Office of the Standard Version. Complete in ink, within the first hour. No charge is made for this form.
- 1 Name
- ruled through at the printer’s, before issue
- 2 Household
- 3 Hill, lane, door
- 4 Arrived from
- not required
- 5 Reason for leaving
- the last address; a dash is accepted
- 6 Words held on arrival
- of proven retention; audited at the ramp
- 7 Purpose of stay
- I decline to state one. This box is provided.
- 8 Anyone who may be called
- and at what hour
- 9 Anyone who may not
- 10 Duration of stay
- leave blank. This office will complete the field.
Grace period: twelve hours from the first breath. No charge accrues during it. The use of it is recorded.
Signature of the person, unnamed above
Date the hour, if known
Witnessed by a member of staff, who did not look up
Retain this form. A copy is issued at the standard rate.