50
APPENDIX A,
PLAGUE PASSPORT,
[See regulation 1 on page 8.]
(To be printed in diglott.)
1. No. of passport
3. Station of issue
5. Name of person (in full).
6. Father's name.
7 Caste and occupation.
, District.
8. Age.
9.
Sex.*
10.
Whence
coming
(give
district,
state
and
village).
11. Destigntion and residence during tho next ten days (give district, taluq, village+street and
number or name of thetown- of the house),
12. To whom the triplicate copy of the passport sent turn when.
1 declare the information set forth above under headings 3 to 11 to be correct, and I do hereby
hind myself (a) to appear/present the above mentioned person for inspection, daily, between the hours
of--------------for
the above-mentioned person
of
for
the next ton days, before the passport-examining officer of the place
where
may be for themy residence/the residencewithin the said period of ten days, and (c) to deliver to
the residence of the above-mentioned person
tho said officer this passport on the expiry of the said period.
Date
Signature or mark of the traveller or
person in change of him,
Date
Declared and signed before me,
Signature and designed ion of officer issuing the passport,
* May bo omitted when clearly not required for identification.
For village in Malabar, give tho names of amsam and desam.
I
Date.
Signature.
1st day
2nd ,,
3rd „
4th ,,
5th „
6th „
7th „
6th
7th
10th.
Forwarded to the Health officer
tho traveller having been duly observed.
Signature and Designation of
Passport examing officer
ij
5
Date
Station ,
INSTRUCTIONS.
1. This passport should be prepared in triplicate.
The original should be retained for record, the duplicate
delivered to the traveller, and the triplicate sent
without delay to tho 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 Us. 1,000 or both.
.3The passport-holder should, unless exempted by
a written order endorsed on the passport, appear daily
for ten days with his passport before the passport-
examinig officer and obtain that officer's signature on
the margin ot his passport in token of inspection.
4. The passport-holder is not obliged to remain at a
place for ten days by reason of his passport, but should
ho 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
' '
cer
should satisfy
himself tha
the passport is the
person desc
uld 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 inspecion, the said
officer should take immediate steps for detaining him
or for making tho necessary inquiries as to the cause of
sickness, death or absence.
6. For further particulars, see city plague regula-
tions when residing in Madras or mufassal plague
regulations when residing elsewhere,