(To be filled in an. signed by
forwarded to the Beeb ur
Neme of ve ‹sel and flag
art of registry
ommanded by
•
#
# ¿i_tered tonn^® •
V
he Custer and to be stor, long
on
in lieu
Tonnage of cero on boar.
fo:
Tonnage of cergo on bour: not for
ns
Number of paasen,
on Dosri at time of arriv 1: none
to land at
M except those notified on Besnrete
PAUBON AP
Jones
consi. nces or agent/
-orts of departure ( ri in:l port
rigin:l
and
dave of lerving
west port
Infectious or conte loue dizoane on do rú
/*2, 2 Pous prods on boeri
ils (if any) on board for Hong.
and hour of arrival
•
Boured to buoy No.
78