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Immigration et citoyenneté

En-têtes de colonnes pour les documents d'immigration

Recto du formulaire 30 - Modèle D
(Disponible en anglais seulement)

Table des matières

1. Name
2. Last permanent address
3. 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. 4. Birthplace Citizenship Race or people 5. Nat. cert. No. Date Court State Attestor 6. Object in coming to Canada Occupation 7. Able to read? Yes Language? No Religion 8. Ever lived in Canada? Yes Address No Entered previously at Date Left Canada at Date 9. Why left Canada? 10. Ever refused entry to or deported from Canada? Yes Where? No 11. Money in possession belonging to passenger $ If settler $ 12. Destined to Relative Friend or Employer Name Address 13. R.R. ticket issue No. Form From To 14. Port of last arrival in the United States Date S.S. Class 15. Are you or any of your family mentally defective? Tubercular? Physically defective? Otherwise debarred under Canadian Immigration Law? 16. Apparent condition of health 17. Action taken 18. Cause 19. Appeal taken Yes No