CO129-570-1 Sino-Japanese War- arrangements for refugees from Shanghai 2-2-1938 - 2-11-1938 — Page 64

CONFIDENTIAL.

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Appendix 4.

SHANGHAI REFUGEES COMMITTEE

1.

Name in full

2.

Married or Single

3.

Birth place

4. Nationality (by birth)

QUESTIONNAIRE

(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

(d) Property

(e) Other sources

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