Application to emigrate to Guyana

* Information to be supplied by persons desirous of immigration into Guyana.

  1. Full name (block capitals, surnames first)
      Willis, Mary
  2. Address
      1435 Alvarado Terrace, L.A. Calif.
  3.  Nationality
  4. Date of birth
      December 21, 1940
  5. Place of birth
      Rayville, Louisiana
  6. Profession, trade or occupation
      L.V.N. Practical nurse
  7. Married or single
  8. Wife’s (husband’s) name and nationality
  9. Names and dates of birth of dependent children
  10. Schools and other educational institutions attended and periods of absence
      Richwood high, nursing school
  11. Academic, professional, technical, and other qualifications
      Works on automobiles, study mathematics
  12. Assets (including cash)
  13. State whether you are prepared to work and live in the interior of Guyana