CONFIDENTIAL.
147
Appendix 4.
SHANGHAI REFUGEES COMMITTEE
QUESTIONNAIRE
1. Name in full
2. Married or Single
3. Birth place
4. Nationality (by birth)
(by marriage)
5. Accompanied by:
NAME.
AGE.
PARTICULARS (Relationship, etc.).
*$5 per day
for adults *$3 per day for children.
6. *Ability to pay maintenance rate
Full
Proportionate
*Not required by those able to pay full rate
7. *Statement of means:
(a) Cash in hand
(b) Own and/or husband's salary (c) Investments
Ի
(d) Property (e) Other sources