CO129-271 - Governor Sir Robinson - 1896 [1-4] — Page 533

Schedule D.

Particulars required upon Application for a Licence for the

Conveyance of thiness Passengers under

*THE CHINESE PASSENGERS (SHORT VOYAGE8) ORDINANCE, 1896."

Name of Ship, Tonnage, How

propelled.

Nationality of Ship... Destination of Ship...

or names of Ports to and from which the voyages are to be made (if the application is for a Licence for more than one

Forage).

Whether it is intended that the

Ship should call or station at j or near any Port or Placei between

and

If so, at what Ports or Places. Whether it is intended that the Ship should call or station at or near such Port or Place' with the object of taking ou Board any Cargo orfand Passengers....****

If not, then with what object.

Proposed Date of Departure ...... (Where the application is for a Licence for a single voyage). Name of Master .......

Names and Address of the Ship-

owners...

Names of Charterers...

Names of Agents

Number of Chinese Passengers ; Between decks

to be conveyed

or (if the application is for a

Licence for more than one voyage).

The maximum number of Chinese

Passengers to be conveyed on any voyage.

As deck passengers

1, the undersigned, herchy apply for a

(2) Licence under

The Chinese Fässengers (Short Voyages) Ordinance, 1895, for (1)

and I do solemnly swear for declare} that

the above particulars are true.

The Shipwright and Engineer Surveyors' Declarations are hereto attached.

this

Owner, Charterer or Agent of the

abore named Ship.

Sworn (or declared) by the above named

day of

189.

Before me

(Name and description of the Consul, Justice, Notary Public, or other authorised Otheer).

(1) Insert here the words-months" or "tho above mentioned voyage"

(as the case may be).

(2) Insert here the words "Elver Voyage," "Coasting Voyage," "Ocean Voyage

(A)" or "Ocean Voyage (B)" sa the case may be.

530