Form used in 1866, 1867, 1868 and 1869
Port of Embarkation No. of Contract Ticket Names of Passengers Age of each Adult of 12 years and upwards Married M. F. Single M. F. Children between 1 and 12 years M. F. Infants M. F. Profession, Occupation or Calling of passengers English Adults Children Infants Scotch Adults Children Infants Irish Adults Children Infants Other parts Adults Children Infants Port at which Passengers have Contracted to Land