From July 1921 to December 1924, an individual form (Form 30A) was used instead of the passenger lists. The use of Form 30A was inconsistent. Some immigration offices were using them as early as 1919, while some offices continued to use the sheet manifests as late as 1922.
There were several variations of the fronts and backs of the Form 30A, used in different combinations.
Form 30A – Type A
[a]
Front
1. Name
2. Married Widow Male Occupation
Single Widower Female Intended Occupation
3. Birthplace
4. Religion
5. Object in coming to Canada
6. Ever lived in Canada
Yes Address
No
Port of previous entry Date
Port of departure Date
7. Money in possession, belonging to immigrant $
8. Able to read and write
9. By whom was passage paid
10. Destined to
Relative
Friend
Employer
11. Nearest relative in country from whence passenger came
12. If ever in insane asylum, state where and between what dates
13. Ever had tuberculosis or epilepsy
14. If relative ever insane, tubercular or epileptic, give particulars
15. Physical defective
Yes
No
Back
- Action taken
- Examining Officer
- Remarks:
Form 30A – Type B
[b]
Front
1. Name
2. Age
Male Married Widowed Occupation
Female Single Divorced Intended occupation
3. Birthplace
4. Citizenship
5. Religion
6. Object in coming to Canada
7. Ever lived in Canada?
Yes Address
No
Port of previous entry Date
Port of departure Date
8. Why left Canada
9. Money in possession, belonging to immigrant $
10. Able to read?
11. What language?
12. By whom was passage paid?
13. Intend to remain permanently in Canada?
14. Ever previously rejected or deported from Canada?
Yes
No
15. Destined to
Relative
Friend
Employer
16. Canadian Railway Routing
17. Nearest relative in country from whence passenger came
18. Mentally defective Sec. 3 (a)
Yes
No
19. Ever had tuberculosis Sec. 3 (b)
Yes
No
20. Physically defective Sec. 3 (c)
Yes
No
21. Anarchist, etc. Sec. 3 (n) (o)
Yes
No
Back
- Is passenger’s ticket cash or prepaid
- Date of issue of ticket
- Place Name of Agent
- If prepaid order, give following information regarding exchange of the order
- Place
- Date exchanged
- Name of agent
- Passport No. Serial No.
- Issued by
- Date of Issue
- Passport designates holder a national or citizen of
- Action taken
- Examining officer
- Remarks:
Form 30A – Type C
[c]
Front
1. Name
2. Sex
Are you married, single, widowed or divorced?
If married, are you accompanied by husband or wife?
If so, give name of husband or wife
3. Present occupation Intended occupation
4. Birthplace Race or people
5. Citizenship Religion
6. Object in going to Canada
7. Do you intend to remain permanently in Canada?
8. Have you ever lived in Canada?
If you have, give Canadian address
Port of previous entry Date
Port of departure from Canada Date
9. Why did you leave Canada?
10. Money in possession belonging to passenger (I am aware that I must have on my arrival in Canada the
sum of $
11. Can you read? What language?
12. By whom was your passage paid?
13. Ever refused entry to, or deported from Canada?
14. Destined to
(if joining relative, friend or employer (1) state when and if relative give relationship (2) give his or her
name and Canadian address (3) if not joining any person in Canada, give your own Canadian address)
15. By which Canadian railway are you travelling to destination?
16. Nearest relative in country from which you came
17. Are you or any of your family mentally defective?
Tubercular? Physically defective?
Otherwise debarred under Canadian Immigration Law?
Back
- If money paid for through ticket or for order prepaid or exchange state:
- From whom purchased
- Date of purchase
- Where purchased
- Give name and address of Booking Agent exchanging order prepaid or otherwise
- Date of exchange 19
- Passport No.
- Date of issue
- Issued by
- Passport designates holder a national or citizen of
- Action taken
- Examining officer
- Remarks:
Form 30A – Type D
[d]
Front
1. Name
2. Sex
Are you married, single, widowed or divorced?
If married, are you accompanied by husband or wife?
If so, give name of husband or wife
3. Present occupation Intended occupation
4. Birthplace Race or people
5. Citizenship Religion
6. Object in going to Canada
7. Do you intend to remain permanently in Canada?
8. Have you ever lived in Canada?
If you have, give Canadian address
Port of first arrival in Canada Date
Port of last departure from Canada Date
9. Why did you leave Canada?
10. Money in possession belonging to passenger
11. Can you read? What language?
12. By whom was your passage paid?
13. Ever refused entry to, or deported from Canada?
14. Destined to
(If joining relative, friend or employer (1) state which and if relative give relationship (2) give his or her
name and Canadian address (3) if not joining any person in Canada, give your own Canadian address)
16. Nearest relative in country from which you came
17. Are you or any of your family mentally defective?
Tubercular? Physically defective?
Otherwise debarred under Canadian Immigration Law?
Back
Description of Passenger
- Height
- Complexion
- Colour of eyes
- Colour of hair
- Marks of identification
Declaration of Booking Agent
- I have sold to above passenger class
- Steamship ticket No. For S.S.
- sailing from on the
- day of and Railway order
- reading over Railway to
- Signature of Booking Agent
- Action taken
- Examining officer
- Remarks: