This is to Certify that I have carefully examined the above-named_______and find him in good health, and of sound constitution, and believe his ace to be as declared by him. I have also examined his wife and find her to be in good health, and of sound constitution.

As Witness my hand this_______day of_______18

Medical Officer

Schedule E.

Declaring on Notice.

Members' Claim for Sick Pay.

To the Officers of Court_______No. _______A.O.F.

I hereby give notice that I have been unable to follow any employment from the_______day of page 51 18. I there fore declare on the Sick Fond of the Court from

Schedules.

that time.

Dated this_______day of_______18

Surgeon's Sick Certificate.

To the Officers of Court_______No. _______A.O.F.

I hereby certify that Brother_______, residing in

_______, is unable to follow any employment, being under my treatment from the_______day_______18_______afflicted with

Dated this_______day of_______18_______, at_______o'clock.

Court Surgeon.

Schedule F.

Declaring off Notice.

To the Officers of Court_______No. _______A O.F.

I hereby declare off the Sick Fund of the Court, considering myself able to follow some employment.

Dated this_______day of_______18

Surgeon's Recovery Certificate.

To the Officers of Court_______No._______A.O.F.

I hereby certify that Brother_______is sufficiently recovered from his illness to enable him to follow some employment.

Dated this_______day of_______18

Court Surgeon.

Schedule G.

To the Auckland District. A.O.F.

We, the Officers of Court_______, hereby certify that Bro._______joined our Court by_______on the_______day of_______188, and that he died on page 52

Schedules.

The______day of______188______, as stated in the certificate attached.

And we further certify that the said Bro.______did not at the time of his death, or for four weeks prior to his death, owe to our Court more than fourteen weeks' contributions, nor has he or this Court in any way forfeited their claim to the Funeral Money allowed by the District.

This Court having advanced the Funeral pay on account of the District, in conformity with District Laws, hereby make application for the repayment of the sum of £