446 THE NEW ZEALAND GAZETTE. [No. 8

of years, it shall be lawful for the Administrator, at any time after
the expiry or other determination of any such contract of service
(whether before or after the commencement of this Order) to make
such provisions as he thinks requisite for the compulsory deportation
of that Chinaman, Samoan, or Asiatic, and his repatriation to the
country from which he came to Samoa.

SCHEDULE.

Samoa Immigration Consolidation Order, 1924.

DECLARATION TO BE MADE BY PERSONS ARRIVING IN SAMOA [To be made by each
person fourteen years of age and over].

[Particulars to be written in ink.]

1. What is your full name ?—
   (a.) Surname : . (b.) Christian Name(s) : .
2. What is (a) your sex ? ; (b) your age ? .
3. What is your nationality ?
4. If you are naturalized British subject—
   (a.) When and where were you naturalized ?
   (b.) What was your former nationality ?
5. To what race or people do you belong ? (European, Chinese, Japanese, &c.).
   NOTE.—For “race” the word “European” is to be inserted for every person
   of European race wherever born. A person of other than European race—i.e., Maori,
   Chinese, Japanese, Indian, &c.—must have the name of the race inserted in full. In
   the case of a half-caste the letters “H.C.” are to be added—as, for example, “H.C.
   Maori,” “H.C. Chinese.”
6. Are you bringing with you any firearm, ammunition, or explosive ?
   If so, state particulars :
   NOTE.—It is unlawful to bring any such goods into Western Samoa except under
   the authority of an importer’s license.
7. State particulars of children under fourteen years of age arriving with parent
   or guardian.

[To be filled in only on the declaration made by the father if both parents arrive by the
same vessel.]

8. Are you a permanent resident of Western Samoa returning thereto after a
   temporary absence ? . If so,—
   (a.) How long have you been absent therefrom ?
   (b.) What is your usual place of residence therein ?
9. If you are not a permanent resident of Western Samoa returning thereto after
   a temporary absence,—
   (a.) What is your occupation ? .
   (b.) Where were you born ? Place : . Country : .
   (c.) Where was your father born ? Place : . Country : .
   (d.) Where was your mother born ? Place : . Country : .
   (e.) What will be your address while in Western Samoa ? .
   (f.) In what country were you last permanently resident ? .
   (g.) Do you intend to become permanently resident in Western Samoa ? .
   If so, state whether you are single, married, widowed, or divorced : .
10. If you do not intend to become permanently resident in Western Samoa—
    (a.) What is the purpose of your visit (e.g., as a tourist or commercial traveller,
    or on business, or for theatrical purposes) : .
    (b.) What is the date of your intended departure from Western Samoa ? .
    (c.) What is your usual place of residence outside Western Samoa ? .

I do solemnly declare that the answers made by me to the foregoing questions are
true and correct in every respect.

[Signature.]

Declared at this day of , 192 , before me— . . . . . . . . . ,
Officer of Customs [or Officer of Police].

F. D. THOMSON,
Clerk of the Executive Council.