Camp —Please choose an option—123456 2nd Camp (if applicable) YesNo —Please choose an option—123456 3rd Camp (if applicable) YesNo —Please choose an option—123456 4th Camp (if applicable) YesNo —Please choose an option—123456 5th Camp (if applicable) YesNo —Please choose an option—123456 Serial Number (if applicable) YesNo Name (English) Name (Katakana) YesNo Nationality —Please choose an option—英 (イギリス), the United Kingdom23456 Rank —Please choose an option—兵, for Private兵長, for Lance Corporal伍長, for Corporal456 Place of Capture —Please choose an option—昭南島23456 Date of Capture 昭和年 —Please choose an option—16 (1941)17 (1942)18 (1943)19 (1944)20 (1945) 月 —Please choose an option—1 (January)2 (Feburary)3 (March)4 (April)5 (May)6 (June)7 (July)8 (August)9 (September)10 (October)11 (November)12 (December) 日 —Please choose an option—12345678910111213141516171819202122232425262728293031 Occupation (Japanese) Occupation (English) Additional notes (optional)