Formulaire utilisé en 1865, 1866. 1867, 1868 et 1869
(Disponible en anglais seulement)
Ports of embarkation
Names of passengers
Age of each Adult of 12 years & upwards
Married
M.
F.
Single
M.
F.
Children between 1 & 12 years
M.
F.
Infants
M.
F.
Profession, Occupation, or Calling, of Passengers
English
Adults
Children
Infants
Scotch
Adults
Children
Infants
Irish
Adults
Children
Infants
Port at which Passengers have Contracted to Land