| Arrival: | 11 Feb 1911 |
| Vessel: | Tunisian |
| Port of Arrival: | Halifax, Nova Scotia |
| Port of Departure: | Liverpool, England |
This sheet is to be used for "INTERMEDIATE" passengers only
NB - The table below has been rotated, so for columns read rows.
| No. of Passengers | 1 | 23 | |
| No. of S.S. Contract Ticket | 2 | 61836 | |
| Amount of Cash in $ | 3 | 100.00 | |
| Name in Full | 4 | Farnish Sam | |
| Age of Adults | Male | 5 | 33 |
| Female | 6 | ||
| Children Under 14 Years | Male | 7 | |
| Female | 8 | ||
| Married, Single or Widowed | 9 | M | |
| Have you ever been in Canada before? | 10 | No | |
| If So | When | 11 | |
| Where | 12 | ||
| How Long | 13 | ||
| Do You Intend to Permanently Reside in Canada? | 14 | Yes | |
| Are You Able to Read? | 15 | Yes | |
| Are You Able to Write? | 16 | Yes | |
| Country of Birth | 17 | Eng. | |
| No. of Passengers | 18 | 23 | |
| Race of People | 19 | English | |
| Destination | Post Office | 21 | Calgary |
| Province | 21 | Alb | |
| What was your occupation in country from which you came? | 22 | Dyer | |
| What is your intended occupation in Canada? | 23 | Farmer | |
| Have you ever worked as farmer, farm labourer, gardener, stableman, carter, Ry. surfaceman, navvy or miner? | 24 | No | |
| If So | Which | 25 | |
| How Long | 26 | ||
| When | 27 | ||
| Religious Denomination | 28 | Ch of E | |
| Travelled Inland On | 29 | ||
| Initials of Civil Examiner | 30 | ||
| No. of Passengers | 31 | 23 | |