CO129-570-1 Sino-Japanese War- arrangements for refugees from Shanghai 2-2-1938 - 2-11-1938 — Page 65

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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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