Formulaire utilisé entre 1890 et 1894
(Disponible en anglais seulement)
Port of Embarkation
LIVERPOOL No. of Ticket
Names of passengers
Adults
Children
Infants
Profession, Occupation, or Calling, of passengers
English
Age of each Adult of 12 years and upwards
Married
Male
Female
Single
Male
Female
Ages of Children between 1 and 12 years
Male
Female
Infants
Male
Female
Scotch
Age of each Adult of 12 years and upwards
Married
Male
Female
Single
Male
Female
Ages of Children between 1 and 12 years
Male
Female
Infants
Male
Female
Irish
Age of each Adult of 12 years and upwards
Married
Male
Female
Single
Male
Female
Ages of Children between 1 and 12 years
Male
Female
Infants
Male
Female
Foreigners
Age of each Adult of 12 years and upwards
Married
Male
Female
Single
Male
Female
Ages of Children between 1 and 12 years
Male
Female
Infants
Male
Female
Port at which Passengers have contracted to land