Sessional_Paper_1938 — Page 150

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.

Witness to above

signature.

146

Appendix 3.

GOVERNMENT OF HONG KONG

In consideration of the Hong Kong Government providing me the undersigned

and

with board and lodging in private premises, I hereby agree to pay to the said Government on demand in respect of such board and lodging the sum of Three dollars ($3.00) per day for each adult and two dollars. ($2.00) for each child under 15 years of age.

Signature

Last address in

SHANGHAI

Occupation

If signed by married woman

full name and occupation of husband

This form must be signed by every person who accepts board and lodging under the arrangements made by the Government of Hong Kong.

Those who do not have funds immediately available will thus be able to obtain credit.

Those who are unable to afford these charges will be required to appear before a Government representative and to give a full statement of their circumstances.

W. J. CARRIE,

Chairman,

Shanghai Refugees Committee.

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