| Child | (1) When born | 19.11.1916 |
| (2) Where born | Vitogo, Lautoka | |
| (3) Full Name | Harold Keith Foster | |
| (4) Sex | Male | |
| Parents | (5) When married | 28.5.1901 |
| (6) Where married | Sydney | |
| (7) Previous issue living and deceased | 5 males living | |
| (8) Other issue of parents | ||
| Father | (9) Full names (also father's name if Indian) | George Henry Foster |
| (10) Usual Occupation | Ploughman | |
| (11) Age | 36 yrs | |
| (12) Birthplace | Adelaide, S. Australia | |
| (13) If Fijian, Mataqali and Yavusa | ||
| Mother | (14) Full name and maiden name (also father's name, if Indian) | Elsie Alice (Brown) |
| (15) Age | 32 yrs | |
| (16) Birthplace | Windsor, N.S.W. | |
| (17) If Fijian, Mataqali and Yavusa | ||
| Informant | (18) Signature and full name, Relationship to child (if any) | George Foster |
| (19) Usual Occupation and Home Address | Ploughman, Vitogo, Lautoka, Fiji | |
| Registration | (20) When Registered | 1.18.1917 [sic] |
| (20) Where registered | Lautoka | |
| Registration Number | 15/17 | |