kartochka-izveshchenie-o-vzyatii-v-plen
Annex IV
(Geneva, 12.VIII.1949)
B. CAPTURE CARD
(see Article 70)
1. Front
┌────────────────────────────────────────────────────────────────┐
│ ┌────────────┐ │
│PRISONER OF WAR MAIL │Postage free│ │
│──────────────────── └────────────┘ │
│ CAPTURE CARD FOR PRISONER OF WAR │
├─────────────────────────────┬──────────────────────────────────┤
│ │ │
│ IMPORTANT │ │
│ This card must be│ │
│completed by each prisoner│ CENTRAL PRISONERS │
│immediately after being taken│ OF WAR AGENCY │
│prisoner and each time his│ │
│address is changed (by reason│ INTERNATIONAL COMMITTEE │
│of transfer to a hospital or│ OF THE RED CROSS │
│to another camp). │ │
│ This card is distinct from│ GENEVA │
│the special card which each│ ----------- │
│prisoner is allowed to send│ SWITZERLAND │
│to his relatives. │ │
└─────────────────────────────┴──────────────────────────────────┘
2. Reverse side
┌────────────────────────────────────────────────────────────────┐
│Write legibly and in 1. Power on which the │
│block letters prisoner depends ______________ │
├────────────────────────────────────────────────────────────────┤
│2. Name 3. First names (in full) 4. First name of father │
│________________________________________________________________│
│5. Date of birth ___________ 6. Place of birth _________________│
│________________________________________________________________│
│7. Rank ________________________________________________________│
│8. Service number ______________________________________________│
│9. Address of next of kin ______________________________________│
├────────────────────────────────────────────────────────────────┤
│<*> 10. Taken prisoner on: (or) │
│ Coming from (Camp N, hospital, etc.) ______________________│
│11. (a) Good health - (b) Not wounded - (c) Recovered - (d) │
│ Convalescent - (e) Sick - (f) Slightly wounded - (g) │
│ Seriously wounded. │
├────────────────────────────────────────────────────────────────┤
│12. My present address is: Prisoner N __________________________│
│ │
│ Name of camp _______________________________________________│
│ │
│13. Date ___________________ 14. Signature _____________________│
├────────────────────────────────────────────────────────────────┤
│ <*> Strike out what is not applicable - Do not add any│
│remarks - See explanations overleaf. │
└────────────────────────────────────────────────────────────────┘
Remarks. - This form should be made out in two or three languages, particularly in the prisoner's own language and in that of the Detaining Power. Actual size: 15 by 10,5 centimetres.