H.—l2

28

(c.) Distress or Benevolent Fund (jf any).

We,* the undersigned, having been appointed to conduct the audit for the year by , under tho authority of Rule No. , having had access to all the books and accounts ofthe (and examined the securities held for loans and investments, and particularly those on which the interest was in arrear),t and having examined the foregoing general statement, and verified the same with the accounts and vouchers relating thereto, now sign the same as found to be correct, duly vouched, and in accordance with law. (1.5.) and , Auditors Date: 18 . If in any respect these accounts are incorrect, unvouched, or not in accordance with law, the Auditors are not to sign as above, but are to make a special report to the , of which a copy is to be sent to the Registrar with this statement.

* If the audit was conducted by a public auditor appointed under " The Friendly Societies Act, 1877," this declaration should be varied accordingly. t If no portion of the assets of the consisted of such investments, these words should be struck out.

Receipts. £ s. d. Expenditure. £ s. d. Contributions of members Donations... interest Dther receipts (to be specified) Gifts to members Other payments (to be specified) Total receipts £ Amount of fund, 1st January, 18 (including investments as well as cash) Total expenditure £ Amount of fund, 31st December, 18 (including investments as well as cash) Total ... £ Total ... £ Balanct 'Sheet. Liabilities. £ s. d. Assets. £ s. d. Amount of sick and funeral fund («.) ... Amount of management expenses fund (*■) Amount of distress or benevolent fund (c.) Amount of other funds, if any (to be specified) (A.) —Investments — 1. In the Post Office Savings Bank 2. In the Savings Bank, yielding interest at per cent. 3. On deposit in the Bank of , yielding interest at per cent. 4. Upon Government securities in New Zealand, yielding interest at per cent. 5. Upon real securities in New Zealand, yielding interest at an average of per Amount of other liabilities, if any (to be specified) cent. 6. In land and buildings (state separately, if possible) 7. On other securities (to be fully specified, with average rate of interest yielded by each investment) (B.)—Cash— 1. On current account in the Bank of 2. In the hands of treasurer or other officers ... (C.) —Value of goods on hand (D.) —Other assets, if any (to be fully specified) . * Total ... £ Total... £ Signature of one of the trustees : Signature of secretary: Signature of treasurer: Registered office of society: