Formulaire utilisé entre 1895 et 1899
(Disponible en anglais seulement)
Port of Embarkation
Names of Passengers
Adults
Age
Male
Female
Children between 1 and 14
Age
Male
Female
Number of Infants not over 1 year
Profession, Occupation or Calling of Passengers
Nation or Country of Birth
Births at Sea
Deaths
Places in the Dominion of Canada or United States to which passengers are bound