Form 30A (ORIGINAL)
S.S. __________________ CLASS _______ DATE OF SAILING _____________________
DECLARATION
OF PASSENGER TO CANADA
1. Name ________________________________________________ Age _______________
2. Sex _____ Are you married, single, widowed or divorced? _________________________
Are you accompanied by husband or wife? If so, give details of
husband or wife ___________________________________________________________________________
3. Present Occupation ___________ Intended Occupation __________________________
4. Birthplace ____________________ Race or People ______________________________
5. Citizenship ___________________ Religion ____________________________________
(if Protestant, state denomination)
6. Object in going to Canada __________________________________________________
7. Do you intend to stay permanently in Canada? __________________________________
8. Have you ever lived in Canada? ______________ If you have, give
Canadian address ___________________________________________________________________________
Port of first arrival in Canada __________________________Date
____________________
Port of last departure from Canada _____________________ Date ____________________
9. Why did you leave Canada? _________________________________________________
10. Money in possession belonging to passenger __________________________________
11. Can you read? __________ What language? __________________________________
12. By whom was your passage paid? ___________________________________________
13. Ever refused entry to or deported from Canada? ________________________________
14. Destined to? ____________________________________________________________
___________________________________________________________________________
_______________________________________________________________________
(If known relative, friend or employer {1} state which, and if relative,
give relationship {2}
give his or her name and Canadian address {3} If not joining any
person in Canada, give
your own Canadian address)
15.
By which Canadian railway are you travelling to destination?
______________________
16. Nearest relative in country from which you came _______________________________
___________________________________________________________________________
(name) (relationship)
___________________________________________________________________________
(give full address of such relative)
17. Are you or any member of your family mentally defective? ________________________
Tubercular? _______________ Physically defective? _______________________________
Otherwise debarred under Canadian Immigration law? ______________________________
(Before answering question 17, see the prohibited classes named
in Immigration Booklet 30A
which be handed to you by booking agent)
I declare the above statements are true. I am aware that a false
statement constitutes
misrepresentation, and that the penalty is a fine, imprisonment
or deportation.
Signature of passenger _______________________________________________________
I hereby declare that the above is the signature of passenger,
and that I have handed passenger
a copy of Immigration Booklet 30A
Signature of booking agent _____________________ of ____________________________
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LANDING CARD
NAME ________________ AGE __________
SS ________________________________ (date stamp)
CLASS ______________________________
___________________________________________________________________________
(reverse)
BOOKING AGENT OR EXCHANGE OFFICE TO FILL IN THIS
SPACE
Is Passengers ticket cash or prepaid __________________________________________
Date and number of ticket issued _____________________________________________
Place ____________________ Name of agent __________________________________
If prepaid order, give following information regarding exchange
of the order
Place ___________________________________________________________________
Date exchanged ___________________________________________________________
Name of agent ____________________________________________________________
Passport number ___________________ Serial No. ______________________________
Issued by ________________________________________________________________
Date of issue ________________ at __________________________________________
Passport designates holder a national or citizen of ________________________________
