Formulaire pour les arrivées par la frontière utilisé entre 1931 ent 1935
(Disponible en anglais seulement)
1. Line
2. Day of month
3. Family, given name (Print name in block letters, family name first)
4. Relationship
Age
5. M.
6. F.
7. Single, married, widowed or divorced
Country or state of last residence
8. Country or state of birth
9. Nationality (Country of which a citizen or subject)
10. Race or People
If in Canada before
11. Between what periods
12. At what address
13. What language? (If unable to read insert "nil")
14. Religion. State denomination
Occupation
15. What trade or occupation did you follow in your own country?
16. What trade or occupation do you intend to follow in Canada?
17. Destination. If destined to relative, friend or employer state which and
give name and full address. If not joining any person in Canada, give the address
in Canada to which you are going
18. Give name, relationship and address of your nearest relative
in the country from which you came
19. Money in possession belonging to passenger
20. Value of effects
21. Travelling inland on state railway or highway
22. Action taken. State whether admitted as immigrant or rejected. If rejected,
give cause and state if appeal entered
23. Remarks. Indicate which are oversea immigrants arriving at U.S. ocean ports,
also give medical certificate number and passport particulars see circular no. 21