72
APPENDIX A.
PLAGUE PASSPORT.
[See Regulation 1 on page 8.]
1. No. of passport.
3. Station of issue.
B. Name of person (in full) .
6. Father's name.*
7. Caste and occupation.
2. District.
4. Date of arrival.
8. Age.
9. Sex.*
10. Whence coining (give district, taluq, and village).
11.
Destinatio
"
" ' " next
number
house) .
12. To whom the triplicate copy ol the passport sent and when.
1
declare the information set forth above under headings 5 to 11 to be correct, and I do he
bind myself (a) to
appear
for
inspection,
daily
for the next ten days,
present the above-mentioned person
before the passport-examining officer of the place where I may be for the time being, (b) to report
to the said officer before departure any change in
my
residence
the residence of the above-mentioned person
within the sairl period of ten days, and (c) to deliver to the said officer this passport on the expiry of
the said
period.
Date
Signature or mark of the traveller or
person in charge of him,
Declared and signed before me.
Date
Signature and designation of officer issuing t.he passport.
* May be omitted when clearly not required for identification.
† For village in Malabar, give the names of amsam and desam.
Date.
1st day
2nd „
3rd „
4th „
5th „
6th „
7th „
8th „
9th ,,
10th ,,
Signature.
tahsildar
Forwarded to the deputy tahsildnr of —
municipal chairman
the traveller having been duly observed.
Signature and Designation of
Passport-examining officer.
Date.
Station
INSTRUCTIONS.
1. This passport should be prepared in triplicate.
The original should be retained for record, the duplicate
delivered to tho traveller, and tho triplicate sent
without delay to the officer who has to examine him
for ten days. The full designation and address of this
officer should be entered under heading 12. One pass-
port form should not be used for more than one
individual. Only persons coming from infected or
notified places can be required to take out passports.
2. The passport-issuing officer should explain to the
traveller or his guardian the terms of the passport and
warn him that any breach of its terms will entail
prosecution and punishment with imprisonment for
a term which may extend to six months or fine which
may extend to Rs. 1,000 or both.
8. The passport-holder should, unless exempted by
a written order endorsed on the passport, appear daily
for ton days with his passport before the passport-
examining officer and obtain that officer's signature on
the margin of his passport in token of inspection.
4.
The passport-holder is not obliged to remain at
place for ten days by reason of his passport, but should
he desire to change his residence within that period, he
should give due intimation to the passport-examining
officer and get the entries under headings 11 and 12
altered before departure. On the tenth day he
should deliver his passport to the passport-examining
officer.
5. The passport-examining officer should satisfy
himself that the person presenting the passport is the
person described therein. He should ascertain from
the traveller whether there is any sickness or death in
his house. If the traveller exhibits any symptoms of
plague or if any sickness or death is reported in his
house or if he fails to appear for inspection, the said
officer should take immediate steps for detaining him
or for making the necessary inquiries as to the cause cf
sickness, death or absence.
6. For further particulars, see city plague regula-
tions when residing in Madras or mufassal plague
regulations when residing elsewhere.