of each separately.)</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Have you any money in any bank, savings bank, building society, or other financial institution?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-14.4pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(If so, state names and amounts.)</span></p><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Is your life assured?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-14.4pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(If so, state name of company, amount, and age at which amount payable; also state by whom premiums are paid)</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Have you any money or property not previously disclosed?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-14.4pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(The reply should include information as to debentures, stock, bank or mining shares, or any other property.)</span></p></td><td style="width:28.34%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:24.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>

Signature of Claimant

———

DECLARATION.

I* of†

do hereby declare that I am the claimant for an Old-age Pension under the Invalid and Old-age-Pensions Act 1908, and that the contents of my pension claim on which this declaration is indorsed are true and correct in every particular.

Declared atthe day of 19	(Signature of Declarant.)

Before me

§ ‡

* Name of Claimant.

† Residence and occupation.

‡ The person before whom this declaration is taken to sign here and add the title by which he takes the declaration, such as “Postmaster,” &c.

§ The declaration may be made before any of the following persons:—A postmaster or a postmistress, or person in charge of a post-office, a police, stipendiary or special magistrate of the Commonwealth or a State, a justice of the peace, a barrister or solicitor, a State school head-teacher, an officer of the Department of Trade and Customs, a member of the police force of the Commonwealth or of a State, a legally qualified medical practitioner, a notary public, a commissioner for affidavits, a registrar under the Invalid and Old-age Pensions Act 1908, a minister of religion, or an officer of the Commonwealth Department of the Treasury.

———

Form 12 (Reg. 11).

To the Magistrate at

The attached claim is forwarded to you, together with the following reports and documents:—

*The claimant is unable to attend by reason of

Registrar of Pensions at Date

* Strike out, if not required.

Form 13 (Reg. 13)

RECOMMENDATION OF MAGISTRATE.

Hereunder I specify all the material points which I find to be respectively proved, disproved, and unproved or insufficiently proved:—

Age of 65 years or over.....................	*	Proved.Disproved.Unproved or Insufficiently Proved.
Age of 60 years or over, and permanent incapacity for work	*	Proved.Disproved.(Unproved or Insufficiently Proved.
Length of residence sufficient.................	*	Proved.Disproved.Unproved or Insufficiently Proved
Good character...........................	*	Proved.Disproved.Unproved or Insufficiently Proved
Claimant is not disqualified by desertion of husband, wife, or children, or by neglect to maintain wife or children	*	Proved.Disproved.Unproved or Insufficiently Proved.
Claimant’s income and property are not sufficient in amounts to preclude the grant of a pension—the annual income being £ and the net capital value of accumulated property being £	*	Proved.Disproved.Unproved or Insufficiently Proved
Claimant has not directly or indirectly deprived himself of property or income in order to qualify for or obtain a pension	*	Proved.Disproved.Unproved or Insufficiently Proved
Claimant has not within six months been refused a Pension Certificate under the Act except for reasons set out in Section 17(g)	*	Proved.Disproved.Unproved or Insufficiently Proved
Claimant is a natural-born or naturalized subject of the King, who has been naturalized for three years, and claimant is not an Asiatic (except one born in Australia), or an Aboriginal native of Australia, Africa, the Islands of the Pacific, or New Zealand	*	Proved.DisprovedUnproved or Insufficiently Proved.

* I recommend the rejection of the claim.

* I recommend that the claim be admitted, and that a pension of £ per annum be granted.

* It appears to me that the claimant, although otherwise qualified for, is unfit to be intrusted with, a pension, and I recommend that the claimant be sent to a benevolent asylum or charitable institution.

Magistrate Date

* Strike out what is inapplicable.

———

INFORMATION FOR CLAIMANTS.

When husband and wife both apply, a separate claim is required for each.,

Claimants should supply the information required on pages 1 to 6 of this pension claim. They should not write on any of the other pages.

The claimant should sign his or her name on page 6, opposite the words “Signature of claimant”; also should make and sign the declaration on the same page.

The claim should be sent to the nearest Registrar of Pensions.

With the claim the claimant must send to the Registrar the following:—

(1) Declarations by two persons who have known the claimant for twenty-five years or more (Form 3).

(2) Identification card (Form 4).

If the claimant cannot find two persons who have known him for twenty-five years the declarations may be made by persons of shorter acquaintance.

Claimants should produce evidence as to age and length of residence in Australia. If they cannot do so, considerable delay may occur before the pensions are granted.

Age may be proved by producing documents such as:—Certificate of birth or baptism; indentures of apprenticeship; military discharge; letter from public department, stating age of a retired public servant; certificate of any public officer, showing age according to immigration record; letter from secretary of lodge, friendly society, or trade union, showing age as appearing in old record; letter from assurance society quoting age in accordance with society’s record; entry in family bible; marriage certificate; certificate of registration of the birth of claimant’s child (this shows ages of parents at date of child’s birth); shipping discharge or master’s certificate.

Length of residence in Australia may be proved by producing documents such as:—Certificate of birth or baptism; certificate of registration of the birth of claimant’s child; Lands Office records and receipts for instalments of rent; miner’s rights; marriage certificate; certificate of the registration of the death of the husband, wife, or children; letter from secretary of lodge, friendly society, or trade union showing information in old records; naturalization certificate; benevolent asylum or hospital record; name of claimant in directory; lodge or savings bank pass-books; certificate of church officer showing membership of claimant; certificate of employer.

Persons between the ages of 60 and 65 are qualified to receive pensions only if permanently incapacitated for work. Every such person must attach to his claim a medical certificate showing the nature of the incapacity and its permanency, except in a case of accident where the permanent incapacity is manifest.

The following extracts from the Act are given in order that it may be seen who are qualified to receive pensions:—

15.—(1) Subject to this Act, every person who has attained the age of sixty-five years, or who, being permanently incapacitated for work, has attained the age of sixty years, shall, whilst in Australia, be qualified to receive an old-age pension.

(3) No old-age pension shall be paid to any person who is under the age of sixty-five years unless and until his claim is certified by a Registrar pursuant to this Act, and is recommended in writing by a Deputy Commissioner.

16.—(1) The following persons shall not be qualified to receive an old-age pension, namely:—

(a) Aliens;

(b) Naturalized subjects of the King who have not been naturalized for the period of three years next preceding the date of their pension claims;

(c) Asiatics (except those born in Australia), or aboriginal natives of Australia, Africa, the Islands of the Pacific, or New Zealand.

(2) No woman having married one of the persons disqualified by this section shall, in consequence only of such marriage, be or become disqualified to receive a pension.

17. No person shall receive an old-age pension unless—

(a) he is residing in Australia on the date when he makes his claim to the pension;

(b) he has on that date so resided continuously for at least twenty-five years;

(d) if a husband, he has not for twelve months or upwards during five years immediately preceding that date, without just cause, deserted his wife, or without just cause failed to provide her with adequate means of maintenance, or neglected to maintain any of his children being under the age of fourteen years; or, if a wife, she has not for twelve months during five years immediately preceding such date, without just cause, deserted her husband, or deserted any of her children being under the age of fourteen years;

(e) the net capital value of his accumulated property, whether in or out of Australia, does not exceed Three hundred and ten pounds;

(f) he has not directly or indirectly deprived himself of property or income in order to qualify for or obtain a pension; and

(g) he has not at any time within six months been refused a pension certificate, except for the reason that he was disqualified on account of his age or for reasons which are not in existence at the time of the further application.

18.—(1) Continuous residence in Australia shall not be deemed to have been interrupted by occasional absences not exceeding in the aggregate one-tenth of the total period of residence.

(2) A person, whether claimants or pensioner, shall not be deemed to be absent from Australia during any period of absence from Australia if he proves that during that period his home was in Australia, and if married that his wife and family, or his wife (if he has no family), or his family (if his wife is dead), resided in Australia and were maintained by him.

24.—(1) The amount of a pension shall in each case be at such rate as, having regard to all the circumstances of the case, the Commissioner or Deputy Commissioner who determines the pension claim deems reasonable and sufficient, but shall not exceed the rate of Twenty-six pounds per annum in any event, nor shall it be at such a rate as will make the pensioner’s income, together with pension, exceed Fifty-two pounds per annum.

(2) Where the pensioner has accumulated property, the amount of a pension shall be subject to the following deductions:—

(a) One pound for every complete Ten pounds by which the net capital value of the property exceeds Fifty pounds; except where the property includes a home in which the pensioner permanently resides, and which produces no income; and

(b) One pound for every complete Ten pounds by which the net capital value of the property exceeds One hundred pounds, where the property includes a home in which the pensioner permanently resides, and which produces no income.

Provided that, where both husband and wife are pensioners, except where they are living apart pursuant to any decree, judgment, order, or deed of separation, in making the deduction in the case of each of them—

paragraph (a) shall be read with the substitution of Twenty-five pounds for Fifty pounds, and

paragraph (b) shall be read with the substitution of Fifty pounds for One hundred pounds.

25. The net capital value of accumulated property shall be assessed in the prescribed manner, and, unless otherwise prescribed, the following provisions shall apply:—

(a) All real and personal property owned by any person shall be deemed to be his accumulated property:

(b) From the capital value of such accumulated property there shall be deducted all charges or encumbrances lawfully and properly existing on the property, and the residue remaining shall be deemed to be the net capital value of all accumulated property:

(c) Where a valuation has been made for any local authority of any accumulated real property, that valuation, being the last valuation of the property, may for the purposes of this Act be taken to be the capital value of the property unless satisfactory evidence is adduced to the contrary:

(d) In the case of husband and wife, except where they are living apart pursuant to any decree, judgment, order, or deed of separation, the net capital value of the accumulated property of each shall be deemed to be half the total net capital value of the accumulated property of both

26. In the computation of income—

(a) where any person receives board or lodging or board and lodging, the actual or estimated value or cost of such board or lodging or board and lodging, not exceeding Five shillings per week, shall be included; and

(b) in the case of husband and wife, except where they are living apart pursuant to any decree, judgment, order, or deed of separation, the income of each shall be deemed to be half the total income of both.

4.—(1) “Income” means any moneys, valuable consideration, or profits earned derived or received by any person for his own use or benefit by any means from any source whatever, whether in or out of the Commonwealth, and shall be deemed to include personal earnings, but not any payment—

(a) By way of benefit from any friendly society registered under any Act or State Act, or

(b) During illness, infirmity, or old-age from any trade union, provident society, or other society or association.

Form 3 (Reg. 3).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

DECLARATION OF PERSON WHO HAS KNOWN CLAIMANT FOR A LENGTHENED PERIOD.

attention is directed to the following:—

(a) Every claimant is expected to send to the Registrar of Pensions declarations (on separate forms), made by two persons who have known claimant for a period of at least 25 years, but if no such person can be found the declarations may be made by persons of shorter acquaintance.

(b) Declarant should not be a relative of claimant.

No person shall by any wilfully false statement or representation aid or abet any person in obtaining or claiming a pension certificate or pension, or instalment of a pension. Penalty—Six months’ imprisonment.

———

Name of Claimant

Occupation of Claimant

Postal address of claimant

I, do solemnly and sincerely declare that the

(Name, occupation, and address of declarant.)

information given in this form, in relation to the above-named claimant for a pension, is to the best of my knowledge and belief, true and correct in every particular.

How long have you known claimant, and in what places?Are you related to claimant?Is claimant indebted to you in any way?Are you under any obligation to claimant?What do you think claimant’s age is and what is your reason for so thinking?(If you have seen any documentary evidence of age, give particulars.)Has claimant lived continuously in Australia for 25 years or more?(Continuous residence is not deemed to have been interrupted by occasional absences, not exceeding in the aggregate one-tenth of total period of residence, and a claimant is not deemed to have been absent during any period of absence, if, during that period, his home was in Australia; and, if married, if his wife and family resided there and were maintained by him.)What are the incidents which assist you in recollecting the length of claimant’s residence in Australia?Have you seen any documents which prove the claimant’s length of residence in Australia?(If so, give particulars.)Could the claimant, since you first knew him or her, have been absent for any considerable period from Australia without your being acquainted with the fact?(If so, give particulars.)Is the claimant a natural-born British subject?Is the claimant a naturalized British subject who has been naturalized for three years?Have you seen naturalization papers?Is the claimant an Asiatic, born outside of Australia, or an aboriginal native of Australia, Africa, the Islands of the Pacific, or New Zealand?Is claimant of good character?Is claimant single, married, a widow, or a widower?If the claimant is a husband, has he for twelve months or upwards during five years immediately preceding the date of the claim, without just cause, deserted his wife, or without just cause failed to provide her with adequate means of maintenance, or neglected to maintain any of his children being under the age of fourteen years?

If the claimant is a wife, has she for twelve months during five years immediately preceding the date of the claim, without just cause, deserted her husband, or deserted any of her children being under the age of fourteen years?Are husband and wife living apart?If so, has a decree, judgment, order or deed of separation been obtained?What is the nature and the value of property of all kinds which you believe claimant to be possessed of?(Reply to this should give information as to land, houses, money in bank, money in hand, furniture, live stock, harness, &c. The value of each class of property should be separately stated.)(If room insufficient here, write on back.)Does such property include a home in which the claimant permanently resides and which produces no income?(If claimant has more than one house, indicate that which is the home, and state its value.)What amount per week do you believe the claimant earns on the average, and in what occupation?Does the claimant’s remuneration include board or lodging in addition to money wages?Do you believe that claimant is given free board or lodging?(If so, give particulars.)Do you believe that claimant is wholly or partly maintained by children or other relatives?(If so, give particulars.)What amount of other income do you believe the claimant has?(Give full particulars.)Do you know or have you any reason to suspect that the claimant has deprived himself or herself of property or income in order to obtain a pension?If claimant is a wife, what property and income do you believe her husband has?(Give full particulars. Reply should include amount of personal earnings, and if board or lodging given either free or for services, the fact should be stated.)If claimant is a husband, what property and income do you believe his wife has?(Give full particulars. Reply should include amount of personal earnings, and if board or lodging given free or for services, the fact should be stated.)Do you know any reason why pension should not be granted?

View image in the official sourceDeclared at this day of 19

before me,

*† Signature of Declarant.

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

*Person before whom this declaration is taken to sign here and add the title by which he takes the declaration, such as “Postmaster,” &c.

† The declaration may be made before any of the following persons:—A postmaster or a postmistress, or person in charge of a post-office, a police, stipendiary or special magistrate of the Commonwealth or a State, a justice of the peace, a barrister or solicitor, a State school head-teacher, an officer of the Department of Trade and Customs, a member of the police force of the Commonwealth or of a State, a legally qualified medical practitioner, a notary public, a commissioner for affidavits, a registrar under the Invalid and Old-age Pensions Act 1903, a minister of religion, or an officer of the Commonwealth Department of the Treasury.

Form 4 (Reg. 3).

This Card to be forwarded by the Registrar to the Deputy Commissioner who, if pension approved, will send it to a Postmaster or other Paying Officer. The last-named must retain the Card as his authority for paying pension. [The Card should not be Folded.]

<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td rowspan="2" style="width:9.34%; height:1pt; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">PARTICULARS FOR IDENTIFICATION OF PENSIONER.</span></p></div></td><td style="width:31.62%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Name in full</span></p><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Date and Place of Birth</span></p><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Postal Address</span></p><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Last Occupation</span></p><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Number of Children</span></p><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Father’s Name</span></p><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Mother’s Maiden Name</span></p><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Signature of Claimant</span></p><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">(or his witnessed mark).</span></p></td><td style="width:25%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:55pt; margin-right:14.4pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">of whom</span></p></td><td style="width:27.56%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:55pt; margin-right:14.4pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">are living</span></p></td><td style="width:6.5%; height:1pt; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif; font-style:italic">Rate of Pension to be paid is shown on other side.</span></p></div></td></tr><tr style="height:1pt"><td style="width:31.62%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:25%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:27.56%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif; font-style:italic">Registrar.</span></p></td><td style="width:6.5%; height:1pt; margin-left:auto; writing-mode:tb-rl; padding-right:2pt; padding-left:2pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif; font-style:italic"></span></p></div></td></tr></tbody></table>

[To be Printed on Back of Card.]

<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:55.76%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:28.8pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Form </span><span style="font-family:'Times New Roman', serif">4 </span><span style="font-family:'Times New Roman', serif; font-variant:small-caps">(Reg. </span><span style="font-family:'Times New Roman', serif">3).</span></p></td><td style="width:6.9%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.96%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td rowspan="3" style="width:4.94%; height:1pt; margin-left:auto; writing-mode:tb-rl; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; margin-left:5.65pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">Postmaster at</span><span class="CommentReference"> </span><span style="width:3.43pt; display:inline-block"></span><span style="font-family:'Times New Roman', serif">Date</span></p></div></td><td style="width:6.92%; padding-right:2pt; 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"></span></p></td><td rowspan="3" style="width:3.94%; height:1pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:middle; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; margin-left:5.65pt; margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Signed</span></p></div></td><td rowspan="3" style="width:3.96%; height:1pt; margin-left:auto; writing-mode:tb-rl; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; margin-left:5.65pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">Postmaster at</span><span style="font-family:'Times New Roman', serif"> </span><span style="width:2.39pt; display:inline-block"></span><span style="font-family:'Times New Roman', serif">Date</span></p></div></td><td style="width:6.16%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td rowspan="3" style="width:3.72%; height:1pt; margin-left:auto; writing-mode:tb-rl; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Signed</span></p></div></td><td rowspan="3" style="width:3.72%; height:1pt; margin-left:auto; writing-mode:tb-rl; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; margin-left:5.65pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">Postmaster at</span><span style="font-family:'Times New Roman', serif"> </span><span style="width:2.39pt; display:inline-block"></span><span style="font-family:'Times New Roman', serif">Date</span></p></div></td></tr><tr style="height:3.15pt"><td style="width:55.76%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Pension Certificate No.</span></p><p style="margin-top:6pt; margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Pensioner’s Name</span></p></td><td rowspan="2" style="width:6.9%; height:3.15pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:middle; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:3.15pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; margin-left:5.65pt; margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Payment to be made in future at Payment made at this office up to</span></p></div></td><td rowspan="2" style="width:3.96%; height:3.15pt; margin-left:auto; writing-mode:tb-rl; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:3.15pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; margin-left:5.65pt; margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Signed</span></p></div></td><td rowspan="2" style="width:6.92%; height:3.15pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:middle; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:3.15pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Payment to be made in future at Payment made at this office up to</span></p></div></td><td rowspan="2" style="width:6.16%; height:3.15pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:middle; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:3.15pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; margin-left:5.65pt; margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Payment to be made in future at Payment made at this office up to</span></p></div></td></tr><tr style="height:150.75pt"><td style="width:55.76%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:0pt; text-indent:14.4pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">Pension at the rate of</span></p><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">fortnightly granted, payable at</span></p><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">as from</span></p><p style="margin-top:6pt; margin-right:28.8pt; margin-bottom:6pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif; font-style:italic">Deputy Commissioner.</span></p><p style="margin-top:6pt; margin-right:86.4pt; margin-bottom:6pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">Date</span></p><p style="margin-left:14.4pt; margin-bottom:0pt; text-indent:-14.4pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">(Note</span><span style="font-family:'Times New Roman', serif">.—This card should not be folded when being forwarded through the post or at any other time)</span></p></td></tr></tbody></table>

Form 5 (Reg. 6).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

The District Register of Pension Claims.

Date of Receipt of Claim.	Surname.	Christian Name.	Occupation.	Address.	Date when finally dealt with by Magistrate.	Nature of Magistrate’s Recommendation.	Date when Claim and Magistrate’s Recommendation sent to Deputy Commissioner.	Short Particulars of Income and Property as accepted by Magistrate.	Remarks

Form 6 (Reg. 7).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

From the Registrar of Pensions at

To the Officer in Charge of Police at

Claimant—Name

Occupation

Address

It is requested that you will be good enough to make all such inquiries as may be necessary for a full investigation of a claim for an Old-age Pension made by the above-named, and to forward to me a report on this form with as little delay as may be. The inquiries should be made as far as possible from persons other than the claimant or the claimant’s relatives.

The report may be returned to me without prepayment of postage, if enclosed in the official envelope of any Commonwealth or State Department and indorsed “Old-age Pensions.”

Registrar.

Date

Questions.	Replies.
In your opinion, what is claimant’s age?What documentary evidence (if any) as to age have you seen?Has claimant lived continuously in Australia for 25 years or more, and is claimant now residing in Australia?(Continuous residence is not deemed to have been interrupted by occasional absences, not exceeding in the aggregate one-tenth of total period of residence, and a claimant is not deemed to have been absent during any period of absence if during that period his home was in Australia; and, if married, if his wife and family resided there and were maintained by him.)What documentary evidence (if any) as to length of residence have you seen?Is the claimant a natural-born British subject?Is the claimant a naturalized British subject who has been naturalized for three years?Were naturalization papers produced to you?Is claimant an Asiatic, born outside of Australia, or an aboriginal native of Australia, Africa, the Islands of the Pacific, or New Zealand?Is claimant of good character?If claimant is a husband, has he for twelve months or upwards during five years immediately preceding the date of the claim, without just cause, deserted his wife, or without just cause failed to provide her with adequate means of maintenance, or neglected to maintain any of his children being under the age of fourteen years?(If you have any knowledge of a maintenance order, please say so.)If claimant is a wife, has she for twelve months during five years immediately preceding the date of the claim, without just cause, deserted her husband, or deserted any of her children being under the age of fourteen years?

Questions.

Replies.

In your opinion, what is claimant’s age?What documentary evidence (if any) as to age have you seen?Has claimant lived continuously in Australia for 25 years or more, and is claimant now residing in Australia?(Continuous residence is not deemed to have been interrupted by occasional absences, not exceeding in the aggregate one-tenth of total period of residence, and a claimant is not deemed to have been absent during any period of absence if during that period his home was in Australia; and, if married, if his wife and family resided there and were maintained by him.)What documentary evidence (if any) as to length of residence have you seen?Is the claimant a natural-born British subject?Is the claimant a naturalized British subject who has been naturalized for three years?Were naturalization papers produced to you?Is claimant an Asiatic, born outside of Australia, or an aboriginal native of Australia, Africa, the Islands of the Pacific, or New Zealand?Is claimant of good character?If claimant is a husband, has he for twelve months or upwards during five years immediately preceding the date of the claim, without just cause, deserted his wife, or without just cause failed to provide her with adequate means of maintenance, or neglected to maintain any of his children being under the age of fourteen years?(If you have any knowledge of a maintenance order, please say so.)If claimant is a wife, has she for twelve months during five years immediately preceding the date of the claim, without just cause, deserted her husband, or deserted any of her children being under the age of fourteen years?

<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:17.25pt"><td rowspan="3" style="width:47.2%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Questions.</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-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Replies.</span></p></td></tr><tr style="height:44.25pt"><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-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">In case of married Claimant, answers to Questions on this page should relate to property and income of both husband and wife.</span></p></td></tr><tr style="height:17.25pt"><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:10pt"><span style="font-family:'Times New Roman', serif">Husband.</span></p></td><td style="width:24.26%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Wife.</span></p></td></tr><tr style="height:1pt"><td style="width:47.2%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">What is the value of the claimant’s property and where situated?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-14.4pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(Reply to this question should give particulars of houses, land, money in hand, money in bank, furniture, live stock, harness, &amp;c. The nature and value of each class of property should be shown.)</span></p><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">What encumbrances exist on the property?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Does the property include a home in which the claimant permanently resides and which produces no income?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-14.4pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(If claimant has more than one house indicate that which is the home, and state its value and encumbrance.)</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">What amount per week does the claimant earn on an average, and in what occupation; and does remuneration include board or lodging in addition to money wages?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Does the claimant receive free board or lodging?</span></p><p style="margin-left:36pt; margin-bottom:0pt; text-indent:-14.4pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(If so, give particulars.)</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">What amount of other income or means of support has the claimant?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Has the claimant directly or indirectly deprived himself or herself of property or income in order to qualify for or obtain a pension?</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; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:24.26%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:12pt; margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Questions.</span></p></td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:12pt; margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Replies.</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Has claimant at any time within six months been refused a Commonwealth or State pension certificate, and under what circumstances?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Would pension be probably misspent in drink or otherwise?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Are husband and wife living together?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">If not, are they living apart pursuant to any decree, judgment, order, or deed of separation?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">If claimant is a husband, has his wife applied for or been granted a pension, or will she soon apply?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">If claimant is a wife, has her husband applied for or been granted a pension, or will he soon apply?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Do you know any reason why pension should not be granted?</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">What are the names and addresses of the persons from whom you have obtained the information contained in this report?</span></p></td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:0pt"><td style="width:215pt"></td><td style="width:12pt"></td><td style="width:117.95pt"></td><td style="width:110.5pt"></td></tr></tbody></table>

I have the honour to report that I have made inquiries in the matter of this claim, and that, to the best of my knowledge and belief, after due inquiry, the information given in reply to the questions on pages 2, 3, and 4, of this document is correct.

Signed

(Insert here name and rank of Member of

Police Force who has made inquiries.)

Date

From the Officer in Charge of Police at

To the Registrar of Pensions at

Above report is forwarded for your information.

Officer in Charge of Police.

Date

Form 7 (Reg. 8).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

CONFIDENTIAL REPORT—GENERAL.

Full Name of Claimant for Pension

Address of Claimant

Section 28, Sub-section 2, of the Act reads:—

“The Registrar may require any person, whom he believes to be in a position to do so, to furnish to him, for submission to the Magistrate, a confidential report as to the circumstances or the financial transactions of any claimant or pensioner or of any relatives of a claimant or pensioner; and any person who, on being required to do so by the Registrar, fails to furnish a report within a reasonable time, or furnishes a report containing any statement which is untrue in any particular, shall be guilty of an offence.” Penalty:—One hundred pounds, or six months’ imprisonment.

———

From the Registrar of Pensions at

The above-named is a claimant for a Pension, and I have to request that you will be so good as to inform me as follows:—

It is requested that the reply be written hereunder.

Registrar

Date

———

From

To the Registrar of Pensions at

Signed

Date

————

Form 8 (Reg. 8).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

CONFIDENTIAL REPORT—BANK.

From the Registrar of Pensions at

To the Manager, Bank of

The persons named in the attached Schedule are claimants for pensions under the above-named Act, and I have to request you will be so good as to show in the Schedule particulars of any money or securities held by you on account of such persons. I may inform you that in section 28, sub-section 2 of the Act, it is provided as follows:—

The Registrar may require any person, whom he believes to be in a position to do so, to furnish to him, for submission to the Magistrate, a confidential report as to the circumstances or the financial transactions of any claimant or pensioner or of any relatives of a claimant or pensioner; and any person who, on being required to do so by the registrar, fails to furnish a report within a reasonable time, or furnishes a report containing any statement which is untrue in any particular, shall be guilty of an offence.

Penalty: One hundred pounds, or six months’ imprisonment.

Registrar.

Date

Schedule: Referred to Above.

<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:24pt"><td rowspan="2" style="width:27.4%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Names of Claimants.</span></p></td><td rowspan="2" style="width:28.1%; 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">Addresses in Full.</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:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Particulars of Money or Securities.</span></p></td></tr><tr style="height:1pt"><td style="width:22.98%; 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">Now held.</span></p></td><td style="width:21.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif">Withdrawn from Bank since 1st July, 1908.</span></p></td></tr><tr style="height:41.55pt"><td style="width:27.4%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:28.1%; border:0.75pt solid #000000; padding-right:1.62pt; 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"></span></p></td><td style="width:22.98%; border:0.75pt solid #000000; padding-right:1.62pt; 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"></span></p></td><td style="width:21.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:9pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>

From the Manager, Bank of

To the Registrar of Pensions at

To the best of my knowledge and belief, I certify, after due inquiry, that the particulars of money or securities shown in the Schedule above are correct.

Manager.

Date

Form 9 (Reg. 8).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

SEARCH FOR PARTICULARS AS TO AGE OR ARRIVAL IN AUSTRALIA.

From the Registrar of Pensions at

To the Deputy Commissioner of Pensions at

* Please cause the date of arrival in Australia to be verified in the following case.

* Please cause search to be made in order to ascertain the age of the claimant, who has given the following information with regard to his (or her) children.

Registrar of Pensions at

Date

Present Name of Claimant (in full)

View image in the official sourceImmigrant†

Name on ship’s books Passenger†

Member of Crew†

Name of ship from the port of

to the port of Date of arrival at latter port

‡ According to shipping record claimant’s age was at the following date, viz,:—

Full Names of Children.	Dates of Birth.	Places of Birth.§ (Name of State required as well as Name of Place.)	Claimant’s Age then given.‡	Wife’s (or Husband’s) Age then given.‡	Registered by.‡	Birthplace of (H) Husband or (W) Wife.‡’

From the Deputy Commissioner to the Registrar—

View image in the official sourceDate of arrival † has been verified, and age appearing in shipping record is shown above

† cannot be traced.

Details as to ages have been supplied above.

Deputy Commissioner.

Date

* If claimant is able to produce satisfactory evidence as to age, the second request should be struck out. If claimant is able to produce satisfactory evidence as to arrival in Australia, the first request should be struck out.

† Strike out what is incorrect.

‡ To be filled in in Deputy Commissioner’s Office.

§ State also places of registration if not registered at places where born.

Form 10 (Reg. 9).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

NOTICE TO CLAIMANT TO ATTEND INVESTIGATION.

Address

Take notice that the investigation of your Pension Claim will be made on day, the day of 19 , at the Court-house* at at o’clock in the noon, and that you are then and there required to attend and to support your claim by the production of papers or other evidence.

Dated at this day of 19

Registrar of Pensions.

* Alter this word if investigation is to be made at a place other than a Court-house.

—————

Form 11 (Reg. 9).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

Sir,

I have the honour to inform you that

have made claims for Pensions, and that they have been requested† to appear before you at the Court-house,‡ at on , at o’clock in the noon.

I have the honour to be,

Sir,

Your most obedient Servant,

Registrar.

To Esq.,

Magistrate,

* Names of Claimants.

†If not requested to attend, alter wording to agree with the facts.

‡Alter this word if investigation is to be made at a place other than a Court-house.

Form 14 (Reg. 13).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

RECORD IN POSTPONED CASE.

In the claim of

In this postponed case I record the following matters as proved:—*

That claimant’s age is 65 years or over.

That claimant’s age is 60 years or over, and that he is permanently incapacitated for work.

That claimant’s residence in Australia is sufficient.

That claimant is of good character.

That claimant is not disqualified by desertion of husband, wife, or children, or by neglect to maintain wife or children.

That net value of the claimant’s accumulated property is £

That claimant’s income is £ per annum.

That claimant has not directly or indirectly deprived himself of property or income in order to qualify for or obtain a pension.

That claimant has not within six months been refused a Pension certificate under the Act except for reasons set out in Section 17 (g).

That claimant is a natural-born or naturalized subject of the King, who has been naturalized for three years, and that claimant is not an Asiatic (except one born in Australia), or an aboriginal native of Australia, Africa, the Islands of the Pacific, or New Zealand.

Magistrate at

Date

* Matters in which the Magistrate is not satisfied to be struck out.

Form 15 (Reg. 14).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

NOTICE OF INTENTION TO ADDUCE FRESH EVIDENCE.

From*

To the Registrar of Pensions at

I hereby give notice that on the day of , 19 , I intend to adduce before the Magistrate at fresh evidence in respect of matters found by the Magistrate on the day of 19 , to be unproved or insufficiently proved. The fresh evidence will be†

Signature of Claimant

Date

* State full name, address, and occupation of Claimant.

† Set out the nature of the evidence to be adduced.

————

Form 16 (Reg. 15).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

APPEAL TO MINISTER.

To the Treasurer of the Commonwealth of Australia.

I,*

do hereby appeal to the Minister against the recommendation of the Magistrate at with regard to†

and in connexion therewith submit the following‡

Signature of Claimant

Date

* State name, occupation, and address.

† State matters appealed against.

‡ State facts in support of appeal.

Form 17 (Reg. 17).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

NOTICE OF THE GRANT OF PENSION.

I have to acquaint you that your claim for an Old-age Pension has been allowed, and a Pension Certificate will be issued to you on application to

Deputy Commissioner of Pensions.

Place

Date 19

Form 18 (Reg. 17.)

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

NOTICE OF REJECTION OF CLAIM.

I have to acquaint you that your claim for a Pension Certificate has been rejected on the ground that

Deputy Commissioner of Pensions.

Place

Date 19

Form 19 (Reg. 18).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

OLD-AGE PENSION CERTIFICATE.

This Pension is payable only at the office named herein, and no application for Temporary Transfers to another office will be entertained.

The Invalid and Old-age Pensions Act 1908 includes the following provision:—

“42.—(1.) Every pension shall be deemed to be granted and shall be held subject to all the provisions of this Act, and to the provisions of any other Act amending or repealing or in substitution for this Act which may at any time be passed, and no pensioner shall have any claim for compensation or otherwise by reason of his pension being affected by the operation of this Act or any such other Act.”

The following Instructions must be strictly adhered to:—

A person authorized by Warrant in Form 27 to receive payment for the benefit of a Pensioner must not draw instalments of the Pension after the Pensioner’s decease, or during the time that Pensioner is absent from Australia, or is an inmate of any Benevolent Asylum, Hospital, or Asylum for the Insane.

OLD-AGE PENSION CERTIFICATE.

Number

I certify that whose signature is subscribed

has been granted an Old-age Pension of shillings and

pence per fortnight, from 19 , payable at

Deputy Commissioner.

Signature of Pensioner.

Note.—This Certificate must be produced when application is made for payment of each instalment of Pension, and no instalment will be paid without its production. Any instalment not applied for within 21 days of its due date may be forfeited.

Payment to be made in future at

(Signed)

Postmaster at

Date

Payment to be made in future at

(Signed)

Postmaster at

Date

The Officer paying to place his date stamp or his initials and the date on the proper space when payment is made. The initials and date must not be written in pencil.

Instalment payable on—

15 July, 1909.	23 Sept., 1909.	2 Dec, 1909.	10 Feb., 1910.
29 July, 1909.	7 Oct., 1909.	16 Dec., 1909.	24 Feb., 1910.
12 Aug., 1909.	21 Oct., 1909.	30 Dec., 1909.	10 Mar., 1910.
26 Aug., 1909.	4 Nov., 1909.	13 Jan., 1910.	24 Mar., 1910.
9 Sept., 1909.	18 Nov., 1909.	27 Jan., 1910.	7 Apr., 1910.
21 Apr., 1910.	14 July, 1910.	6 Oct., 1910.	29 Dec., 1910.
5 May, 1910.	28 July, 1910.	20 Oct., 1910.	12 Jan., 1911.
19 May, 1910.	11 Aug., 1910.	3 Nov., 1910.	26 Jan., 1911.
2 June, 1910.	25 Aug., 1910.	17 Nov., 1910.	9 Feb., 1911.
16 June, 1910.	8 Sept., 1910.	1 Dec., 1910.	23 Feb., 1911.
30 June, 1910.	22 Sept., 1910.	15 Dec., 1910.	9 Mar., 1911.

Form 20 (Reg. 20).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

APPLICATION FOR DUPLICATE CERTIFICATE.

To the Deputy Commissioner of Pensions at

being a Pensioner under the aforesaid Act, hereby make application for a duplicate Pension Certificate in lieu of the original Certificate No. ; and in support of the application I hereby declare as follows:—

1. The original Certificate was duly issued to me as Pensioner, and has been lost [or, as the case may be, destroyed].

2.*

† I have made diligent search for the lost Certificate, but have been unable to find it.

I do hereby solemnly declare that this statement is true.

Declared by the said at

this 19 , before me—

Applicant.

‡§

* If destroyed, state when and how.

† If lost.

‡The person before whom this declaration is taken to sign here and add the title by which he takes the declaration, such as “Postmaster,” &c.

§The declaration may be made before any of the following persons:—A postmaster or a postmistress, or person in charge of a post-office, a police, stipendiary or special magistrate of the Commonwealth or a State, a justice of the peace, a barrister or solicitor, a State school head-teacher, an officer of the Department of Trade and Customs, a member of the police force of the Commonwealth or of a State, a legally qualified medical practitioner, a notary public, a commissioner for affidavits, a registrar under the Invalid and Old-age Pensions Act 1908, a minister of religion, or an officer of the Commonwealth Department of the Treasury.

————

Form 21 (Reg. 21).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

APPLICATION FOR CHANGE OF PLACE OF PAYMENT.

(Application, accompanied by Pension Certificate, must be sent to Postmaster or other Officer who pays Pension.)

Address

Date

Pension Certificate No.

I hereby apply that place of payment of my Pension be changed from

to for the following reasons:—

Signature of Applicant

———

I beg to report to the Deputy Commissioner of Pensions at

that I have authorized the transfer from

Postmaster or Paying Officer.

————

Form 22 (Reg. 24).

Pension Certificate No.

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

RECEIPT FOR INSTALMENT OF PENSION.

I acknowledge to have received from the Commonwealth of Australia the sum of £ : : , being Pension payable in accordance with Pension Certificate numbered as above for the fortnight ended

Signature

Note.—Whenever payment of a pension instalment is made, the paying officer will hand to the pensioner a blank form of receipt, which must be brought back, on the next pension pay-day, already filled in and signed. The pensioner must not hand the receipt to another person under any circumstances, but must bring it back himself (or herself).

Form 23 (Reg. 24).

Pension Certificate No.

COMMONWEALTH OF AUSTRALIA.

——

The Invalid and Old-age Pensions Act 1908.

——

RECEIPT FOR INSTALMENT OF PENSION.

Warrant No.

I acknowledge to have received, for the benefit of the Pensioner, from the Commonwealth of Australia, the sum of £ : : , being Pension payable in accordance with Pension Certificate numbered as above for the fortnight ended I have good reason to believe that the Pensioner is alive in Australia, and that he is not an inmate of any Benevolent Asylum, Hospital, or Asylum for the Insane. I last saw him on

Signature

Note.—Whenever payment of a pension instalment is made, the paying officer will hand to the warrantee a blank form of receipt, which must be brought back on the next pension pay-day, already filled in and signed. The warrantee must not hand the receipt to another person under any circumstances, but must bring it back himself for herself).

Form 24 (Reg. 26).

COMMONWEALTH OF AUSTRALIA.

——

The Invalid and Old-age Pensions Act 1908.

——

APPLICATION FOR PAYMENT OF FORFEITED INSTALMENT.

I,*

of* , being the Pensioner [or, as the case may be, the authorized payee] under Pension Certificate No. apply for payment of the forfeited instalment (or instalments) which was (or were) due for the period of weeks ended 19 , and which amounts (or amount) to £

I declare that the information given in reply to the following questions is true and correct:—

(a) Has pensioner during any portion of the period referred to been an inmate of a Benevolent Asylum, Hospital, or Asylum for the Insane?	(a) †
(b) Why was the amount not applied for in due time?	(b) ‡

View image in the official sourceI do hereby declare that this statement is true and correct in every particular.

Declared at thisday of 19 , beforeme—	Applicant

§.............................

To the Registrar of Pensions at

* Name and address of applicant.

† If pensioner was an inmate, give name of institution and dates of admission and discharge.

‡ Here set out briefly but clearly the reason why the instalment or instalments not applied for in due time.

§ The person before whom this declaration is taken to sign here and add the title by which he takes the declaration, such as “Postmaster,” &c.

|| The declaration may be made before any of the following persons:—A postmaster or a postmistress, or person in charge of a post-office, a police, stipendiary or special magistrate of the Commonwealth or a State, a justice of the peace, a barrister or solicitor, a State school head-teacher, an officer of the Department of Trade and Customs, a member of the police force of the Commonwealth or of a State, a legally qualified medical practitioner, a notary public, a commissioner for affidavits, a registrar under the Invalid and Old-age Pensions Act 1908, a minister of religion, or an officer of the Commonwealth Department of the Treasury.

Form 25 (Reg. 26).

COMMONWEALTH OF AUSTRALIA.

——

The Invalid and Old-age Pensions Act 1908

——

WAIVER OF FORFEITURE.

I hereby grant this Warrant waiving forfeiture of the instalment of the pension which was payable to pursuant to Pension Certificate No. for the fortnight ended but which became forfeited because it was not applied for within twenty-one days of the due date. The instalment may now be paid as though it had not been forfeited. This Warrant must be presented to the Postmaster or other Paying Officer.

Dated at this

day of 19 .

Registrar of Pensions.

Form 26 (Reg. 28).

COMMONWEALTH OF AUSTRALIA.

——

The Invalid and Old-age Pensions Act 1908.

——

APPLICATION FOR WARRANT AUTHORIZING PAYMENT TO PERSON OTHER THAN THE PENSIONER.

Note.—A Warrant cannot be issued in respect of any Pensioner who is an inmate, or is about to become an inmate, of a Benevolent Asylum, Hospital or Asylum for the Insane.

To the Registrar of Pensions at

I. (1)

hereby apply for a Warrant under the Act directing that until the Warrant is cancelled all instalments of the Pension payable to (2)

pursuant to Pension Certificate No.

may be paid to (3)

for the benefit of the Pensioner, on the grounds (4)

Dated at this day of 19

Applicant.

I consent hereto. I am already the holder of Warrants for Payment of Pensions in the following cases, and no others:—(5)

* I hereby certify that the Pensioner and the proposed Payee are personally known to me, and that owing to

the Pensioner is now unable, and, in my opinion, will be unable for a period of† to collect the Pension instalments, and that the proposed Payee is a suitable person for the purpose.

‡

To the Deputy Commissioner at

I am satisfied that this Application should be granted.

Registrar of Pensions at

Date

(1) Full name, occupation, and address of applicant.

(2) Full name of pensioner.

(3) Full name, occupation, and address of proposed payee.

(4) Set out briefly but clearly the grounds.

(5) Proposed payee.

* This certificate must be signed by one of the following persons:—A postmaster or a postmistress, or person in charge of a post-office, a police, stipendiary or special magistrate of the Commonwealth or a State, a justice of the peace, a barrister or solicitor, a State school head-teacher, an officer of the Department of Trade and Customs, a member of the police force of the Commonwealth or of a State, a legally qualified medical practitioner, a notary public, a commissioner for affidavits, a registrar under the Invalid and Old-age Pensions Act 1908, a minister of religon, or an officer of the Commonwealth Department of the Treasury.

† State how long inability will probably continue.

‡ State title under which certificate is given.

Form 27 (Reg. 28).

COMMONWEALTH OF AUSTRALIA.

——

The Invalid and Old-age Pensions Act 1908.

——

WARRANT FOR PAYMENT TO PERSON OTHER THAN PENSIONER.

I direct that until* all instalments of the Pension granted to (Certificate No. ) shall be paid to for the benefit of the pensioner.

This Warrant, with the Pension Certificate, must be presented to the Postmaster or other Paying Officer whenever application is made for payment.

Deputy Commissioner of Pensions.

Date

Signature of person to whom Warrant granted

* If Warrant granted for an indefinite period, insert here “otherwise ordered by me.”

Form 28 (Reg. 30).

COMMONWEALTH OF AUSTRALIA.

——

The Invalid and Old-age Pensions Act 1908.

——

PENSIONER IN CHARITABLE INSTITUTION.

I report that [insert name of Pensioner] of [insert address of Pensioner] who is a Pensioner under the above-named Act, was admitted to the [insert name of Institution] on the day of 19 , and that he is still an inmate.

(Pension Certificate No. * Payable at )

Signature

Office held by person reporting

Date

To the Postmaster or Officer Paying Old-age Pensions at

* The number should be filled in if the Pension Certificate has come under the notice of the person reporting.

Form 29 (Reg. 31).

COMMONWEALTH OF AUSTRALIA.

——

The Invalid and Old-age Pensions Act 1908.

——

DISCHARGE OF PENSIONER FROM CHARITABLE INSTITUTION.

I certify that [insert name and address of Pensioner] who was admitted to the [insert name of Institution] was discharged therefrom on the day of 19

Signature

Office held by person reporting

Date

To the Postmaster or Officer Paying Old-age Pensions at

Form 30 (Reg. 32).

COMMONWEALTH OF AUSTRALIA.

——

The Invalid and Old-age Pensions Act 1908.

——

NOTICE OF DEATH.

To the Deputy Commissioner of Pensions at

*Insert full name and last address; also any other available particulars likely to assist in identification.

I advise that I have received notice of the death of*

who died on the day of 19 ,

aged years, and I believe him to have been a Pensioner under the above-named Act whose pension was paid at

District Registrar of Births, Deaths, and Marriages,

Or Official charged with duty of registering Deaths.

Address of the Official making this report

Date 19

A regulation under the Invalid and Old-age Pensions Act 1908 authorizes the official registering a death to inquire, when registering the death of a person of 60 years and upwards, whether the deceased was a Pensioner under the Act, and, if so, to notify the Deputy Commissioner. As pensions are granted to persons of 60 years and upwards who are permanently incapacitated, inquiry should be made in all cases above the age of 60 years.

————

Form 31 (Reg. 33).

COMMONWEALTH OF AUSTRALIA.

———

The Invalid and Old-age Pensions Act 1908.

———

REQUISITION FOR FORMS.

(In order to guard against any waste of Forms, &c., it is requested that care be exercised to see that reasonable quantities only, having regard to actual requirements, are applied for.)

I beg to apply for the following printed Forms for the use of this Office.

(Place)

Signature

Office

Date 19 .

Approximate. No. in Stock.	No. now required.	Distinguishing No., &c., of Form.
		1. Declaration by Officer2. Pension Claim3. Declaration by person who has known Claimant, &c.4. Identification Card5. District Register6. Police Report7. Confidential Report—General8. Confidential Report—Bank9. Search for particulars as to age or arrival in Australia10. Notice to Claimant to attend Investigation11. Notice to Magistrate

Requisitions for Forms—continued.

Approximate No. in Stock.	No. now required.	Distinguishing No., &c., of Form.
		12. Registrar’s Report to Magistrate. (This is printed at end of Form 2.)13. Recommendation of Magistrate. (This is printed at end of Form 2.)14. Record in Postponed Case15. Notice of Intention to Adduce Fresh Evidence16. Appeal to Minister17. Notice of the Grant of a Pension (not supplied to Registrars, Postmasters, or Paying Officers)18. Notice of Rejection of Claim (not supplied to Registrars, Postmasters, or Paying Officers)19. Pension Certificate (not supplied to Registrars, Post-masters, or Paying Officers)20. Application for Duplicate Certificate21. Application for Change of Place of Payment22. Receipt to be given by Pensioner for Instalment of Pension23. Receipt to be given by Warrantee on behalf of Pensioner for Instalment of Pension24. Application for Payment of Forfeited Instalment25. Waiver of Forfeiture26. Application for Warrant authorizing payment to person other than Pensioner27. Warrant for Payment to person other than Pensioner (not supplied to Registrars, Postmasters, or Paying Officers)28. Pensioner in Charitable Institution29. Discharge of Pensioner from Charitable Institution30. Notice of Death31. Requisition for Forms32. Postage and Telegram Docket

Form 32 (Reg. 34).

COMMONWEALTH OF AUSTRALIA.

———

Department of the Treasury.

———

OLD-AGE PENSIONS.

Place

Date

Number of Articles

View image in the official source*Postage due £ : :

*Due for Telegram

Signature and Designation of Officer.

* Strike out what is inapplicable.

Printed and Published for the Government of the Commonwealth of Australia by J. Kemp, Government Printer for the State of Victoria.

Old-age Pensions Regulations 1909 (Provisional)

Plain English Summary

Deep dive

Current sections

Old-age Pensions Regulations 1909 (Provisional)

Source text: opening excerpt

1 Old-age Pensions Regulations 1909 (Provisional)