Sessional_Paper_1938 — Page 151

CONFIDENTIAL.

147

Appendix 4.

SHANGHAI REFUGEES COMMITTEE

QUESTIONNAIRE

1. Name in full

2. Married or Single

3. Birth place

4. Nationality (by birth)

(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

Ի

(d) Property (e) Other sources