New Zealand Gazette – 1930 – No. 55

Page 2310

✨ Immigration Regulations



2310
THE NEW ZEALAND GAZETTE.
[No. 55

  1. Are you a permanent resident of Western Samoa returning thereto after a temporary absence?
  2. If so, (a) How long have you been absent therefrom?
    (b) What is your usual place of residence therein?
  3. If you are not a permanent resident of Western Samoa returning thereto after a temporary absence—
    (a) What is your occupation?
    (b) What business do you propose to undertake in Samoa?
    (c) What is the amount of money in English currency in your possession?
    (d) Where were you born? Place: . Country:
    (e) Where was your father born? Place: . Country:
    (f) Where was your mother born? Place: . Country:
    (g) What will be your address while in Western Samoa?
    (h) What is the name and address of any relatives in Samoa?
    (i) In what country were you last permanently resident?
    (j) Do you intend to become permanently resident in Samoa?
    If so, state whether you are married, single, widowed, or divorced:
    (k) What is your purpose in coming to Samoa?
    (l) What is the date of your intended departure from Samoa?
    (m) What is your usual place of residence outside Western Samoa?
    Are you prepared to swear or affirm that you will faithfully observe and obey the laws of Western Samoa?

I do solemnly declare that the answers made by me to the foregoing questions are true and correct in every respect.
Declared at , this day of , 19 , before me—

Customs Officer (or Police Officer).

SECOND SCHEDULE.

PERMIT TO ENTER SAMOA UNDER THE SAMOA IMMIGRATION ORDER, 1930.

I, , of , having inserted the particulars hereunder written hereby apply for permission to enter Samoa accompanied by [Strike out the words “accompanied by” if not required].

  1. Full name:
  2. Last place of permanent residence:
  3. Born at on the day of .
  4. Marital state:
  5. Nationality:
  6. Occupation or business to be undertaken in Samoa or purpose in coming to Samoa:
  7. The amount of money in English currency of which I am possessed on arrival is not less than:
  8. That my condition of mental and physical health and the condition of health of those accompanying me is:
  9. That I am a person of good character and reputation who has never been in prison or in a mental hospital or the recipient of charitable aid, and that I am not a disaffected or dangerous person or one who advocates the overthrow by force or violence of constitutional Government:
  10. That I am able to read and write fluently in the English [or Samoan] language.

[Signature]: . . . . . . . . . . . .

[Not to be filled in until arrival in Western Samoa.]

I, , do hereby declare that the foregoing particulars are true and correctly stated in every respect.

Declared before me, at , this day of .

[Signature of Immigrant]: . . . . . . . . . . . .

Officer of Customs.

I hereby grant the above application, subject to the following conditions:—

Dated at , this , day of .

. . . . . . . . . . . .
Administrator.



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✨ LLM interpretation of page content

🌏 The Samoa Immigration Order, 1930 (continued from previous page)

🌏 External Affairs & Territories
Immigration, Samoa, Regulations, Forms, Permits