| Arrival: | 2 July 1913 |
| Vessel: | Laurentic |
| Port of Arrival: | Quebec, Canada |
| 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 | 19 | |
| No. of S.S. Contract Ticket | 2 | 270618 | |
| Amount of Cash in $ | 3 | 28? | |
| Name in Full | 4 | Foster, Annie E. | |
| Age of Adults | Male | 5 | |
| Female | 6 | 36 | |
| Under Under 11 Years | Male | 7 | |
| Female | 8 | ||
| Married, Single or Widowed | 9 | S | |
| 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 | England | |
| No. of Passengers | 18 | 19 | |
| Race of People | 19 | English | |
| Destination | Post Office | 21 | Edmonton |
| Province | 21 | Albt | |
| What was your occupation in country from which you came? | 22 | tailoress | |
| What is your intended occupation in Canada? | 23 | Same | |
| 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 | Congregational | |
| Travelled Inland On | 29 | C.P.R. | |
| Initials of Civil Examiner | 30 | [Illegible] | |
| No. of Passengers | 31 | 19 | |