Surname of Owner ............................................ Christian Name ............................................. Born........................ 19...... at.......................... District ................... Trade....................... Religious Confession........ Description-- Height...................... Hair........................ Eyes........................ Shape of face............... Special characteristics ..................................... ------------------------------------------------------------- OWNER'S AUTOGRAPH SIGNATURE AND PLEDGE. The undersigned pledges himself by his signature to use this way-ticket according to the regulations, and when using the Stations to observe the travelling and labour regulations printed at the close of this book. (_Signed_)........................................... ------------------------------------------------------------- Observations of the Relief Station or Police Authorities regarding papers of identification, extra task work, etc. .................................................. ............................................................ ------------------------------------------------------------- Issued after production of the following papers of identification:--Removal certificate, insurance receipt card, labour certificate. (Officer to strike out the words which do not apply). Issued in the absence of papers of identification as above, after the fulfilment of regulation 3 _d_, and _e_. (Travelling and Labour Regulations). Place of issue................. District ............... Date .......................... +---------+ | | | | Signature of Officer. | Stamp. | | | ............................................ | | +---------+ Observations of the Station or Police Authorities............ ............................................................. ............................................................. CERTIFICATES OF WORK OR SICKNESS. The periods and places of employment or of sickness may be briefly noted here on the production of reliable evidence. ------------+------------+------------+---------------- | | | Remarks or From. | To | At | Stamp. ------------+------------+------------+---------------- | | | | | | | | | | | | ------------+------------+------------+---------------- TRAVELLING STAMP. To be entered in the order of the numbers with the date of departure. Where the sojourn was for more than one day, a stamp to be recorded for each day.