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The Pamphlet Collection of Sir Robert Stout: Volume 21

Schedule of Forms

Schedule of Forms.

No. 1.—Form of Application for Dispensation for Opening New Tents.

To the Chief Ruler of the New Zealand Central District.

We, the undersigned, pledged total abstainers, residing at _____ hereby make application for a Dispensation to open a Tent of the Independent Order of Rechabites, to be held at _____ to be called the _____ Tent, to be opened on the _____ day of _____ 18 _____, and we request that you will provide the necessary material for such opening and for the proper conduct of such Tent.

[Here follow the names, ages, professions, and places of resi- page 38 dence of the candidates, The application must be forwarded under cover to the District Secretary, and should be accompanied with a remittance of not less than thirty shillings.]

The following Rules should he adopted with reference to the opening of New Tents:—
1.A greater number than ten candidates should, if possible, be procured, in order to provide for the unavoidable absence of one or two candidates, as it is not considered expedient to open a Tent with a lesser number than ten members.
2.No candidate can be initiated into the order unless he produce a certificate of health from a medical practitioner; hence the candidates should endeavour to arrange with a Surgeon in their neighbourhood to examine them and furnish them with certificates. It is recommended that the candidates select for this purpose the medical practitioner whom they intend to elect as their Tent Surgeon.
3.The candidates should meet together, and decide as to the place and night of meeting, and the candidates they intend to select for officers of the new Tent—the principal officers being Chief Ruler, Deputy Ruler, Secretary, and Treasurer.
4.All candidates must, at their initiation, pay at least half their initiation-money. The tables at pages 17-18 will give the exact figures.
5.Upon any doubtful matter, consult the District Secretary.

No, 2.—Form of Notice to Secretary when claiming Sick Pay.

Tent, No. To Bro. Secretary.

I hereby claim the Sick Allowance to which I am entitled under the General Laws, being unable to follow my employment.

Name

Address

Note.—This Notice to Secretary, and the Tent Surgeon's Certificate underneath, must be forwarded to the Secretary in accordance with Bye-law of Tent.

No. 3.—Form of Surgeon's Certificate on Fund.

I certify that the above-named _____ is afflicted with or suffering from _____ and is not able to follow his employment. _____ Tent Surgeon.

No. 4.—Form of Declaration off Fund.

Tent, No. To Bro. Secretary.

I hereby declare myself off the Sick Fund of the Tent, being now able to return to my occupation.

Name

Address

No. 5.—Form of Surgeon's Certificate off Fund.

I certify that the above-named _____ is now able to resume his occupation. _____ Tent Surgeon.

Note.—The 48th General Law requires this Notice to be forwarded Immediately to Tent Secretary.

page 39

No. 6.—Medical Certificate claiming Funeral Allowance.

I, _____ hereby certify that _____ aged _____ years, late of _____ died on the _____ day of _____ 18 _____, and that I consider his (or her) death to have been caused by _____ (or the verdict was, as the case may be). _____ Dated this _____ day of _____ 18 _____ Tent Surgeon (or legally-qualified Medical Practitioner, residing at _____, or Coroner, as the case may be).

No. 7.—Certificate of Appointment of Representatives to District Council.

To the District Secretary.

This is to certify that Brother _____ was duly elected to represent this Tent in the District Council. _____ Dated at _____ Tent, No. _____, this _____ day of _____ 18

(Tent Seal.) C.R.

Secretary.

[If the representative cannot attend personally, he must give his proxy an appointment according to following form, which must be forwarded by the Secretary to the District Secretary.]

No. 8.—Certificate of Appointment of Proxy.

This is to certify that I have appointed Brother _____ of _____ Tent, No. _____ to act as my proxy at the meetings of the District Council.

Dated this _____ day of _____ 18 .

Tent Representative.

No. 9.—Form of Receipt or Acknowledgment to be endorsed on Mortgages or further charges.

We, the undersigned, being the Trustees for the time being of the within-named [New Zealand Central District Independent Order of Rechabites; or _____ Tent, No. _____ of the New Zealand Central District Independent Order of Rechabites, as the case may be], do hereby acknowledge to have received of and from the within-named Mortgagor, his heirs, executors, administrators, or assigns, all moneys intended to be secured by he within written deed or instrument.

Witness our hands the _____ day _____ 18

Witness,