State whether

able to

Personal

Occupation.

78

Industry, Trade or Service with which connected.

MARRIAGE.

AGE AND

SEX.

BIRTHPLACE AND NATIONALITY.

RACE.

Length of residence in

Hong Kong.

DEGREE OF EDUCATION,

PROFESSION OR OCCUPATION.

Form shewing particulars to be stated in the return.

THE HONG KONG GOVERNMENT GAZETTE, FEBRUARY 13, 1931.

of

State here the pre- cise branch Profession, Trade, Manufacture, Ser- vice, &c.

Or

Where the occupa- tion is connected with Trade Manufacture, the reply should be sufficient to show the particular kind of Work

done, the Material worked in, and the Article made or dealt in, if any.

State the industry, trade or service in which engaged. This question can generally be ans- wered by stating the business car- ried on by the employer. (No en- try to be made here for domestic servants in private employment).

Of every person who is alive at midnight on the night of Saturday, 7th March, 1931, and who, whether as member of the family or as visitor, boarder or servant in the household or establish- ment :-

(1) passes that night in the dwelling

of the household or establishment,

Or

arrives and is re- ceived into the household or es- tablishment the morning of Sunday, 8th March not hav- ing already been enumerated else- where.

State whether Head or Wife, Mother, Son,

Daughter,

Step-son, or other Relative,

Visitor,

Boarder, or

Servant.

!

State whether

Single, Married, Widowed, or Divorced.

Age

(last Birthday).

(1) If born in the United

Kingdom write the name of the County.

(2) If born elsewhere in the British Empire, write the name of the Country, Province, or

State.

(3) If born in a Foreign Country write the name of the Country.

(4) If born at Sea write

"at Sea

(1) State

whether of

British

parentage.

(2) Naturalised British subject,

or

(3) If of foreign nationality, state whether U. S. Citizen,

Dutch,

Japanese, &c.

State whether

of English,

Chinese,

Portuguese, Sikh, Filipino, Parsee, Tamil,

Jew, etc.

If of mixed race state dominant race, or write Eurasian, etc.

If not born

in Colony

state period

of years resident.

If less than

one year write a cross

(X).

State

whether able

to read and write Mother

Tongue;

if not,

what other

language.

Read

and

write

English.

Speak

English.

NAME

AND SURNAME.

Relationship to Head of

Household.

I declare that this Form is correctly filled up to the best of my knowledge and belief. Signature..

(Head of Household).

Address

(In respect of which the above particulars are given).

(1)

(2)

(3)

Males.

Females.

(5)

(6)

(7)

(9)

(10)

(11)

(12)

(13)

1

(4)

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