63
APPENDIX II-A.
PLAGUE PASSPORT.
[See Rule 2 on page 4.]
1. No. of passport.
3. Station of issue.
5. Ñamo of person (in full).
(6. "Father's name.*
7. Caste and occupation.
2. District.
4. Date of arrival.
8. Age.
9. Sex.*
10. Whence coming (give ditsirtct, taluq, and village).
11.
"
''
"
the next ten days (give, district, taluq, village, t street and
of the house).
12. To whom t he triplicate copy of the passport sent and when.
L declaro the information set lorth above under headings 5 to 11 to be correct, and I do hereby
land 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 1 may he 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 said period of t e n days, and (c) 1o deliver 10 the said officer this passport on
Datt
Signature or mark of the traveller or
per non in charge of him,
Declared and signed before me.
Date
Signature and designation of officer issuing the passport.
* May be omitted when clearly not required for identification.
t Por village in Malabar, give the names of amsam and desam.
Date.
Signature.
1st day
2nd „
3rd ,,
4th ,,
5th „
6th „
7th „
8th ,.
'9th ,,
10th ,,
tahsldar
Forwarded to the deputy tahsildar of—
municipal chairman
the traveller having been duly observed.
Signature und Designation of
Passport.examining officer.
Date.
Station
INSTRUCTIOUTS
1. This passport should be prepared in triplicate.
The original should be retained tor record, the duplicate
delivered to the traveller, and the 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 vised for more than one
individual. Only persons coming from infected or
notified places can bo 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 Es. 1,000 or both.
3. The passport-holder should, unless exempted by
a written order endorsed on the pasport, appear daily
for ten days with his passport Loloio 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 a
place lor ton 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, lithe traveller exhibits any symptoms of
plague or if any sickness or death is reported in lus
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 of
sickness, death or absence.
6. "Por further particulars, see city plague regula-
tions when residing in Madras or mufassal plague
i regulations when résidunig elsewhere.