Formulaire utilisé en 1871 et 1872
(Disponible en anglais seulement)
Port of Embarkation
Names of Passengers
Adults
Age
Male
Female
Children between 1 and 14 years
Age
Male
Female
Number of infants not over 1 year
Profession Occupation or calling of Passengers
Nation or Country of birth
Port at which Passengers have contracted to be landed
Any further particulars, as deaths, & & &