A.—3a.

16

chief mate of his vessel.. The statements will be delivered by him, and duty, if any, paid to the revenue officer at the first island at which he may find this official established.

FORM A. GoVEENMENT OF THE COOK ISLANDS. Port of . Bill of Health. To all to whom these presents shall come. I, the undersigned, being the officer appointed thereto by the Government of the Cook Islands, hereby make known that whereas the vessel called the , whose master is , is about to sail from the said port of on the day of , in the year of our Lord, , and from thence to , and other places beyond the seas, with persons on board, including the said master. Now know ye that I, the said master, do hereby make it known to all men, and pledge my faith thereto, that at the time of my granting these presents, no pestilence, plague, cholera, nor any dangerous or contagious disorder exists in the above port or neighbourhood. In testifying whereof I have hereunto set my name on the day and year aforesaid. Given in the office of the Collector of Eevenue at the Port of , on the day of , in the year of our Lord . (Collector of Eevenue.)

FORM B. I, , master of the steamship , of ,do hereby authorise ,of , to act for me, and to perform all requirements of the regulations under the Import Duty Acts in my behalf, and I [or we] , the said agent [or agents], do hereby accept all responsibility that would otherwise devolve upon the master of the said steamship if in Earotonga. In presence of , Collector. (Master.) (Agent or Agents.)

FORM C. This is to certify that the ,of , was duly entered on the day of , that all duties have been paid upon her cargo, and that she is entitled to trade with any island of the Cook Group. Earotonga, day of . (Collector.)

FORM D. is hereby authorised to land the following arms, ammunition, dynamite, or other explosives from the , at Earotonga, (Collector.)

FORM E. Outwards Fobbign. Outwaeds Manifest of the , for , tons register, Port of Barotonga. of the p ort of , a ship with men, of whom ' British and foreign, besides , a master and passengers, consisting of males, females, adults; '.'I yy and male and female children. (Agents).,

I declare that the above-written manifest is a just report of the ship and of her lading, and that the particulars therein inserted are true to the best of my knowledge. (Master or Agent.) Declared before me this day of , in the presence of— " (Collector.)

Marks and Numbers. Number and Description of Packages and Contents. Shippers. Consignees. Number of Passengers. Names of Crew. List of Stores.