Register of Australian Citizens

Date of Birth: Place of Birth: Occupation: Address Home: Business: Phone: Fax: Passport No: Date of issue: Place of issue:  ... or documents produced as evidence of Australian citizenship Other Nationality or Citizenship, if any: Date of arrival in country: Intended date of departure from country: Address in Australia:        Particulars Of Family Resident Within Jurisdiction Of Post: (A) Wife or Husband (include address if different from address shown above) Name: Address: Nationality: Date of Birth: Place of Birth: (B) Children Name: Nationality: Date of Birth: Place of Birth: Name: Nationality: Date of Birth: Place of Birth: Name: Nationality: Date of Birth: Place of Birth: Name: Nationality: Date of Birth: Place of Birth:        Next of kin or relatives in Australia including names and addresses: I, the undersigned, acknowledge having received, read and understood the explanatory notice relating to the purpose of registration, protection of Australian citizens and emergency situations. Date: