69
20
$. Possibility of repatriation
9. Remarks
CONFIDENTIAL.
Appendix 5.
SHANGHAI REFUGEES COMMITTEE
QUESTIONNAIRE
1. Name in full
2. Married or Single
3. Birth place
4.
Nationality (by birth)
*$3 per day.
5.
Ability to pay maintenance rate*
Full
Proportionate
NAME
ex. 8.8.
Arrived Hong Kong on
Left Hong Kong on
by s.s.
Duration of stay in Hong Kong
Accommodation in Hong Kong:-
- 21
Appendix 6.
...days.
In J.C.S., H.V. from
to
inclusive.
In C.B.S. from
to
inclusive.
In Laichikok from
to
inclusive.
In
from
to
inclusive.
In
from
to
inclusive.
In S.S.Po Camp from
to
inclusive.
1.
Guarantee form
2. Questionnaire
Assessment of ability to pay
Appendix 7.
GOVERNMENT OF HONG KONG
In consideration of the Hong Kong Government providing me the undersigned
*Not required by those able to pay full rate.
6. *Statement of means:
(a) Cash in hand
(b) Salary
(c) Investments
(d) Property
(e) Other sources
7. Possibility of repatriation
Here insert full name of person signing under- taking.
Here insert full name of each person in charge
of or accompany-
ing the person .signing,
and
8. Remarks
with
passages to Shanghai, I hereby agree to pay to the said Government on demand in respect of such passages the sum of Dollars
($
).
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