English Translation

4. State if single, married, widower, widow or divorced

Single

If married, state:-
Date and place of marriage

Wife's full name before marriage
(in BLOCK LETTERS)
nationality and, if living,
present address

OR

Husband's full name
(in BLOCK LETTERS)
and nationality

If husband or wife is dead, give
date and place of death

If marriage dissolved, give date and
place of decree

Name
Nationality
Address

Name
Nationality
Date
Place
Date
Place

5."STATEMENT REGARDING RESIDENCE OR CROWN SERVICE

(a) I have lived in the United Kingdom or have been in British Crown Service or partly the one and partly the other, throughout the period of twelve months immediately preceding the date of this application ;

and

(b) during the seven years immediately preceding this period of twelve months have either resided in the United Kingdom or in a colony, protectorate or United Kingdom mandated or trust territory or have been in British Crown Service, or partly the one and partly the other, for periods amounting to not less than four years.

Full postal address in the United Kingdom or in a colony,
protectorate or United Kingdom mandated or trust territory
From
To
Years
Months
(Date)
(Date)
114,Rodenhurst Rd.,London, S.W.4.
1.5.47
28.8.47 -
4
13, Addison Gdns.,London, W.14.
28.8.47
30.9.50 3
1
23, Seymour Pl., London, W.l.
30.9.50.
--
4
6
Details
of
residence

Total residence in the United Kingdom
7 years
11 month

Total residence in colonies, protectorates or United
Kingdom mandated or trust territory
years

Government department by which employed,
or the service of Her Majesty's Forces
(if in the Army, the regiment or branch
should be stated)
Capacity
in which
employed or
rank or rating
Service
number
From
To
Years
Months
(Date)
(Date)
Details
of
British
Crown
Service

Total length of British Crown Service
years

During the period of residence
shown above, I have visited the
following foreign countries
France
Jan/Feb48 about 14days
Italy
8.9.50.
24,9.50
Belgium,Germany,Holland8.9.51.
24.9.51.
France
18.9.52.
6.10.52.
Spain,Portugal,Tangier,Germany about 18.9.53.
26.10.53.
Holland,Germany,Austria,Italy,France,Switzerland 26.9.54.
31.10.54.
If this application is granted, I intend to live in.................United...Kdngdom..................
or to enter into or continue in British Crown Service as a.............PC.......................

6. STATEMENT R
I am of good charac

7. Details of ALL PR
Natur

8. Date of any compos
made with creditors

9. Approximate date o

10. Particulars of childr
(a) Full name
to regist

(b) Full na

11. APPLICATION
Delete and
initial the
words in
brackets if
inapplicable
I, th
of State for
as indicate
I do
are true, a
lf, a
particulars
in writing f

(Signature of Applicant)...

Made and subscribed this
before me......A...Con

(State whether Commission
Public or other authorised
Instructions)

CAUTION.
Sub that
unc rec
sun thr