Form

Identity declaration 1195

Department of Home Affairs

Who should use this form What the photograph requirements are
Form 1195 Identity declaration is to be completed and You will need to submit a passport-size photograph with this
provided to the Department of Home Affairs (the form. The person who completes Questions 2 and 3 must also
Department) if: write on the back of your photograph the words:
• you are applying online for citizenship or evidence of This is a true photograph of [your full name]
citizenship – a separate form 1195 must be completed for
yourself and each person included in the online application, and sign the back of the photograph using the same signature
or as at Question 3.
• you are applying for citizenship on a paper form and have The photograph must be:
more children than the space on your application form • no more than 6 months old, and
allows – a separate form 1195 must be completed for each • a full-face view of your head and shoulders (untinted
additional child. prescription glasses can be worn – a photograph that shows
An application for Australian citizenship or evidence of facial features only is acceptable if you wear a head covering
citizenship cannot be approved where a person’s identity is for religious reasons), and
not able to be verified. • of good quality, in colour, against a plain, light coloured
Important – Please read this information carefully before you background (laser copies are not acceptable).
complete this form. Once you have completed this form we
strongly advise that you keep a copy for your records. Example of photograph
PHOTOGRAPH FRONT PHOTOGRAPH BACK
Integrity of application
The Department is committed to maintaining the integrity “This is a true
of the visa and citizenship programs. If you or a third photograph of”
party acting on your behalf provide, or have provided in Max 36mm
Min 32mm

a previous application, false or misleading information or JOHN CITIZEN

documents (either knowingly or otherwise), this application (full name of applicant)
may be refused. In addition, you may be prosecuted under
the Migration Act 1958 and/or the Australian Citizenship
Act 2007. If information or documents are found to be PSmith
(signature)
fraudulent or misleading after you become an Australian
citizen, you may be prosecuted and may be subject to SIZE
revocation of your Australian citizenship. Photograph to be no more than 6 months old

Who can complete the Identity declaration

Questions 1 and 4 of this form must be completed by How to submit this form and photograph
the person who is applying for citizenship or evidence of If you are applying online for citizenship or evidence of
citizenship (the applicant). citizenship, pages 3 and 4 of this form must be scanned and
Questions 2 and 3 of this form must be completed, and the attached to your online application. The front and back of
photograph endorsed and signed, by a person who: your endorsed photograph must also be separately scanned, in
• is an Australian citizen, and colour, and attached to your online application.
• has known you for at least one year, and If you are applying for citizenship on a paper form, submit this
• is currently working in a profession or occupation listed on form with your paper form. Place the endorsed photograph in
pages 1 and 2, and a plastic sleeve or envelope and staple it to this form.
• is not related to you by birth, marriage or de facto
relationship, and List of professions and occupations
• is easy to contact by telephone during normal working 1. Australian Consular Officer or Australian Diplomatic
hours. Officer (within the meaning of the Consular Fees Act 1955)
Note: If you are applying from outside Australia and do 2. Bailiff
not know an Australian citizen, Questions 2 and 3 can be 3. Bank officer with 5 or more years of continuous service
completed, and the photograph endorsed and signed by a 4. Building society officer with 5 or more years of continuous
citizen of your country of residence who has known you service
for at least one year, is currently working in a profession or
occupation listed on pages 1–2, and is not related to you by 5. Chiropractor (licensed or registered)
birth, marriage or de facto relationship. 6. Clerk of court
For children under 6 years of age, Questions 2 and 3 can be 7. Commissioner for Affidavits
completed by an Australian citizen (or citizen of the child’s 8. Commissioner for Declarations
country of residence if applying from outside Australia) who 9. Credit union officer with 5 or more years of continuous
has known the child for less than 12 months, is currently service
working in a profession or occupation listed on pages 1–2,
and is not related by birth, marriage or de facto relationship. 10. Dentist (licensed or registered)
© COMMONWEALTH OF AUSTRALIA, 2024 1195 (Design date 03/24) - Page 1
 11. Fellow of the National Tax Accountant’s Association Important information about privacy
12. Finance company officer with 5 or more years of The Privacy Act 1988 contains 13 Australian Privacy
continuous service Principles which regulate the way that the Department
13. Judge of a court collects and handles personal information. Information about
14. Justice of the peace how the Department collects, uses and discloses personal
information for its key functions can be found in form 1442i
15. Legal practitioner (licensed or registered) Privacy notice. More information about the Department’s
16. Magistrate general information handling practices (including form
17. Marriage celebrant licensed or registered under 1442i) can be found in the Department’s Privacy policy at
Subdivision C of Division 1 of Part IV of the Marriage www.homeaffairs.gov.au/access-and-accountability/our-
Act 1961 commitments/privacy
18. Master of a court Personal identifiers collected under the Australian Citizenship
19. Medical practitioner (licensed or registered) Act 2007 are generally photographs. The Department and the
Department of Foreign Affairs and Trade (DFAT) have signed
20. Member of Chartered Secretaries Australia an arrangement in accordance with the Australian Citizenship
21. Member of Engineers Australia, other than at the grade of Act 2007 that permits disclosure of your personal identifiers
student for the purposes of administering the Australian Passport
22. Member of the Association of Taxation and Management Act 2005. If your application for Australian citizenship is
Accountants approved, your photograph, client number, name, date of
23. Member of the Australian Defence Force with 5 or more birth and gender will be provided to DFAT.
years of continuous service More information on personal identifiers is contained in
24. Member of the Institute of Chartered Accountants in information form 1243i Your personal identifiers. Information
Australia, the Australian Society of Certified Practicing form 1243i is available from the Department’s website
Accountants or the Institute of Public Accountants www.homeaffairs.gov.au/allforms
25. Member of the Parliament of the Commonwealth, a state, Citizenship testing by Services Australia
a territory Legislature, or a local government authority of
Citizenship appointments are conducted at selected offices of
a state or territory
Services Australia (Centrelink).
26. Minister of religion licensed or registered under
Subdivision A of Division 1 of Part IV of the Marriage Test administrators at Services Australia are authorised to
Act 1961 collect and access your identifying information such as your
photograph and signature, and use it along with personal and
27. Nurse (licensed or registered) identifying information provided to Services Australia by the
28. Optometrist (licensed or registered) Department to verify your identity and confirm that you are
29. Permanent employee of Commonwealth, state or local eligible to sit the citizenship test. Personal and identifying
government authority with at least 5 or more years of information includes your name, date of birth, address,
continuous service photograph, signature and copies of identity documents.
30. Permanent employee of the Australian Postal Corporation At the conclusion of your test appointment, the test
with 5 or more years of continuous service administrator will electronically transmit the documents
31. Pharmacist (licensed or registered) and photograph that were used to verify your identity, to
the Department for storage in the Department’s records
32. Physiotherapist (licensed or registered) management system. The test administrator will then securely
33. Police officer destroy the personal and identifying information, including
34. Psychologist (licensed or registered) electronic records, except for a record of your name, date of
birth and the date of your appointment.
35. Registered migration agent (where registration is not
suspended or subject to a caution)
Department of Home Affairs contact details
36. Registrar, or Deputy Registrar, of a court
See your paper application form for the postal address of the
37. Sheriff office of the Department closest to you.
38. Teacher employed on a full-time basis at a school or
tertiary education institution
39. Veterinary surgeon (licensed or registered).

Home page www.homeaffairs.gov.au/citizenship

Citizenship Telephone 131 880 during business hours
Information in Australia to speak to an operator (recorded
Line information available outside these hours).
If you are outside Australia, telephone
+61 2 6196 0196.

Please keep these information pages for your reference

1195 (Design date 03/24) - Page 2 © COMMONWEALTH OF AUSTRALIA, 2024
 Form

Identity declaration 1195

Department of Home Affairs

Please open this form using Adobe Acrobat Reader.

Either type (in English) in the fields provided or print this form
Details of the person who is making the
and complete it (in English) using a pen and BLOCK LETTERS. identity declaration (not the applicant)
Tick where applicable 3 IMPORTANT – Questions 2 and 3 must be completed by a person
who:
Details of the person who is applying • is an Australian citizen, and
for citizenship or evidence of • has known the applicant for at least one year, and
• is currently working in a profession or occupation listed on
citizenship (the applicant) pages 1–2, and
• is not related to the applicant by birth, marriage or de facto
1 Family name relationship, and
Given names • is easy to contact by telephone during normal working hours.
DAY MONTH YEAR The person will also need to endorse and sign a passport-size
Date of birth photograph of the applicant as described on page 1.

Current residential address

2 Family name
Note: You must tell the Department if your address changes after you
lodge this form. Given names

Address (home or business)

POSTCODE

Current postal address POSTCODE

(If the same as your residential address, write ‘AS ABOVE’)
Telephone numbers
Note: You must tell the Department if your address changes after you
lodge this form. Work (AREA CODE          )

Home (AREA CODE        )

Mobile/cell
POSTCODE
Are you an Australian citizen? Yes No
Telephone numbers
What is your profession or occupation group number from
Work (AREA CODE          ) pages 1 and 2?
Home (AREA CODE        )
3 Identity declaration
Mobile/cell
I declare that I have known (full name of the applicant who is applying
Transaction Reference Number (the number that you were given when for citizenship)
you lodged your online application)
Family name

Given names
Note: You (the applicant) must also complete the Declaration(s)
(Question 4) on page 4. for year(s) month(s) and vouch for their identity.
I have endorsed the back of the applicant’s photograph with the words
‘This is a true photograph of [name of applicant]’ and signed the
photograph.
Signature
of person
making this
declaration
-
DAY MONTH YEAR

Date

© COMMONWEALTH OF AUSTRALIA, 2024 1195 (Design date 03/24) - Page 3

 Declaration by the applicant who is
applying for citizenship or evidence of
citizenship
WARNING: It is an offence under section 50 of the Australian Applicants for citizenship aged 16 or 17 years – responsible
Citizenship Act 2007 to deliberately make, or cause to make, parent declaration
a false or misleading statement, or conceal circumstances in The responsible parent is to complete the following declaration if the
relation to an application. applicant is aged 16 or 17 years.
4 Please read the following carefully before signing. • I declare that I am the responsible parent of the applicant.
Applicants aged 16 years and over • I consent to the applicant’s personal information being provided to
the National Police Checking Service (NPCS) for the purpose of the
Complete this declaration if you are the main applicant and are NPCS conducting a Nationally Coordinated Criminal History Check
aged 16 years or over. (NCCHC) in relation to the applicant as part of their application for
• I declare that the information I have supplied in this form is Australian citizenship.
complete, truthful and correct in every detail. • I understand that this is for the purposes of assessing whether the
• I have read the information contained in form 1442i Privacy Offences provision, as defined in section 24(6) of the Australian
notice. Citizenship Act 2007, applies to the applicant.
• I understand the Department may collect, use and disclose my • I understand that more than one police check may be requested by
personal information (including biometric information and other the Department, including a further check that may be undertaken if
sensitive information) as outlined in form 1442i Privacy notice. the applicant is not approved as an Australian citizen and an appeal
• For applicants for citizenship aged 18 years or over only – of the decision is requested.
I acknowledge that I electronically signed my application for • I acknowledge that the applicant’s personal information will be
Australian citizenship and in doing so consented to a Nationally disclosed to Australian police agencies for them to use for their
Coordinated Criminal History Check (NCCHC) under the terms of the respective law enforcement purposes including the investigation of
National Police Checking Service (NPCS). any outstanding criminal offences.
• I acknowledge that I have read the National Police Checking
Signature of Service – General Information and understand the spent convictions
applicant
- legislation.
• I understand that spent convictions of specific offences (5 years
DAY MONTH YEAR
from the date of conviction for juvenile offenders) will be disclosed
Date to the Department by Australian police agencies for the purposes
outlined above.
Applicants aged under 16 years – responsible parent declaration • I have read the information contained in form 1442i Privacy notice.
The responsible parent is to complete the following declaration if the • I understand the Department may collect, use and disclose the
applicant is under 16 years of age. applicant’s personal information (including biometric information and
other sensitive information) as outlined in form 1442i Privacy notice.
• I declare that I am the responsible parent of the applicant.
• I declare that the information I have supplied in this form is See www.homeaffairs.gov.au/citizenship for information about the
Offences provision, spent convictions and the National Police Checking
complete, truthful and correct in every detail.
Service – General Information.
• I have read the information contained in form 1442i Privacy notice.
• I understand the Department may collect, use and disclose the Signature of
applicant’s personal information (including biometric information and responsible
other sensitive information) as outlined in form 1442i Privacy notice. parent -
Signature of DAY MONTH YEAR

responsible Date
parent - Full name of responsible parent
DAY MONTH YEAR

Date
Telephone numbers
Full name of responsible parent COUNTRY CODE AREA CODE NUMBER

Work (            ) (            )

Telephone numbers Home (            ) (            )

COUNTRY CODE AREA CODE NUMBER

Work (            ) (            ) Mobile/cell

Home (            ) (            )

We strongly advise that you keep a copy of your application
Mobile/cell and all attachments for your records.

1195 (Design date 03/24) - Page 4 © COMMONWEALTH OF AUSTRALIA, 2024