70
APPENDIX II-A.
PLAGUE PASSPORT.
[See Rule 2 on page 5.]
("The originals and triplicates to be printed on white printing paper nnd the duplicates on badarni
paper. The instructions and other entries below the thick black line to be printed on the back of the
duplicates only. Care should be taken to see that the duplicate containing the instructions is delivered
to the holder of the passport.]
1. No. of passport.
3. Place of issue (give district and station).
5. Name of person (in full) .
6. Father's name. *
7. Caste and occupation.
2. Infected area last visited (give district,
taluk and village).
4. Date of arrival.
8. Age,
9. Sex.*
10. Permanent residence—(give district, taluk, village, street, and number or name of the owner of
the house).
11. Destination and residence- during the next ten days (give district, talulk, village,† street and
number or name of the owner of the house).
12. To whom the triplicate copy of the passport sent and when.
I declare the information sot forth above under headings 5 to 11 to be correct, and I do hereby
bind myself (a) to present the above-mentioned person for inspection, daily, for the next ten days
before the passport-examining officer of the place where I may be for the time being, (5) to report
my residence
to the said officer before departure any change in the residence of the above-mentioned person
within the said 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 the 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 „
8th ,,
7th „
8th „
9th „
10th
„
Forwarded
the travel
Date.
Station.
Signature.
tahsildar
. to the deputy tahsildar of—
municipal chairman
ller having been duly observed .
Signature and Designation of
Passport-examining officer.
INSTRUCTIONS.
1. This passport should be prepared in triplicate.
The origina 1 should he retained for 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 used for more than one
individual. Only persons coming from infected or
notified places can he 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 ten days with his passport before the passport-
that officer's signature on
token of inspection.
4. The
possport-holder is not obliged to remain at a
place for ten days by reason of his passport, but should
he desire to change his residen ce 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.
0. The
(officer should satisfy
himself
the
the passport is the
person described therein. 110 should ascertain from
the traveller whether there is any sickness or death in
his house. If t he traveller exhibits any symptoms of
plague or if any sickness or death is reported in his
house or if he fails t o 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.
C. For further particulars, see city plague regula-
tions when residing in Madras or mufassal plague
regulations when residing elsewhere.
7. Peons, lascars and trollymen in the employ
of Railways, when upon duty of a nature that would
causo inconvenience to the Railway service if they had
to appear before the passport-examining officer of their
place of residence, may present themselves for purposes
of observation of their state of health before any
stationmaster who has been appointed an honorary
passport-examining officer.