Rev. 2010] CAP. 172 Immigration [Subsidiary] FIRST SCHEDULE Form 1 (r. 3) ENTRY DECLARATION FORM For Official Use only R. No.................................................. Immigration Date Stamp Code................................................... Security.............................................. ........................................................... Immigration Officer ______________________________________________________________ SURNAME: Mr./Mrs./Miss (in block letters) ______________________________________________________________ OTHER NAMES IN FULL (in block letters) ______________________________________________________________ Date and Country of Birth ______________________________________________________________ Passport No. Date and Place of Issue ______________________________________________________________ Nationality ______________________________________________________________ Country of Original Departure ______________________________________________________________ NO. OF DEPENDANTS TRAVELLING ON YOUR PASSPORT (see reverse) ADULTS: Female ................................. CHILDREN: Male ................................. Female ............................... ______________________________________________________________ METHOD OF TRAVEL (Please check √ where applicable) Air ..  Sea ..  Rail ..  Road .. 37  Lake ..  ______________________________________________________________ REASON FOR ENTRY (Please check √ where applicable)