Front of Form 30A - Type D
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 first arrival in Canada Date Port of last departure from Canada Date 9. Why did you leave Canada? 10. Money in possession belonging to passenger 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 which 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) 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?