PROVISIONAL REGULATIONS UNDER THE WAR PENSIONS ACT 1914.
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 War Pensions Act 1914 should come into immediate operation, and make the Regulations to come into operation forthwith as Provisional Regulations.
Dated this twenty-fifth day of March, One thousand nine hundred and fifteen.
R. M. FERGUSON,
Governor-General.
By His Excellency’s Command,
E. J. RUSSELL,
for Treasurer.
WAR PENSIONS REGULATIONS.
1. These Regulations may be cited as the War Pensions Regulations.
2. In these Regulations, unless the contrary intention appears—
“Claim” means a claim for a pension in accordance with the War Pensions Act 1914.
“Claimant” means a person who has made a claim for a pension on behalf of himself, or on behalf of a person under the age of sixteen years, or on behalf of a person of unsound mind.
“Pensioner” means a person to whom a pension has been granted and includes a person under the age of sixteen years as well as a person of unsound mind.
“Commissioner” means the Commissioner of Pensions appointed under the Invalid and Old-age Pensions Act 1908-1912.
“Deputy Commissioner” means a Deputy Commissioner of Pensions appointed under the Invalid and Old-age Pensions Act 1908-1912.
“Special Magistrate” means a Special Magistrate appointed under the Invalid and Old-age Pensions Act 1908-1912.
“Registrar” means a Registrar of Pensions appointed under the Invalid and Old-age Pensions Act 1908-1912.
“Commonwealth Medical Referee” means a Commonwealth Medical Referee appointed by the Commissioner to examine claimants for pensions under the Invalid and Old-age Pensions Act 1908-1912.
“Incapacity” means bodily or mental infirmity which wholly or in part prevents the earning of a livelihood and which results or has resulted from employment in connexion with the warlike operations referred to in the Act.
C.2847.—Price, 8d.
“Trustee” means a person appointed to collect and disburse a pension payable on behalf of a pensioner under the age of sixteen years, or on behalf of a pensioner of unsound mind, or on behalf of a pensioner who consents to the payment of his pension to such person.
3. Where a person under the age of sixteen years or a person of unsound mind is entitled to a pension, a claim may be made on behalf of such person by any other person over the age of sixteen years, and the Commissioner or a Deputy Commissioner may direct that payment of the pension be made to a trustee for the benefit of the pensioner, provided that the appointment of a trustee may at any time be cancelled by the Commissioner or a Deputy Commissioner.
4. Every member of the Forces who claims a pension on the ground that he suffers from an incapacity shall prepare a claim in accordance with Form Z.
5. Every person who claims a pension on the ground that such person was or would have been a dependent of a member of the Forces shall prepare a claim in accordance with Form Y: Provided that where a dependant or dependants is or are under the age of sixteen years, the claim shall be made on Form X and the declaration on that form may be made, by any person who has a knowledge of the facts and who is more than sixteen years of age.
6. Every claim shall be forwarded by the claimant to a Registrar or a Deputy Commissioner, who shall note on the claim the date of its receipt by him.
7. Whenever a Registrar receives a claim, he shall arrange for hearing the claimant and some other person over the age of sixteen years who knows the circumstances of the person or persons for whom pension is claimed. If the claimant and such other person do not forthwith attend at the office of the Registrar, the Registrar shall, in Form W, request the claimant to attend there and to cause such other person to attend also: Provided that, for any special reason, the Registrar may dispense with the attendance of the claimant or such other person.
8. All evidence given orally to the Registrar by the claimant and such other person shall be recorded in accordance with Form U.
9. Where the claim has been made by or on behalf of an incapacitated member of the Forces, the Registrar shall question the claimant and such other person with a view to ascertaining whether, in the claim, the replies to questions and requests for information fairly represent the facts, and shall forthwith report the result by letter to a Deputy Commissioner, to whom at the same time the Registrar shall forward all the papers in the case.
10. Where the claim has been made by or on behalf of a dependant or dependants of a member of the Forces, the Registrar shall question the claimant and such other person with a view to ascertaining—
(a) the extent to which the person for whom a pension is claimed was dependent upon the earnings of the member of the Forces at the time of his death, or the extent to which such person would have been dependent upon the earnings of the member of the Forces but for the incapacity of such member; and
(b) the exact relationship which the person for whom a pension is claimed bears to the member of the Forces.
11. In the case of a claim made on behalf of a person under the age of sixteen years or on behalf of a person of unsound mind, the Registrar shall also question the claimant and such other person with a view to ascertaining the name and address of some person who is suitable for appointment as trustee.
12. If unable to satisfy himself by the examination of the claimant and such other person as to the extent of such dependence, and as to the nature of such relationship, and as to the name and address of a person suitable for appointment as trustee, the Registrar may, in accordance with Form T, address to the State police a request for inquiries and report. The Registrar may also address to any person a request in accordance with Form S, and may by letter request a Deputy Commissioner to ascertain any relationship by search at an office in which births, deaths, and marriages are registered.
13. When satisfied as to the extent of such dependence and the nature of such relationship and the name and address of a person suitable for appointment as trustee, the Registrar shall, in accordance with Form R, forthwith report the result of his investigations to a Deputy Commissioner, to whom also the Registrar shall at the same time forward all the papers in the case.
14. The Commissioner or the Deputy Commissioner or the Registrar may require any person whom he believes to be in a position to do so, to furnish to him a confidential written report as to the circumstances of, the names ages and means of livelihood of the dependants of, the family and blood relationships of, the means of livelihood of, and the age of any person who claims a pension or for whom a pension is claimed; and any person who, on being required to do so by the Commissioner or the Deputy Commissioner or 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, and shall be liable to a penalty not exceeding One hundred pounds.
15. Whenever a claim which has not been dealt with by a Registrar is received by a Deputy Commissioner, the latter shall forward the claim to a Registrar or a Special Magistrate for investigation.
16. Claims referred to a Special Magistrate for investigation shall be dealt with by him in the manner in which it is directed claims received by a Registrar shall be dealt with by the Registrar, and the Special Magistrate shall have in that respect the same powers and duties as a Registrar.
17. When the Registrar or the Special Magistrate is not in a position to make his report to the Deputy Commissioner within one week after the receipt of a claim, the Registrar or the Special Magistrate shall, by letter advise the Deputy Commissioner that such claim has been received and shall state why a delay has occurred. The Deputy Commissioner shall thereupon take such steps as to him seem calculated to insure an early conclusion of the investigation.
18. The Deputy Commissioner shall obtain from the Defence Department a copy of the record of the member of the Forces who is referred to in the claim. In the case of a member of the Forces who, it is claimed, suffers from an incapacity, the Deputy Commissioner may accept such evidence of incapacity as is part of the member’s record; but if not satisfied by that evidence, he shall take such other steps as to him seem desirable in order to ascertain the nature and extent of the incapacity. For this purpose he may request a Commonwealth Medical Referee to make an examination.
19. When the Deputy Commissioner finds that the member of the Forces died as a result of his employment in connexion with the warlike operations referred to in the Act, or when he finds sufficient evidence showing the nature and extent of an incapacity suffered by the member, he shall immediately forward ail the papers in the case to the Commissioner.
20. (1) Declarations under 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 of 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 1908-1912, a minister of religion, an officer of the Commonwealth Department of the Treasury, or a member of the Parliament of the Commonwealth.
(2) If any person wilfully makes any false statement in any declaration provided for under these Regulations he shall be liable to a penalty not exceeding One hundred pounds.
21. Unless otherwise directed by the Commissioner, every Registrar shall keep a record, in accordance with Form L, of war pension claims received by him.
22. A medical certificate of incapacity may be in accordance with Form K.
23. On the grant of a pension, a pension certificate in accordance with Form J and an identification card in accordance with Form H shall be forwarded to a postmaster or other officer, who shall retain the identification card, and deliver the certificate to the pensioner or the trustee under departmental instructions.
24. 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: Provided that, as regards the method of paying and 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 a Deputy Commissioner, the postmaster or other officer shall not make payment of the pension: Provided further that the postmaster or other officer shall not make payment of any instalment until he has made a note, in relation to such payment, on the pension certificate (Form J) which shall be produced to him for that purpose.
25. (1) Pensions shall be payable fortnightly, provided that a proportionate payment may be made for a number of days less than a fortnight.
(2) The amount of every fortnightly instalment shall be ascertained by dividing the annual pension by twenty-six.
26. The fortnights in respect of which instalments of pension are payable shall in every case commence on a Thursday and end on a Wednesday. Every such fortnight shall be known as a “pension fortnight,” and the first day of every “pension fortnight” shall be known as “pension Thursday.”
27. The due date of each instalment shall be the first day of the fortnight for which the instalment is payable.
28. The pensioner or the trustee shall give a receipt for each instalment, in avoidance with Form P.
29. No payment shall be made to any person other than the pensioner or the trustee, unless such person is the holder of an order in accordance with Form O.
30. An instalment of a pension granted to the widow of a member of the Forces shall not in any case be paid unless there is presented to the postmaster or other officer at the time of payment a declaration in Form N showing that, on the due date of such instalment, the widow had not married again.
31. An instalment of a pension payable to a trustee shall not in any case be paid unless there is presented to the postmaster or other officer at the time of payment a declaration in Form M showing that, on the due date of such instalment, the person on behalf of whom the pension is payable is alive.
32. Where the Commissioner or a Deputy Commissioner is satisfied that a pensioner is misspending money, the Commissioner or a Deputy Commissioner, if he considers it to be in the interests of the pensioner to do so, may suspend payment of the pension: Provided that in such a case the amount of the pension accrued during the period of suspension shall at a later date be paid to the pensioner or a trustee.
33. The Commissioner or a Deputy Commissioner may, with the consent of the pensioner, make payment of the pension to a trustee.
34. If a pensioner or a trustee loses his pension certificate, he may make application, in accordance with Form G, to a 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.
35. If a pensioner or a trustee desires to permanently leave the place at which he resides to reside in another place, he may make application in Form ZZ to the postmaster or other officer authorized to pay the pension, and if such postmaster or other officer is satisfied that the request is a reasonable one, he shall make a note on the 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:— “The last payment made at this office was due on ‘pension Thursday,’ the 191 .” 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 a Deputy Commissioner, make payment of the pension as it falls due.
36. The application in accordance with Form ZZ shall, if approved by the postmaster or other officer, be transmitted to a Deputy Commissioner.
37. Any undrawn instalment of a pension due at the date of a pensioner’s decease, if applied for within six months after such decease, may be paid to such person as in the opinion of the Deputy Commissioner has a legal or equitable claim thereto. Provided that the Deputy Commissioner shall not authorize payment to any person who is not a legal representative of the deceased, until the Deputy Commissioner has satisfied himself that probate of will or letters of administration will not be applied for.
38. (1) Whenever the death of any person is reported to a Registrar of Deaths for registration, the Registrar of Deaths may inquire whether the deceased was a pensioner under the War Pensions Act 1914, and the person reporting the death shall state, to the best of his knowledge, whether the
deceased was a pensioner or not. It the deceased was a pensioner, the Registrar of Deaths should send to the Deputy Commissioner a notice of death, in accordance with Form WW.
(2) In this Regulation Registrar of Deaths means any Commonwealth or State officer charged with the duty of registering deaths.
39. Every Registrar, postmaster, and other officer charged with duties under the Act or Regulations, shall requisition for all the forms which are required in connexion with his duties. Such requisition, in accordance with Form YY, 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. 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.
40. 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 pensions, are to be transmitted without prepayment, if enclosed in the official envelopes of any Commonwealth or State Department, and indorsed “Pensions”, the postage thereon at prepaid rates to be paid by the Commissioner.
(2) The letter-carrier delivering the correspondence will 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 will 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), and except those addressed to a Deputy Commissioner, who will give a docket on delivery, are to be handed in at post offices, with dockets to be supplied by the Registrars,
(4) Telegrams from Registrars on pension business are to be transmitted, without prepayment, on production by the transmitter of a signed docket.
(5) The postmaster shall transmit the dockets to the Deputy Postmaster-General, who will claim payment from the Commissioner in the usual way.
(6) The dockets shall be in accordance with Form XX.
Form Z.
Commonwealth of Australia.
The War Pensions Act 1914.
CLAIM FOR WAR PENSION.
Claim by an Incapacitated Member of the Forces.
(Before filling up this form, read the particulars given on the back of the form for the information of Registrars, Special Magistrates, and Claimants.)
Section 14 of the War Pensions Act 1914 reads:—
Any person who—
(a) obtains any pension or instalment which is not payable;
(b) obtains payment of any pension or instalment by means of any false or misleading statement; or
(c) makes or presents to the Minister or to the Pensions Board or to any officer doing duty in relation to this Act or the regulations, any statement or document which is false in any particular,
shall be guilty of an offence.
Penalty: One hundred pounds or imprisonment for one year.
To the Registrar of Pensions at
I, [here write full name] of [here write full postal address] hereby claim for myself a pension, and I declare that, to the best of my knowledge and belief, the following replies to the questions and requests for information are true and correct in every particular.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:50.92%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Q</span><span style="font-family:'Times New Roman', serif">uestions</span><span style="font-family:'Times New Roman', serif; font-variant:small-caps"> </span><span style="font-family:'Times New Roman', serif">and requests for information.</span></p></td><td style="width:49.08%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center"><span style="font-family:'Times New Roman', serif">Replies.</span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">State your number, rank, and the regiment or branch of the Forces in which you served</span></p></td><td style="width:49.08%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">State how where and when your incapacity was caused</span><span style="width:10.09pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.08%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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-right:28.8pt; margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Where and when were you born? (Give name of town and country, also exact date, if known.)</span><span style="width:18.73pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.08%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">What was your occupation before the outbreak of war?</span><span style="width:10.1pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.08%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">If you are or have been married, state</span><span style="font-family:'Times New Roman', serif; font-variant:small-caps">, </span><span style="font-family:'Times New Roman', serif">in respect of your first marriage:—</span></p></td><td rowspan="4" style="width:49.08%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:28.8pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Full maiden name of wife</span><span style="width:73.56pt; font-family:'Lucida Console', monospace; display:inline-block">...........</span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:28.8pt"><span style="font-family:'Times New Roman', serif">Place of marriage</span><span style="width:109.63pt; font-family:'Lucida Console', monospace; display:inline-block">................</span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:28.8pt"><span style="font-family:'Times New Roman', serif">Date of marriage</span><span style="width:112.69pt; font-family:'Lucida Console', monospace; display:inline-block">.................</span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Give similar particulate of your subsequent marriage, or marriages, if any</span><span style="width:0.23pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.08%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Have you earned any money since your services as</span><span style="font-family:'Times New Roman', serif; font-variant:small-caps"> </span><span style="font-family:'Times New Roman', serif">a member of the Forces ended?</span></p></td><td style="width:49.08%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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:14.4pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">If so, give full particulars</span><span style="width:104.51pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...............</span></p></td><td style="width:49.08%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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-right:28.8pt; margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Give the names and addresses of all who would have been dependent upon your earnings but for your incapacity, also state the relationship which each of such dependants bears to yourself</span><span style="font-family:'Times New Roman', serif"></span></p></td><td rowspan="2" style="width:49.08%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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:64.8pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">(State here whether the relationship is that of wife, son, daughter, step-son, step-daughter, or an adopted child.)</span></p></td></tr></tbody></table>
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Q</span><span style="font-family:'Times New Roman', serif">uestions</span><span style="font-family:'Times New Roman', serif; font-variant:small-caps"> </span><span style="font-family:'Times New Roman', serif">and requests for information.</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center"><span style="font-family:'Times New Roman', serif">Replies.</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-right:28.8pt; margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">In the last twelve months did any of your dependants named above earn any money?</span><span style="width:23.94pt; text-indent:0pt; display:inline-block"></span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">If so, give full particulars of such earnings</span><span style="width:29.67pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">....</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">In the last twelve months did any of your dependants named above have any means, of support other than that which was contributed by yourself, or which was earned by the dependant or dependants?</span><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">It so, give full particulars</span><span style="width:105.11pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...............</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Are you receiving or entitled to receive under any Commonwealth Act other than the </span><span style="font-family:'Times New Roman', serif; font-style:italic">War Pensions Act </span><span style="font-family:'Times New Roman', serif">1914, or under any Imperial Act or State Act, any payment by way of compensation, pension, retiring allowance, superannuation, or gratuity?</span><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">If so, give full particulars</span><span style="width:104.51pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...............</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">At what Post Office should pension, if granted, be paid?</span><span style="width:4.86pt; text-indent:0pt; display:inline-block"></span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:35.78%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt"><span style="font-family:'Times New Roman', serif">Declared at</span></p></td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt"><span style="font-family:'Times New Roman', serif">the</span></p></td><td style="width:18.54%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt"><span style="font-family:'Times New Roman', serif">day of</span></p></td><td style="width:23.7%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt"><span style="font-family:'Times New Roman', serif">191</span><span style="width:19.5pt; display:inline-block"> </span><span style="font-family:'Times New Roman', serif">.</span></p></td></tr><tr style="height:1pt"><td style="width:35.78%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif">Signature of Declarant—</span></p></td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:18.54%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:23.7%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:35.78%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="text-align:center"><span style="font-family:'Times New Roman', serif">Before me,</span></p><p style="text-align:center"><span style="font-family:'Times New Roman', serif">*†</span></p></td><td style="width:18.54%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:23.7%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:0pt"><td style="width:179.95pt"></td><td style="width:73.4pt"></td><td style="width:37.1pt"></td><td style="width:93.25pt"></td><td style="width:119.2pt"></td></tr></tbody></table>
* The person before whom this declaration is made to sign here and add the title by which he takes the declaration, such as “Postmaster,” &c.
† The declaration 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 of 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 1908-1912, a minister of religion, an officer of the Commonwealth Department of the Treasury, or a member of the Parliament of the Commonwealth.
The foregoing claim was received by me on
191 .
Registrar of Pensions at
Date
INFORMATION FOR REGISTRARS, SPECIAL MAGISTRATES, AND CLAIMANTS.
In order to avoid the preparation of claims which must fail, it is important to note that a pension under the War Pensions Act 1914 is payable only to one or more of the following:—
(a) an incapacitated member of the Forces;
(b) a dependant of a deceased or incapacitated member of the Forces.
No matter what the relationship to the member of the Farces may be, a pension cannot be paid unless dependence can be proved.
2. If, as a result of employment in the warlike operations referred to in the Act, any member of the Forces has lost his life, each of the following members of his family is entitled to a pension if he or she was wholly or in part dependent upon the earnings of the member at the time of his death. viz. widow, father, mother, grandfather, grandmother, step-father, step-mother, son, daughter, grandson, granddaughter, step-son, step-daughter, brother, sister, half-brother, half-sister, adopted child, mother-in-law, ex-nuptial child, ex-nuptial grandchild. (See also clauses 5 and 6 hereunder.)
3. If, as a result of such employment, any member of the Forces has not lost his life but has been incapacitated, his wife and such of his children who, but for his incapacity, would have been dependent upon his earnings, are entitled to pensions. The Act defines “child” as a dependant who is under the age of sixteen years and who is a son, a daughter, a step-son, a step-daughter, or an adopted child of a member of the Forces.
4. It will be noticed that, in the case of a member of the Forces who has not lost his life, the list of persons to whom pensions may be granted is not so comprehensive as it is in the case of a member of the Forces who has died. It should be pointed out, also, that, in the case of a member who has lost his life, the person for whom a pension is claimed must have been a dependant at the time of the member’s death (except as is shown in the next paragraph), while, in the case of a member who has not lost his life, it is necessary to prove that the person for whom pension is claimed would have been dependent upon the earnings of the member but for his incapacity. In the case of an ex-nuptial child, it is necessary to prove that the member of the Forces, at the time of his death, was actually contributing to the maintenance of the child. Mere blood-relationship does not show dependence.
5. Where the parents of a member who has so lost his life were not dependent upon his earnings at the time of his death, but are, at any time within five years after such death, without adequate means of support, a pension may be granted to each of them.
6. Where a member of the Forces who has so lost his life was an ex-nuptial child, any parent or grandparent who was dependent upon his earnings at the time of his death may be granted a pension.
7. (a) “Member of the Forces” means a member of the Commonwealth Naval or Military Forces enlisted or appointed for or employed on active service outside Australia or employed on a ship of war.
(b) “Incapacity” means bodily or mental infirmity which wholly or in part prevents the earning of a livelihood and which results or has resulted from employment in connexion with the warlike operations referred to in the Act.
(c) “Incapacity” includes incapacity of a member of the Forces arising from disease, not due to the default of the member, contracted by him while employed on active service.
8. (1) In case of the death of a member of the Forces, a claim by a dependant (including widow) will not be recognised if made more than six months after the date of the public notification in the Gazette of the death of the member; but a parent who though not dependent upon the earnings of the member at the time of his death, is at any time within five years after such death, without adequate means of support, may make a claim within five years after such death;
(2) In case of the incapacity of a member of the Forces, a claim by the member or a dependant (including wife) will not be recognised if made more than six months after the termination of the appointment or discharge of the member,
9. In the case of a dependant under the age of sixteen years, it is desirable that the claim be filled in and the truth of the statements declared to by a near relative over the age of sixteen years. If there is not a near relative who is willing to do so, and who is of sufficient ago, the form may be filled in and declared to by any person over the age of sixteen years. In any case the claim must be made within the said period of six months.
10. Pensions cannot be granted in excess of the following:—
(a) In case of the death of a member of the Forces—
(1) To the widow, the rate specified in column two of the Schedule;
(2) To each child, the rate of Thirteen pounds per annum;
(3) To the other dependants, such rates as are assessed by the Pensions Board, but not exceeding in the aggregate the rate specified in column two of the Schedule plus Fifty-two pounds per annum;
Provided that the maximum rate of pension payable to any one dependant of a member shall not in any case exceed the amount specified in column two of the Schedule.
(b) In case of the total incapacity of a member of the Forces—
(1) To the member, the rate specified in column three of the Schedule;
(2) To the wife of the member, Fifty per centum of that rate
(3) To each child of the member, the rate of Thirteen pounds per annum.
(c) In case of the partial incapacity of a member of the Forces, such less rates than these referred to in paragraph (b) as are assessed by the Pensions Board, having regard to the nature and probable duration of the incapacity.
11. Where the Pensions Board is satisfied that in the case of any member of the Forces the rate of pension payable under the Act is not more than thirty per centum of the rate which would be payable as for the total incapacity of the member, the Pensions Board may, with the sanction of the Minister, assess the lump sum which would in its opinion be equivalent to the payment of a pension under the Act, and in that case the liability to payment of the lump sum so assessed must be substituted for the liability to payment of a pension under the Act.
12. A pension payable to the widow of a member of the Forces ceases upon her re-marriage.
13. Subject to the Act, a pension is absolutely inalienable whether by way or in consequence of sale, assignment, charge, execution, insolvency, or otherwise howsoever. It will be seen, therefore, that a pensioner cannot give his pension as security for the repayment of borrowed money.
14. The provisions of the Act extend to the case of any soldier of the Imperial Reserve Forces called up for active service who, at the commencement of the state of war referred to in the Act was bond fide resident in Australia, as if that soldier were a member of the Forces as defined in the Act.
Provided that where the soldier or his dependants is or are entitled to any pension or compensation under any Imperial Act, the rate or amount of that pension, or compensation must be taken into account in assessing the rate of pension payable under the Commonwealth Act.
A pension is not payable in the case of any such soldier to any person who is not bona fide resident in Australia.
15. Every member of the Forces who claims a pension on the ground that he suffers from an incapacity should prepare a claim in accordance with Form Z.
16. Every person (including wife or widow) who claims a pension on the ground that such person was or would have been a dependant of a member of the Forces, should prepare a claim in accordance with Form Y; provided that where a dependant or dependants is, or are, under the age of sixteen years, a claim should be made on Form X.
17. Every claim should be forwarded by the claimant to a Registrar of Pensions or a Deputy Commissioner of Pensions appointed under the Invalid and Old-age Pensions Act. The police will be found always willing to give to claimants the address of a Registrar of Pensions who, it may be stated, is usually a Clerk of Petty Sessions or a Clerk of the local Court. If there is any doubt about the matter, the claim may be forwarded direct to the Deputy Commissioner of Pensions, whose address may be indicated merely as “Sydney,” “Melbourne,” “Brisbane,” “Adelaide,” “Perth,” or “Hobart,” as the case may be.
18. In any case in which a claimant believes that his claim is being unduly delayed, he should first communicate with the officer to whom he sent the claim, but he may, if the claim is further delayed, communicate with the Commissioner of Pensions, Melbourne.
19. Every claim will be heard by a Registrar or a Special Magistrate, who will request the claimant to appear and to bring before the Registrar or Special Magistrate some other person over the age of sixteen years who knows the circumstances of the person or persons for whom pension is claimed. The claimant alone will receive notification as to the place and time at which the claim will be heard, and the claimant will be expected to notify the other person. Except in special circumstances, no claim will be admitted unless both the claimant and the other person attend before the Registrar or Special Magistrate to give evidence.
THE SCHEDULE.
Scale of Pensions Payable to Widow on Death of a Member of the Forces or to a Member Upon Total Incapacity.
Where the rate of pay of a member of the Forces exceeds a rate shown in column one of this Schedule, and is less than the next higher rate in that column, the rates of pensions payable for the purposes of columns two and three will be proportionately adjusted.
Commonwealth of Australia. Form Y.
The War Pensions Act 1914.
CLAIM FOR WAR PENSION.
Claim by a Dependant (including Wife or Widow) Over the Age of Sixteen Years.
(Before filling up this form, read the particulars given on the back of the form for the information of Registrars, Special Magistrates, and Claimants.)
Section 14 of the War Pensions Act 1914 reads:—
Any person who—
(a) obtains any pension or instalment which is not payable;
(b) obtains payment of any pension or instalment by means of any false or misleading statement; or
(c) makes or presents to the Minister or to the Pensions Board or to any officer doing duty in relation to this Act or the regulations, any statement or document which is false in any particular,
shall be guilty of an offence.
Penalty: One hundred pounds or Imprisonment for one year.
To the Registrar of Pensions at
I, [here write full name] of [here write full postal address] hereby claim for myself a pension, and I declare that, to the best of my knowledge and belief, the following replies to the questions and requests for information are true and correct in every particular.
Questions and requests for information.
Replies.
Give the full name of the member of the Forces on whose death or incapacity the claim is based
State his rank, his number (if known), and the regiment or branch of the Forces in which he served
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:50.56%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">Questions and requests for information.</span></p></td><td style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">Replies.</span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">State whether he is dead, or is alive but incapacitated</span><span style="width:3.86pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; font-size:10pt"><span style="font-family:'Times New Roman', serif">What is your relationship to him?</span><span style="width:81.86pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">.............</span></p></td><td style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-right:28.8pt; margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">When and where were you born? (Give name of town and country, also exact date, if known)</span><span style="width:22.8pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; font-size:10pt"><span style="font-family:'Times New Roman', serif">What is your occupation?</span><span style="width:113.53pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..................</span></p></td><td style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; 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:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">If you are or have been married, state, in respect of your first marriage:—</span></p></td><td rowspan="5" style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt; font-size:10pt"><span style="font-family:'Times New Roman', serif">Full name of husband</span><span style="width:100.27pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">................</span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt; font-size:10pt"><span style="font-family:'Times New Roman', serif">Full maiden name of wife</span><span style="width:83.89pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">.............</span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt; font-size:10pt"><span style="font-family:'Times New Roman', serif">Place of marriage</span><span style="width:116.68pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...................</span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; 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:43.2pt; text-indent:-14.4pt; font-size:10pt"><span style="font-family:'Times New Roman', serif">Date of marriage</span><span style="width:119.46pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...................</span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">Give similar particulars of your other marriage or marriages (if any)</span><span style="width:15.89pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; 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:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">Were you dependent upon the earnings of the aforesaid member of the Forces at the time of his death?</span></p></td><td rowspan="2" style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:28.8pt; text-indent:21.6pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">(This question will, of course, not be answered if such member is alive.)</span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; 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:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">Would you have been dependent upon the earnings of the aforesaid member of the Forces but for his incapacity?</span><span style="width:17.04pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:28.8pt; text-indent:21.6pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">(This question will, of course, not be answered if such member is dead.)</span></p></td><td style="width:49.44%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">In the last twelve months has any person other than the aforesaid member of the Forces contributed towards your maintenance?</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">If so, give full particulars</span><span style="width:114.64pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...................</span></p></td><td style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">Have you earned any money in the last twelve months?</span><span style="width:30.68pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">If so, give full particulars</span><span style="width:114.64pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...................</span></p></td><td style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">Are you in receipt of an Invalid or Old-age Pension?</span><span style="width:5.79pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">Have you at any time applied for an Invalid or Old-age pension?</span><span style="width:30.03pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; font-size:10pt"><span style="font-family:'Times New Roman', serif">If so, state when and where</span><span style="width:106.6pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">.................</span></p></td><td style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.56%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">Have you, during the last twelve months, had any means of support other than means of support shown on the preceding page?</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:49.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="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%; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:50.92%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">Questions and requests for Information.</span></p></td><td style="width:49.08%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">Replies.</span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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:14.4pt; text-indent:-14.4pt; font-size:10pt"><span style="font-family:'Times New Roman', serif">If so, give full particulars</span><span style="width:114.64pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...................</span></p></td><td style="width:49.08%; 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="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">Are you receiving or entitled to receive, under any Commonwealth. Act other than the </span><span style="font-family:'Times New Roman', serif; font-style:italic">War Pensions Act </span><span style="font-family:'Times New Roman', serif">1914, or under any Imperial Act or State Act, any payment by way of compensation, pension, retiring allowance, superannuation, or gratuity?</span></p></td><td style="width:49.08%; 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="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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:14.4pt; text-indent:-14.4pt; font-size:10pt"><span style="font-family:'Times New Roman', serif">If so, give full particulars</span><span style="width:114.64pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...................</span></p></td><td style="width:49.08%; 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="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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-right:28.8pt; margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">At what Post Office should pension, if granted, be paid?</span><span style="width:27.33pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.08%; 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="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">Give the names and addresses of all persons known to you who were dependent upon the comings of the aforesaid member of the Forces at the time of his death</span><span style="font-family:'Times New Roman', serif"></span></p></td><td rowspan="2" style="width:49.08%; 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="font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.92%; 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:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif">(This question will, of course, not be answered if such member is alive.)</span></p></td></tr></tbody></table>
Declared at
The
day of
191
Signature of Declarant—
Before me,*†
*The person before whom this declaration is made 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 postmistress or person in charge of a post office, a police, stipendiary, or special magistrate of the Commonwealth or of 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 1908-1912, a minister of religion, an officer of the Commonwealth Department of the Treasury, or a member of the Parliament of the Commonwealth.
The foregoing claim was received by me on
191 .
Registrar of Pensions at
Date
INFORMATION FOR REGISTRARS, SPECIAL MAGISTRATES, AND CLAIMANTS.
In order to avoid the preparation of claims which must fail, it is important to note that a pension under the War Pensions Act 1914 is payable only to one or more of the following
(a) an incapacitated member of the Forces;
(b) a dependant of a deceased or incapacitated member of the Forces.
No matter what the relationship to the member of the Forces may be, a pension cannot be paid unless dependence can be proved.
2. If, as a result of employment in the warlike operations referred to in the Act, any member of the Forces has lost his life, each of the following members of his family is entitled to a pension if he or she was wholly or in part dependent upon the earnings of the member at the time of his death, viz., widow, father, mother, grandfather, grandmother, step-father, step-mother, son, daughter, grandson, granddaughter, step-son, step-daughter, brother, sister, half-brother, half-sister, adopted child, mother-in-law, ex-nuptial child, ex-nuptial grandchild. (Sec also clauses 5 and 6 hereunder.)
3. If, as a result of such employment, any member of the Forces has not lost his life, but has been incapacitated, his wife and each of his children who, but for his incapacity, would have been dependent upon his earnings, are entitled to pensions. The Act defines “child” as a dependant who is under the age of sixteen years and who is a son, a daughter, a step-son, a step-daughter, or an adopted child of a member of the Forces.
4. It will be noticed that, in the case of a member of the Forces who has not lost his life, the list of persons to whom pensions may be granted is not so comprehensive as it is in the case of a member of the Forces who has died. It should be pointed out, also, that, in the case of a member who has lost his life, the person for whom a pension is clamed must have been a dependant at the time of the member’s death (except as is shown in the next paragraph), while, in the case of a member who has not lost his life, it is necessary to prove that the person for whom pension is claimed would have been dependent upon the
earnings of the member but for his incapacity. In the case of an ex-nuptial child, it is necessary to prove that the member of the Forces, at the time of his death, was actually contributing to the maintenance of the child. Mere blood relationship does not show dependence.
5. Where the parents of a member who has so lost his life were not dependent upon his earnings at the time of his death, but are, at any time within five years after such death, without adequate means of support, a pension may be granted to each of them.
6. Where a member of the Forces who has so lost his life was an ex-nuptial child, any parent or grandparent who was dependent upon his earnings at the time of his death may be granted a pension.
7. (a) “Member of the Forces” means a member of the Commonwealth Naval or Military Forces enlisted or appointed for or employed on active service outside Australia or employed on a ship of war.
(b) “Incapacity” means bodily or mental infirmity which wholly or in part prevents the earning of a livelihood, and which results or has resulted from employment in connexion with the warlike operations referred to in the Act.
(c) “Incapacity” includes incapacity of a member of the Forces arising from disease, not due to the default of the member, contracted by him while employed on active service.
8. (1) In case of the death of a member of the Forces, a claim by a dependant (including widow) will not be recognised if made more than six months after the date of the public notification in the Gazette of the death of the member; but a parent who, though not dependent upon the earnings of the member at the time of his death, is at any time within five years after such death without adequate means of support, may make a claim within five years after such death;
(2) In case of the incapacity of a member of the Forces, a claim by the member or a dependant (including wife) will not be recognised if made more than six months after the termination of the appointment or discharge of the member.
9. In the case of a dependant under the age of sixteen years, it is desirable that the claim be filled in and the truth of the statements declared to by a near relative over the age of sixteen years. If there is not a near relative who is willing to do so, and who is of sufficient ago, the form may be filled in and declared to by any person over the age of sixteen years. In any case the claim must be made within the said period of six months.
10. Pensions cannot be granted in excess of the following:—
(a) In case of the death of a member of the Forces—
(1) To the widow, the rate specified in column two of the Schedule;
(2) To each child, the rate of Thirteen pounds per annum;
(3) To the other dependants, such rates as are assessed by the Pensions Board, but not exceeding in the aggregate the rate specified in column two of the Schedule plus Fifty-two pounds per annum;
Provided that the maximum rate of pension payable to any one dependant of a member shall not in any case exceed the amount specified in column two of the Schedule.
(b) In case of the total incapacity of a member of the Forces—
(1) To the member, the rate specified in column three of the Schedule;
(2) To the wife of the member, Fifty per centum of that rate;
(3) To each child of the member, the rate of Thirteen pounds per annum.
(c) In case of the partial incapacity of a member of the Forces, such less rates than these referred to in paragraph (b) as are assessed by the Pensions Board, having regard to the nature and probable duration of the incapacity.
11. Where the Pensions Board is satisfied that in the case of any member of the Forces the rate of pension payable under the Act is not more than thirty per centum of the rate which would be payable as for the total incapacity of the member, the Pensions Board may, with the sanction of the Minister, assess the lump sum which would in its opinion be equivalent to the payment of a pension under the Act, and in that case the liability to payment of the lump sum so assessed must be substituted for the liability to payment of a pension under the Act.
12. A pension payable to the widow of a member of the Forces ceases upon her re-marriage.
13. Subject to the Act, a pension is absolutely inalienable whether by way or in consequence of sale, assignment, charge, execution, insolvency, or otherwise howsoever. It will be seen, therefore, that a pensioner cannot give his pension as security for the repayment of borrowed money.
14. The provisions of the Act extend to the case of any soldier of the Imperial Reserve Forces called up for active service who, at the commencement of the state of war referred to in the Act was bonâ fide resident in Australia, as if that soldier were a member of the Forces as defined in the Act.
Provided that where the soldier or his dependants is or are entitled to any pension or compensation under any Imperial Act, the rate or amount of that pension or compensation must be taken into account in assessing the rate of pension payable under the Commonwealth Act.
A pension is not payable in the case of any such soldier to any person who is not bonâ fide resident in Australia.
15. Every member of the Forces who claims a pension on the ground that he suffers from an incapacity should prepare a claim in accordance with Form Z.
16. Every person (including wife or widow) who claims a pension on the ground that such person was or would have been a dependant of a member of the Forces, should prepare a claim in accordance with Form Y; provided that where a dependant or dependants is, or are, under the age of sixteen years, a claim should be made on Form X.
17. Every claim should be forwarded by the claimant to a Registrar of Pensions or a Deputy Commissioner of Pensions appointed under the Invalid and Old-age Pensions Act. The police will be found always willing to give to claimants the address of a Registrar of Pensions who, it may be stated, is usually a Clerk of Petty Sessions or a Clerk of the local Court. If there is any doubt about the matter, the claim may be forwarded direct to the Deputy Commissioner of Pensions, whose address may be indicated merely as “Sydney,” “Melbourne,” “Brisbane,” “Adelaide,” “Perth,” or “Hobart,” as the case may be.
18. In any case in which a claimant believes that his claim is being unduly delayed, he should first communicate with the officer to whom he sent the claim, but he may, if the claim is further delayed, communicate with the Commissioner of Pensions, Melbourne.
19. Every claim will be heard by a Registrar or a Special Magistrate, who will request the claimant to appear and to bring before the Registrar or Special Magistrate some other person over the age of sixteen years who knows the circumstances of the person or persons for whom pension is claimed. The claimant alone will receive notification as to the place and time at which the claim will be heard, and the claimant will be expected to notify the other person. Except in special circumstances, no claim will be admitted unless both the claimant and the other person attend before the Registrar or Special Magistrate to give evidence.
THE SCHEDULE.
Scale of Pensions Payable to Widow on Death of a Member of the Forces or to a Member Upon Total Incapacity.
Where the rate of pay of a member of the Forces exceeds a rate shown in column one of this Schedule, and is less than the next higher rate in that column, the rates of pensions payable for the purposes of columns two and three will be proportionately adjusted.
Form X.
Commonwealth of Australia,
The War Pensions Act 1914.
CLAIM FOR WAR PENSION.
(This Form is to be used only in claiming pensions for Dependants under the age of sixteen years. Before filling up the form, road the particulars given on the back of the form for the information of Registrars, Special Magistrates, and Claimants.)
Section 14 of the War Pensions Act 1914 reads:—
Any person who—
(a) obtains any pension or instalment which is not payable;
(b) obtains payment of any pension or instalment by means of any false or misleading statement; or
(c) makes or presents to the Minister or to the Pensions Board or to any officer doing duty in relation to this Act or the regulations, any statement or document which is false in any particular,
shall be guilty of an offence.
Penalty: One hundred pounds or imprisonment for one year.
To the Registrar of Pensions at
I, [here write full name] residing at [here write full postal address and occupation] hereby claim a pension for each dependant who is named in this Pension Claim. I declare that I am more than sixteen years of age and that, to the best of my knowledge and belief, the following replies to the questions and requests for information are true and correct in every particular.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:50.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center"><span style="font-family:'Times New Roman', serif">Questions and requests for Information.</span></p></td><td style="width:49.52%; 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-top:3pt; margin-bottom:3pt; text-align:center"><span style="font-family:'Times New Roman', serif">Replies.</span></p></td></tr><tr style="height:1pt"><td style="width:50.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-right:28.8pt; margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Give the full name of the member of the Forces on whose death or incapacity the claim is based</span><span style="width:10.47pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.52%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">State his rank, his number (if known), and the regiment or branch of the Forces in which he served</span><span style="width:34.23pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.52%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">State whether he is dead, or is alive but incapacitated</span><span style="width:18.64pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.52%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif">State in respect of his first marriage:—</span></p></td><td rowspan="4" style="width:49.52%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full maiden name of wife</span><span style="width:73.56pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...........</span></p></td></tr><tr style="height:1pt"><td style="width:50.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Date of marriage</span><span style="width:112.69pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">.................</span></p></td></tr><tr style="height:1pt"><td style="width:50.48%; 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:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Place of marriage</span><span style="width:109.63pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">................</span></p></td></tr><tr style="height:1pt"><td style="width:50.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif">State in respect of his second marriage (if any):—</span></p></td><td rowspan="4" style="width:49.52%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full maiden name of wife</span><span style="width:73.56pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...........</span></p></td></tr><tr style="height:1pt"><td style="width:50.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Date of marriage</span><span style="width:112.69pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">.................</span></p></td></tr><tr style="height:1pt"><td style="width:50.48%; 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:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Place of marriage</span><span style="width:109.63pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">................</span></p></td></tr><tr style="height:1pt"><td style="width:50.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Give similar details in relation to his other marriages (if any)</span><span style="width:20.41pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:49.52%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:50.94%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center"><span style="font-family:'Times New Roman', serif">Questions and requests for Information.</span></p></td><td style="width:49.06%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center"><span style="font-family:'Times New Roman', serif">Replies.</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; 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:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">State in respect of the first dependant for whom pension is claimed:—</span></p></td><td rowspan="8" style="width:49.06%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full name of dependant</span><span style="width:83.03pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">............</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Date of birth of dependant</span><span style="width:71.13pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..........</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Place of birth of dependant</span><span style="width:68.07pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..........</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Where living at present</span><span style="width:84.27pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">............</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full name of father of dependant</span><span style="width:42.72pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">......</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-right:28.8pt; margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full maiden name of mother of dependant</span><span style="width:2.09pt; text-indent:0pt; display:inline-block"></span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; 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:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Relationship of dependant to the deceased or incapacitated member of Forces who is named above*</span><span style="width:28.76pt; text-indent:0pt; display:inline-block"></span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; 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:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">State in respect of the second dependant for whom pension is claimed</span><span style="width:17pt; text-indent:0pt; display:inline-block"></span></p></td><td rowspan="8" style="width:49.06%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full name of dependant</span><span style="width:83.03pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">............</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Date of birth of dependant</span><span style="width:71.13pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..........</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Place of birth of dependant</span><span style="width:68.07pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..........</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Where living at present</span><span style="width:84.27pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">............</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full name of father of dependant</span><span style="width:42.72pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">......</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-right:28.8pt; margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Fall maiden name of mother of dependant</span><span style="width:2.7pt; text-indent:0pt; display:inline-block"></span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; 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:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Relationship of dependant to the deceased or incapacitated member of Forces who is named above*</span><span style="width:28.76pt; text-indent:0pt; display:inline-block"></span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; 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:14.4pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">State in respect of the third dependant for whom pension is claimed:—</span></p></td><td rowspan="8" style="width:49.06%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full name of dependant</span><span style="width:83.03pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">............</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Date of birth of dependant</span><span style="width:71.13pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..........</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Place of birth of dependant</span><span style="width:68.07pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..........</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Where living at present</span><span style="width:84.27pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">............</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full name of father of dependant</span><span style="width:42.72pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">......</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-right:28.8pt; margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full maiden name of mother of dependant</span><span style="width:2.09pt; text-indent:0pt; display:inline-block"></span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; 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:43.2pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Relationship of dependant to the deceased or incapacitated member of Forces who is named above*</span><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; 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:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">State in respect of the fourth dependant for whom pension is claimed:—</span></p></td><td rowspan="8" style="width:49.06%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full name of dependant</span><span style="width:83.03pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">............</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Date of birth of dependant</span><span style="width:71.13pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..........</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Place of birth of dependant</span><span style="width:68.07pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..........</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Where living at present</span><span style="width:84.27pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">............</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full name of father of dependant</span><span style="width:42.72pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">......</span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-right:28.8pt; margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full maiden, name of mother of dependant</span><span style="width:35.34pt; text-indent:0pt; display:inline-block"></span></p></td></tr><tr style="height:1pt"><td style="width:50.94%; 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:43.2pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Relationship of dependant to the deceased or incapacitated member of Forces who is named above*</span><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
*State here whether the relationship is that of son, daughter, grandson, granddaughter, step-son step-daughter, brother, sister, half-brother, half-sister, adopted child, ex-nuptial child or ex-nuptial grandchild.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:51.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center"><span style="font-family:'Times New Roman', serif">Questions and requests for Information.</span></p></td><td style="width:48.52%; 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-top:3pt; margin-bottom:3pt; text-align:center"><span style="font-family:'Times New Roman', serif">Replies.</span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; 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:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">State in respect of the fifth dependant for whom pension is claimed:—</span></p></td><td rowspan="8" style="width:48.52%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full name of dependant</span><span style="width:83.03pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">............</span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Date of birth of dependant</span><span style="width:71.13pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..........</span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Place of birth of dependant</span><span style="width:68.07pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..........</span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Where living at present</span><span style="width:84.27pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">............</span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full name of father of dependant</span><span style="width:42.72pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">......</span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-right:28.8pt; margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full maiden name of mother of dependant</span><span style="width:2.09pt; text-indent:0pt; display:inline-block"></span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; 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:43.2pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Relationship of dependant to the deceased or incapacitated member of Forces who is named above*</span><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; 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:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">State in respect of the sixth dependant for for whom pension is claimed:—</span></p></td><td rowspan="8" style="width:48.52%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full name of dependant</span><span style="width:83.03pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">............</span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Date of birth of dependant</span><span style="width:71.13pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..........</span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Place of birth of dependant</span><span style="width:68.07pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..........</span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Where living at present</span><span style="width:84.27pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">............</span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full name of father of dependant</span><span style="width:42.72pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">......</span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-right:28.8pt; margin-left:43.2pt; text-indent:-14.4pt"><span style="font-family:'Times New Roman', serif">Full maiden name of mother of dependant</span><span style="width:2.09pt; text-indent:0pt; display:inline-block"></span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; 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:43.2pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Relationship of dependant to the deceased or incapacitated member of Forces who is named above*</span><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Give similar details in respect of each other dependant for whom pension is claimed</span><span style="width:26.09pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:48.52%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; 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-right:14.4pt; margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Was every one of the persons named in this claim dependent upon the earnings of the aforesaid member of the Forces at the time of his death?</span><span style="font-family:'Times New Roman', serif"></span></p></td><td rowspan="2" style="width:48.52%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; 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:50.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">(This question will, of course, not be answered if such member is alive.)</span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; 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:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Would every one of the persons named in this claim have been dependent on the earnings of the aforesaid member of the Forces but for his incapacity?</span><span style="font-family:'Times New Roman', serif"></span></p></td><td rowspan="2" style="width:48.52%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:36pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">(This question will, of course, not be answered if such member is dead.)</span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Do you consider yourself well qualified to speak of the sources of maintenance of the dependants referred to in this claim?</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:48.52%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">Give your reasons for considering yourself to be so qualified</span><span style="width:20.71pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:48.52%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">What is your relationship to the dependants?</span><span style="width:19.89pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...</span></p></td><td style="width:48.52%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:51.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify"><span style="font-family:'Times New Roman', serif">In the last twelve months has any person other than the aforesaid member of the Forces maintained or contributed towards the maintenance of any of the dependants referred to in this claim?</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:48.52%; 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><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
*State here whether the relationship is that of son, daughter, grandson, granddaughter, step-son step-daughter, brother, sister, half-brother, half-sister, adopted child, ex-nuptial child or ex-nuptial grandchild.
Questions and requests for Information.
Replies.
If so, give full particulars...............
If as any of the dependants referred to in this claim earned money in the last twelve month?
If so, give full particulars...............
Give the name and address of some person over the age of sixteen years who is able and willing to receive and economically disburse the pensions which may be granted in pursuance of this claim*
What relationship does such person bear to the dependants?
Are any of the dependants named in this claim receiving or are they entitled to receive under any Commonwealth Act other than the War Pensions Act 1914, or under any Imperial Act or State Act, any payment by way of compensation, pension, retiring allowance, superannuation, or gratuity?
If so, give full particulars...............
At what Post Office should pensions, if granted, be paid?
Give the names and addresses of all persons known to you (other than those named in this claim) who were dependent upon the earnings of the aforesaid member of the Forces at the time of his death. (This question will, of course, not be answered if such member is alive.)
* If the dependants have a parent, the parent’s name and address should be here given unless the parent is a person to whom, (or say reason, the pension should not be paid.
Declared at
the
day of
191
Signature of Declared —
Before me,*†
* The person before whom this declaration is made 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 postmistress, or person in charge of a post office, a police, stipendiary, or special magistrate of the Commonwealth or of 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 1908-1912, a minister of religion, an officer of the Commonwealth Department of the Treasury, or a member of the Parliament of the Commonwealth.
The foregoing claim was received by me on
191
Registrar of Pensions at
Date
INFORMATION FOR REGISTRARS, SPECIAL MAGISTRATES, AND CLAIMANTS.
In order to avoid the preparation of claims which must fail, it is important to note that a pension under the War Pensions Act 1914 is payable only to one or more of the following:—
(a) an incapacitated member of the Force;
(b) a dependant of a deceased or incapacitated member of the Forces.
No matter what the relationship to the member of the Forces may be, a pension cannot be paid unless dependence can be proved.
2. If, as a result of employment in the warlike operations referred to in the Act, any member of the Forces has lost his life, each of the following members of his family is entitled to a pension if he or she was wholly or in part dependent upon the earnings of the member at the time of his death, viz., widow, father, mother, grandfather, grandmother, step-father, step-mother, son, daughter, grandson, granddaughter, step-son, step-daughter, brother, sister, half-brother, half-sister, adopted child, mother-in-law, ex-nuptial child, ex-nuptial grandchild. (Sec also clauses 5 and 6 hereunder.)
3. If, as a result of such employment, any member of the Forces has not lost his life, but has been incapacitated, his wife and each of his children who, but for his incapacity, would have been dependent upon his earnings, are entitled to pensions. The Act defines “child” as a dependant who is under the age of sixteen years and who is a son, a daughter, a step-son, a step-daughter, or an adopted child of a member of the Forces.
4. It will be noticed that, in the case of a member of the Forces who has not lost his life the list of persons to whom pensions may be granted is not so comprehensive as it is in the case of a member of the Forces who has died. It should be pointed out, also, that, in the case of a member who has lost his life, the person for whom a pension is claimed must have been a dependant at the time of the member’s death (except as is shown in the next paragraph), while, in the case of a member who has not lost his life, it is necessary to prove that the person for whom pension is claimed would have been dependent upon the earnings of the member but for his incapacity. In the case of an ex-nuptial child, it is necessary to prove that the member of the Force, at the time of his death, was actually contributing to the maintenance of the child. Mere blood relationship does not show dependence.
5. Where the parents of a member who has so lost his life, were not dependent upon his earnings at the time of his death, but are, at any time within five years after such death, without adequate means of support, a pension may be granted to each of them.
6. Where a member of the Forces who has so lost his life was an ex-nuptial child, any parent or grandparent who was dependent upon his earnings at the time of his death may be granted a pension.
7. (a) “Member of the Forces” means a member of the Commonwealth Naval or Military Forces enlisted or appointed for or employed on active service outside Australia or employed on a ship of war.
(b) “Incapacity” means bodily or mental infirmity which wholly or in part prevents the earning of a livelihood, and which results or has resulted from employment in connexion with the warlike operations referred to in the Act.
(c) “Incapacity” includes incapacity of a member of the Forces arising from disease, not due to the default of the member, contracted by him while employed on active service.
8. (1) In case of the death of a member of the Forces, a claim by a dependant (including widow) will not be recognised if made more than six months after the date of the public notification in the Gazette of the death of the member; but a parent who, though not dependent upon the earnings of the member at the time of his death, is at any time within five years after such death without adequate means of support, may make a claim within five years after such death;
(2) In case of the incapacity of a member of the Forces, a claim by the member or a dependant (including wife) will not be recognised if made more than six months after the termination of the appointment or discharge of the member.
9. In the case of a dependant under the age of sixteen years, it is desirable that the claim be filled in and the truth of the statements declared to by a near relative over the age of sixteen years. If there is not a near relative who is willing to do so, and who is of sufficient age, the form may be filled in and declared to by any person over the age of sixteen years. In any case the claim must be made within the said period of six months.
10. Pensions cannot be granted in excess of the following:—
(a) In case of the death of a member of the Forces—
(1) To the widow, the rate specified in column two of the Schedule;
(2) To each child, the rate of Thirteen pounds per annum;
(3) To the other dependants, such rates as are assessed by the Pensions Board, but not exceeding in the aggregate the rate specified in column two of the Schedule plus Fifty-two pounds per annum;
Provided that the maximum rate of pension payable to any one dependant of a member shall not in any case exceed the amount specified in column two of the Schedule.
(b) In case of the total incapacity of a member of the Forces—
(1) To the member, the rate specified in column three of the Schedule;
(2) To the wife of the member, Fifty per centum of that rate;
(3) To each child of the member, the rate of Thirteen pounds per annum.
(c) In case of the partial incapacity of a member of the Forces, such less rates than these referred to in paragraph (b) as are assessed by the Pensions Board, having regard to the nature and probable duration of the incapacity
11. Where the Pensions Board is satisfied that in the case of any member of the Forces the rate of pension payable under the Act is not more than thirty per centum of the rate which would be payable as for the total incapacity of the member, the Pensions Board may, with the sanction of the Minister, assess the lump sum which would in its opinion be equivalent to the payment of a pension under the Act, and in that case the liability to payment of the lump sum so assessed must be substituted for the liability to payment of a pension under the Act.
12. A pension payable to the widow of a member of the Forces ceases upon her re-marriage.
13. Subject to the Act, a pension is absolutely inalienable whether by way or in consequence of sale, assignment, charge, execution, insolvency, or otherwise howsoever. It will be seen, therefore, that a pensioner cannot give his pension as security for the repayment of borrowed money.
14. The provisions of the Act extend to the case of any soldier of the Imperial Reserve Forces called up for active service who, at the commencement of the state of war referred to in the Act was bonâ fide resident in Australia, as if that soldier were a member of the Forces as defined in the Act.
Provided that where the soldier or his dependants is or are entitled to any pension or compensation under any Imperial Act, the rate or amount of that pension or compensation must be taken into account in assessing the rate of pension payable under the Commonwealth Act.
A pension is not payable in the case of any such soldier to any person who is not bonâ fide resident in Australia.
15. Every member of the Forces who claims a pension on the ground that he suffers from an incapacity should prepare a claim in accordance with Form Z.
16. Every person (including wife or widow) who claims a pension on the ground that such person was or would have been a dependant of a member of the Forces, should prepare a claim in accordance with Form Y; provided that where a dependant or dependants is, or are, under the age of sixteen years, a claim should be made on Form X.
17. Every claim should be forwarded by the claimant to a Registrar of Pensions or a Deputy Commissioner of Pensions appointed under the Invalid and Old-age Pensions Act. The police will be found always willing to give to claimants the address of a Registrar of Pensions who, it may be stated, is usually a Clerk of Petty Sessions or a Clerk of the
local Court. If there is any doubt about the matter, the claim may be forwarded direct to the Deputy Commissioner of Pensions, whose address may be indicated merely as “Sydney,” “Melbourne,” “Brisbane,” “Adelaide,” “Perth,” or “Hobart,” as the case may be.
18. In any case in which a claimant believes that his claim is being unduly delayed, he should first communicate with the officer to whom be sent the claim, but he may, If the claim is further delayed, communicate with the Commissioner of Pensions, Melbourne.
19. Every claim will be heard by a Registrar or a Special Magistrate, who will request the claimant to appear and to bring before the Registrar or Special Magistrate some other person over the age of sixteen years who knows the circumstances of the person or persons for whom pension is claimed. The claimant alone will receive notification as to the place and time at which the claim will be heard, and the claimant will be expected to notify the other person. Except in special circumstances, no claim will be admitted unless both the claimant and the other person attend before the Registrar or Special Magistrate to give evidence.
THE SCHEDULE.
Scale of Pensions Payable to Widow on Death of a Member of the Forces or to a Member Upon Total Incapacity.
Where the rate of pay of a member of the Forces exceeds a rate shown in column one of this Schedule, and is less than the next higher rate in that column, the rates of pensions payable for the purposes of columns two and three will be proportionately adjusted.
Commonwealth of Australia. Form W.
The War Pensions Act 1914.
REQUEST TO CLAIMANT FOR ATTENDANCE.
To
You are requested to attend at my office in at o’clock in the
noon of 191 , in order that you may give evidence in relation to the claim made by you for a war pension. It is further requested that you bring with you some other person over the age of sixteen yean who has a knowledge of the circumstances of the person or persons for whom pension is claimed.
If you are unable to attend, you should so inform me immediately, and give the reason which prevents your attendance.
* Registrar of Pensions,
* Special Magistrate
Date
* Strike out what is inapplicable
Form U.
Commonwealth of Australia.
The War Pensions Act 1914.
RECORD OF EVIDENCE.
Evidence given by of
in respect of the claim made by
for a pension to be paid to
(Signed)
Date
The foregoing evidence was read by me to the person who gave it before he (or she) signed this sheet.
*Registrar of Pensions at
*Special Magistrate at
Date
*Strike out what is inapplicable.
Form T.
Commonwealth of Australia.
The War Pensions Act 1914.
POLICE REPORT.
From the Registrar of Pensions at
To the Officer in Charge of Police at
Claimant—Name
Address
It is requested you will be good enough to make inquiries and report to me in the matter referred to hereunder. The inquiries should be made, if possible, from disinterested persons.
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 “Pensions.”
Registrar of Pensions.
Date
Matter in which report is requested
Report
(Signed)
(Name and rank of member of Police Force who makes the report.)
Date
Commonwealth of Australia. Form S.
The War Pensions Act 1914.
CONFIDENTIAL REPORT.
Regulation No. 14 under the Act reads:—
The Commissioner or the Deputy Commissioner or the Registrar may require any person whom he believes to be in a position to do so to furnish to him a confidential written report as to the circumstances of, the names ages and means of livelihood of the dependants of, the family and blood relationships of, the means of livelihood of, and the age of any person who claims a person or for whom a pension is claimed; and any person who, on being required to do so by the Commissioner or the Deputy Commissioner or the Registrar, falls 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, and shall be liable to a penalty not exceeding One hundred pounds.
From the Registrar of Pensions at
To
Address
Claimant—Name
Address
It is requested that you will be good enough to supply, on this form, the information which is asked for hereunder.
Registrar of Pensions.
Date
Information asked for—
Reply—
(Signed)
Date
Commonwealth of Australia. Form R.
The War Pensions Act 1914
REPORT OF REGISTRAR.
To the Deputy Commissioner of Pensions at
(Here set out the names of the dependants to the Member of the Forces and the extent of the dependence in each case.)
I have to report that I have investigated the claim made byfor a pension for and I find that
(Here set out the name and the relationship to the Member of the Forces of each person for whom pension in claimed.)
I also find that
I further find that the person whose name and address here follow is a person over the age of sixteen years who is able and willing to receive and economically disburse the pensions which may be granted in pursuance of the claim under notice.
The name and address referred to are:—
Registrar of Pensions at
Date
Form P.
War Pension Certificate No.
Post Office Date Stamp to be
Image unavailable in extracted textCommonwealth of Australia.
The War Pensions Act 1914.
RECEIPT.
placed in this square
I acknowledge to have received the sum of £ : : , being pension payable in advance in accordance with Pension Certificate numbered as above for the fortnight commenced
Signature
Note—Whenever payment of a pension instalment is made, the paying officer will hand to the pensioner or the trustee a blank form of receipt which must be brought back, on the next pension pay-day, already filled in and signed. If the pensioner or the trustee cannot call at the pay office he should not use this form of receipt, but he may obtain from any post office an order form, on which he may authorize another person to draw an instalment of the pension.
War Pension Certificate No.
Post Office Date Stamp to be
Image unavailable in extracted textform O. Commonwealth of Australia.
The War Pensions Act 1914.
ORDER FORM AND RECEIPT.
placed in this square
I hereby authorize , who is a person over the age of sixteen years, to receive the pension payable under the Certificate above referred to for the fortnight commenced
Signature
Postal Address
Date
I, being a person over the age of sixteen years, acknowledge to have received the sum of £ : : , being pension payable as above. I last saw the person whose signature appears above on
Signature
Address
Note—Whenever payment of a pension instalment is made, the paying officer will hand to the person who is paid a blank form of receipt, which must be brought back on the next pension pay-day, already filled in and signed.
[See instructions on back.]
[To be printed on back.]
If the pensioner or the trustee cannot write, he should make his mark in the presence of a witness, and the witness should sign his own name. A mark, properly taken and witnessed, reads;—
his
John x Brown,
mark.
Witness to mark—John Robinson
Form N
Commonwealth of Australia.
The War Pensions Act 1914.
DECLARATION OF WIDOW
I hereby declare that I am the widow of , and that, at the date which is written after my signature hereon, I have not married again
Signature
Date
Note.—One of these forms must be duly completed and handed to the postmaster whenever a widow applies for payment of an instalment of pension, and the form will not be accepted by the postmaster if it bears a date prior to the date on which the instalment became due.
Form M.
Commonwealth of Australia.
The War Pensions Act 1914.
DECLARATION OF TRUSTEE.
I hereby declare that the pensioners whose names are written below are alive at the date which is written after my signature hereon and that I am entitled to draw their pensions.
Names of pensioners—
Signature
Date
Note—One of these forms must be duly completed and handed to the postmaster whenever a trustee applies for payment of an instalment of pension and the form will not be accepted by the postmaster if it bears a date prior to the date on which the instalment became due.
Commonwealth of Australia. Form L
The War Pensions Act 1914.
THE DISTRICT REGISTER OF WAR PENSION CLAIMS
Date of Receipt of Claim.
Name of Claimant.
Address of Claimant.
Surname of each Person, for whom Pension Claimed.
Christian Name of each Person for whom Pension Claimed.
Date when papers forwarded to the Deputy Commissioner.
Remarks.
Form K.
Commonwealth of Australia.
The War Pensions Act 1914.
MEDICAL CERTIFICATE.
I,
hereby declare that I have this day examined of
a claimant for a pension under the above-named Act.
I find that the claimant—
(1) Is about years of age.
(2) Is suffering from (a)
(3) The above condition is the result of (b)
(4) It has in my opinion existed for (c)
and is (d) to the default of the claimant.
(5) The condition is such as to render claimant incapacitated for work for the
period of (e) from this date.
(6) The claimant has lost his earning power to the extent of (f)
Commonwealth Medical Referee.
(Address)
Date 191
To the
Deputy Commissioner of Pensions.
(a) Fully describe claimant’s general condition.
(b) Give information showing whether the condition has resulted from claimant’s employment in connexion with warlike operations.
(c) Fill in period of time.
(d) Insert “due” or “not due,” as the case requires.
(e) State period of time
(f) If earning power wholly lost state “the whole.” If only partially lost give the fraction which has been lost as, for example, “one-half” or “three-fourths”
[Outside of Card]
6, July, 1916.
23 Sept., 1916.
21 Dec., 1916.
15 Mar., 1917.
20 July, 1916.
12 Oct., 1916.
4 Jan., 1917.
29 Mar., 1917.
3 Aug., 1916.
26 Oct., 1916.
18 Jan., 1917
12 Apr., 1917.
17 Aug., 1916.
9 Nov., 1916.
1 Feb., 1917
26 Apr., 1917.
31 Aug., 1916.
23 Nov., 1916.
15 Feb., 1917
10 May, 1917.
14 Sept., 1916.
7 Dec., 1916.
1 Mar., 1917.
24 May, 1917.
Form J
WAR PENSION CERTIFICATE.
I certify that a Pension, detailed on the other side hereof, has been granted. The first instalment payable was due on Pension Thursday, the 191
on which date the following amount became due:—
Odd days, from to £
Fortnight in advance, from
Total................................£
Deputy Commissioner,
Date
The Pension is payable only at the office named herein, and no application, for Temporary Transfer to another office will be entertained.
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.
If the pensioner or the trustee cannot apply in person, he may, on a form obtainable from any Post Office, give an order to another person.
It is important to note that a Pension is not a security on which money may be borrowed, because, subject to the Act, a pension is absolutely inalienable whether by way or in consequence of sale, assignment, charge, execution, insolvency, or otherwise, howsoever.
Transfers to another office of payment should be noted hereunder:—
Payment to be made in future at—
Signature of Postmaster
Date
The officer paying to place his date stamp on the proper space when payment is made. If he has no date stamp he must place his initials and the date in the space (in ink, not pencil). When, for example, the instalment due on 13th May, 1915, for the fortnight commenced on that day, is paid, the date stamp must be placed in the space in which the date 13th May, 1915, is printed.
Image unavailable in extracted textName of member of the Forces in respect of whose death or incapacity this pension is payable
Pension certificate No.
Pension as above, at the rate of fortnightly, has been granted from
payable in advance at
The first instalment payable was due on “Pension Thursday,” the 191 , on which date the following amount became due.
<table cellspacing="0" cellpadding="0" style="width:79.58%; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:50.6%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:72pt"><span style="font-family:'Times New Roman', serif">Odd days from</span></p></td><td style="width:29.82%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif">to</span><span style="width:94.54pt; font-family:'Lucida Console', monospace; display:inline-block">..............</span></p></td><td style="width:19.58%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p><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-left:72pt"><span style="font-family:'Times New Roman', serif">Fortnight in advance from</span><span style="width:64.83pt; font-family:'Lucida Console', monospace; display:inline-block">.........</span></p></td><td style="width:19.58%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p><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-left:94.5pt; text-align:right"><span style="font-family:'Times New Roman', serif">Total</span><span style="width:98.29pt; font-family:'Lucida Console', monospace; display:inline-block">..............</span></p></td><td style="width:19.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif">£</span></p></td></tr><tr style="height:1pt"><td colspan="3" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="text-align:right"><span style="font-family:'Times New Roman', serif">Deputy Commissioner.</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:19.58%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p><span style="font-family:'Times New Roman', serif">Date</span></p></td></tr></tbody></table>
Payment to be made in future at
The last payment made at this office was due on “Pension Thursday,” the
191
(Signed)
Postmaster at
Date
Payment to be made in future at
The last payment made at this office was due on “Pension Thursday,” the
191 .
(Signed)
Postmaster at
Date
Payment to be made in future at
The last payment made at this office was due on “Pension Thursday,” the
191 .
(Signed)
Postmaster at
Date
*Strike out what is inapplicable.
Form G.
Commonwealth of Australia.
The War Pensions Act 1914.
APPLICATION FOR DUPLICATE CERTIFICATE.
To the Deputy Commissioner of Pensions at
I, of being a pensioner, or trustee, 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 name or names of the pensioner or pensioners is or are
2. The original Certificate was duly issued to me and has been lost [or, as the case may be, destroyed].
3.*
4. † I have made diligent search for the lost Certificate, but have been unable to find it.
5. I do hereby solemnly declare that this statement is true.
Image unavailable in extracted textDeclared by the said
at this
, 191 , before me— Applicant.
‡§
* If destroyed, state when and how.
† If lost.
‡ The person before whom this declaration is made 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 postmistress, or person in charge of a post-office, a police, stipendiary or special magistrate of the Commonwealth or of 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 a affidavits, a registrar under the Invalid and Old-Age Pensions Act 1908-1912, a minister of religion, an officer of the Commonwealth Department of the Treasury, or a member of the Parliament of the Commonwealth.
Form ZZ.
Commonwealth of Australia.
The War Pensions Act 1914.
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 the 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 to The last payment made at this office was due on “Pension Thursday,” the 191
Postmaster or Paying Officer.
Form YY.
Commonwealth of Australia,
The War Pensions Act 1914.
REQUISITION FOR FORMS.
In order to guard against any waste of forms, &c., care should be exercised to see that responsible 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
Signature
Office
Place
Date
Approximate number in stock.
Number now required.
Designation of Form.
Z Claim by an Incapacitated Member of the Forces.
Y Claim by a dependant (including wife or widow) over the age of sixteen years.
X Claim on behalf of Dependants under the age of sixteen years.
W Request to Claimant for Attendance.
U Record of Evidence.
T Police Report.
S Confidential Report.
R Report of Registrar.
P Receipt.
O Order Form and Receipt.
N Declaration of Widow.
M Declaration of Trustee.
L District Register of War Pension Claims.
K Medical Certificate.
J Pension Certificate.
H Identification Card.
G Application for Duplicate Certificate.
ZZ Application for Change of Place of Payment.
YY Requisition for Forms.
XX Postage and Telegram Docket (in sheet form) for Registrars only
XX Postage and Telegram Docket (in book form) for Postmasters only.
WW Notice of Death.Envelope addressed “Registrar of Pensions.”War Pensions Docket.
Form XX.
Commonwealth of Australia.
Department of the Treasury.
PENSIONS.
Place
Date
Number of Articles
Image unavailable in extracted text* Postage due
* Due for Telegram £ : :
Signature and Designation of Officer.
*Strike out what is inapplicable.
Form WW.
Commonwealth of Australia
The War Pensions Act 1914.
NOTICE OF DEATH.
To the Deputy Commissioner of Pensions at
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 War Pensions Act, whose Pension was paid at
Image unavailable in extracted textDistrict Registrar of Births, Deaths, and Marriages, or, Official charged with duty of registering deaths.
Address of the official making this report
Date 19
*Insert full name and last address; also any other available particulars likely to assist in identification.
A regulation under the War Pensions Act 1914 authorizes the official registering a death to inquire when registering the death of any person, whether the deceased was a Pensioner under the Act, and. if so, to notify the Deputy Commissioner. As War Pensions are granted to persons of all ages, inquiry should be made in all cases.
Printed and Published for the Government of the Commonwealth of Australia by Albert J. Mullett, Government Printer for the State of Victoria.