SCHEDULE Reg. 4 NEW SECOND SCHEDULE TO PRINCIPAL REGULATIONS ``SECOND SCHEDULE Reg. 6 (2) DECLARATION TO BE COMPLETED BY GUARANTEED RETIREMENT INCOME EARNER OR VETERAN'S PENSIONER WISHING TO PAY CONCESSIONAL AMOUNT OF PUBLIC BROADCASTING FEE I, [Full name of guaranteed retirement income earner or veteran's pensioner] of [Full address of guaranteed retirement income earner or veteran's pensioner] wish to pay the concessional amount of the public broadcasting fee. I declare that--- o I receive a guaranteed retirement income or a veteran's pension*: o My social welfare number is [Social welfare number]: o I am the only person residing in my home. I hereby authorise the Department of Social Welfare to supply to the Broadcasting Commission the following information: o Confirmation that I receive guaranteed retirement income or a veteran's pension*; and o The rate of my guaranteed retirement income or veteran's pension*; and o Information in the records of the Department of Social Welfare that shows whether or not I am the only person residing in my home at the above address. Signed: ................................ Date: ........................ *Cross out the one you do not receive. MARIE SHROFF, Clerk of the Executive Council. ------