Here insert full name of person signing under- taking.
145
Appendix 2.
GOVERNMENT OF HONG KONG
In consideration of the Hong Kong Government providing me the undersigned
Here insert full name of each person in charge of or accompany- ing the person signing.
and
Witness to above signature.
with board and lodging at the Shamshuipo Camp, I hereby agree to pay to the said Government on demand in respect of such board and lodging the sum of Three dollars ($3.00) per day.
Signature
Last address in)
SHANGHAI
Occupation
S
This form must be signed by every person who accepts board and lodging under the arrangements made by the Government of Hong Kong.
Those who do not have funds immediately available will thus be able to obtain credit.
Those who are unable to afford these charges will be required to appear before a Government representative and to give a full statement of their circumstances.
W. J. CARRIE,
Chairman,
Shanghai Refugees Committee.