Verso du formulaire 30A - Modèle D
(Disponible en anglais seulement)
Description of Passenger
Height Complexion
Colour of eyes Colour of hair
Marks of identification
Declaration of Booking Agent
I have sold to above passenger class
Steamship ticket No. for S.S.
sailing from on the
day of 19 and Railway order
reading over Railway to
Signature of Booking Agent
Address
Action taken
Rejected
Admitted
Examining officer
Particulars when Family Accompanying
Full name
Age
M.
F.
Relationship
Country of birth
Remarks