931 - Application for an Australian Declaratory visa - Department of ...

11
Address for correspondence
(If different from your residential address)
16 Do you hold any nationality or citizenship other than Australian citizenship?
No
Yes Give details
12 Your telephone numbers
Office hours
After hours
POSTCODE
13 Do you agree to the department communicating with you by fax, e-mail,
or other electronic means?
No Yes Give details
Fax number
E-mail address
COUNTRY CODE
AREA CODE
( ) ( )
( ) ( )
COUNTRY CODE
AREA CODE
( ) ( )
NUMBER
NUMBER
14 Do you have, or have you ever had an Australian passport?
Country
Date acquired
How acquired?
Country
Date acquired
How acquired?
DAY MONTH YEAR
DAY MONTH YEAR
If insufficient space, attach a separate sheet
17 If you are 18 years of age and are included in passports other than shown
in Question 3, give details of the other passports
Family name of
passport holder
Given name
No
Yes
Australian
passport number
Date of issue
Date of expiry
Issuing authority/
Place of issue as
shown in your
passport
Give details of your last or current
Australian passport
DAY MONTH YEAR
DAY MONTH YEAR
Passport number
Country of
passport
Date of issue
Date of expiry
Issuing authority/
Place of issue as
shown in your
passport
DAY MONTH YEAR
DAY MONTH YEAR
If insufficient space, attach a separate sheet
15
Why are you unable to travel on an Australian passport?
18 If you are under 18 years of age and are proposing to travel on another
person’s passport, does that person hold other passports?
No Yes Give details
If insufficient space, attach a separate sheet
Passport number
Country of
passport
Date of issue
Date of expiry
Issuing authority/
Place of issue as
shown in your
passport
DAY MONTH YEAR
DAY MONTH YEAR
If insufficient space, attach a separate sheet
931 (Design date 11/13) - Page 4 © COMMONWEALTH OF AUSTRALIA, 2013