Total Amount Received on Account of—
Sickness Benefits
Annuities Commencing
Yeal* Ending
Total
Funds at
end
of Year.
Amount
Received
as
Interest.
Ceasing
at Age .
to
.3 o
CO to
§◄
Ceasing
at Age .
Throughout
Life.
Sums at
Death.
At Age . j
At Age . '
l
At Age . J
Endowments.
Other
Receipts
(to be
specified).
£
31st Dec., 18
„ 18
„ 18
„ 18
„ 13
£
£
£
£
£
£
£
£
£
£
£
£
Total -
to Total Amount Paid on Account of Sickness Benefits.
Ceasing at Age
Ceasing at Age
Ceasing at Age
Throughout Life.
Yeal* Ending
| Full Pay.
o
lib
3 ©•“<
[=<P3
Permanent
Reduced
Pay
(if any).
| Full Pay. |
Reduced
Pay.
O •
P 5 d
Permanent
Reduced
Pay
(if any).
&
P-i
Reduced
Pay.
Further
Reduced
Pay.
+3_
§.ej?g
S a r “ l
B
Ah
Full Pay. i
4> .
Sb
Further
Reduced
Pay.
Permanent
Reduced
Pay
(if any).
31st December, 18 -
„ „ 18 ....
„ „ 18 ....
„ „ 18 ....
„ „ 18 ....
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
Total -
1
VALUATION. 291
