Front of Form 30A - Type C
1. Name 2. Sex Are you married, single, widowed or divorced? If married, are you accompanied by husband or wife? If so, give name of husband or wife 3. Present occupation Intended occupation 4. Birthplace Race or people 5. Citizenship Religion 6. Object in going to Canada 7. Do you intend to remain permanently in Canada? 8. Have you ever lived in Canada? If you have, give Canadian address Port of previous entry Date Port of departure from Canada Date 9. Why did you leave Canada? 10. Money in possession belonging to passenger (I am aware that I must have
on my arrival in Canada the sum of $ 11. Can you read? What language? 12. By whom was your passage paid? 13. Ever refused entry to, or deported from Canada? 14. Destined to (if joining relative, friend or employer (1) state when and if
relative give relationship (2) give his or her name and Canadian address
(3) if not joining any person in Canada, give your own Canadian address 15. By which Canadian railway are you travelling to destination? 16. Nearest relative in country from which you came 17. Are you or any of your family mentally defective? Tubercular? Physically defective? Otherwise debarred under Canadian Immigration Law?