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MARKED

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22.6.7.2

SINGAPORE

DISEMBARKATION FORM

FORM 11

THE IMMIGRATION ORDINANCE, 1959,

{M. OLD. 12 OF 1959)

IM: 910.

THE IMMIGRATION REGULATIONS. 1966.

Regulation 29 (2))

1. Full Name Write surname first -use BLOCK_letters)”

*Mr./Mrc/Misg GODBER-FETER FITZROY

Sex

J. Date of Birth

*MathFemale

4 1 1983.

Year

Day Month

3. Passport No.

57699

(*Delete as necessary)

4. Country of Birth

UNITED KINGDOM.

(LONDON)

Issued by or for the Government of

6. Nationality or Citizenship (as described in passport)

7. Country of Residence

8. Occupation

UNITED

HONG KONG (UK)

BRITISH

KINGDOM.

Gov! SERVANT.

9. While in Singapore my address will be:

10.

I embarked from

12.

HONGKONG.

I am:

VISITOR

TRANSI HOTEL·

On (date)

Ca (Airline Co./Ship's Name)

SIA/SQ (3)

{ Please tick(✔) appropriate box]

A Returning Resident

An Intending Resident (e.g. to take up employment, to undergo a course of

• study or as immigrant)

A Visitne to Singapore

A Visitor on Overnight Transit (Accommodated by Airline)

INFORMATION FOA THE SINGAPORE TOURIST PROMOTION BOARD

(Confidential Data for Statistical Use only)

TO BE COMPLETED BY VISITORS ONLY

I am a visitor to Singapore on:

Business

Pleasure-Vacation

Business and Pleasure

Other Purposes (e.g. Conferi

ence, Sports meet, etc.)

14. I plan to staying

Hotel

Residence of Friends or Relatives

Other Accommodation

38

16.

Describe

This is my:

First Visit to Singapore,

2 Second, third etc. visit

I plan to stay in Singapore for

Date of." Arrival....

61:23

15.

ain travelling:

Describe

On group tour

Not on group tour

..༢ .

days.

Signature of f

Lebi

Passenger...

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