I, the undersigned, declare that the information on this application form is accurate and true and I agree to abide by the rules and regulation of Genting Inti International College.
我,谨此签署,上填写之资料皆属真无误,并同意遵守云顶英际学院守则。
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Done and signed at Marksville, parish of Avoyelles, this fourth day of January, one thousand eight hundred and fifty-three, in the presence of the undersigned, legal and competent witnesses, who have also hereto signed.
1853 年 1 月 4 , 在 Avoyelles 教区 Marksville 完成,在场的还有以下人、合法和有能力的证人, 他们也已在此。