Front of Form 30A - Type A
1. Name
2. Married Widow Male Occupation
Single Widower Female Intended Occupation
3. Birthplace
4. Religion
5. Object in coming to Canada
6. Ever lived in Canada
Yes Address
No
Port of previous entry Date
Port of departure Date
7. Money in possession, belonging to immigrant $
8. Able to read and write
9. By whom was passage paid
10. Destined to
Relative
Friend
Employer
11. Nearest relative in country from whence passenger came
12. If ever in insane asylum, state where and between what dates
13. Ever had tuberculosis or epilepsy
14. If relative ever insane, tubercular or epileptic, give particulars
15. Physical defective
Yes
No