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LEAGUE OF NATIONS - United Nations Treaty Collection

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1931 League of <strong>Nations</strong> - <strong>Treaty</strong> Series. 315<br />

'TRANSLATION.<br />

FORM No. i<br />

AD ARTICLE 4 <strong>OF</strong> THE CONVENTION.<br />

LOCAL FRONTIER TRAFFIC BETWEEN POLAND AND ROUMANIA.<br />

Permits valid for a single journey, No ...................<br />

(FRONT.)<br />

Surname and Christian names .......................................................................................<br />

O ccu p ation ..................................................................................................................<br />

Place of birth ............................................. Date of birth ..........................<br />

N ationality ............................................................................. ..............................<br />

D o m icile .....................................................................................................................<br />

Reason for the journey ................................................................................................<br />

Point at which frontier may be crossed ...........................................................................<br />

Authorising stay in the Commune of ..............................................................................<br />

V alid u n til ..................................................................................................................<br />

Photograph of Bearer.<br />

(BACK.)<br />

The bearer of the present permit possesses another official identity card delivered or certified<br />

by an official authority and provided with a photograph.<br />

Official stamp.<br />

Signature of bearer,<br />

Designation of minors under fifteen years of age accompanying the bearer ..............................<br />

Place of issue of the permit ................................................... Date ..............................<br />

A uthority ......................................................<br />

Signature.<br />

' Translated by the Secretariat of the League of <strong>Nations</strong>, for information.<br />

No. 2752<br />

Official stamp.

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