Application for evidence of

Australian citizenship

This information is provided to help you complete the

application form and guide you through the application
process.
Use this form if you require evidence of Australian citizenship
for yourself or your child/children.
If you require confirmation of the Australian citizenship status
of a deceased parent or grandparent and it is for official
purposes, use form 1391 Request for confirmation of
Australian citizenship status of a deceased person. Form1391
is available from the Department of Immigration and Border
Protection (the department) website www.citizenship.gov.au

Form

119

Integrity of application
The department is committed to maintaining the integrity of
the visa and citizenship programs. If you or a third party acting
on your behalf provide, or have provided in a previous
application, false or misleading information or documents
(either knowingly or otherwise), this application is likely to be
refused. In addition, you may be prosecuted under the
Migration Act 1958 and/or the Australian Citizenship
Act2007. If information or documents are found to be
fraudulent or misleading, you may be prosecuted and may be
subject to revocation of your Australian citizenship.

If you are seeking citizenship information that is more than

30years old and it is for genealogy or family research
purposes contact the National Archives of Australia
www.naa.gov.au

Step 1 Eligibility

If you are seeking information about a third party (other than

your child) please make a request under the Freedom of
Information Act 1982 on form 424A Request for access to
documents or information, available from the departments
website www.immi.gov.au

previously issued with an Australian citizenship certificate

or extract (this includes children on a parents citizenship
certificate)

There are 4 steps in the citizenship application process to

obtain evidence of your citizenship.

You can apply for evidence of your Australian citizenship if you

were:

born in Australia and acquired Australian citizenship by

birth
born in Australia on or after 20 August 1986 and acquired
Australian citizenship on your 10th birthday

Step 1

Eligibility determine if you are eligible

adopted in Australia and acquired Australian citizenship

Step 2

Original documents gather your original

documents

Step 3

Copy and certify your documents

born in the former Australian Territory of Papua before

16September 1975 acquired Australian citizenship and
did not subsequently lose Australian citizenship on
Independence Day

Step 4

Complete and lodge your application form

born outside Australia after 26 January 1949 and acquired

Australian citizenship by descent
born outside Australia before 26 January 1949 and acquired
Australian citizenship.

Need help?
The citizenship website provides more detailed information
www.citizenship.gov.au
In Australia The Citizenship Information Line provides
recorded information and access to information officers.
Telephone 131 880 Monday to Friday 8.30am 4.30pm.
Outside Australia The citizenship website provides the
location, hours of operation and telephone numbers for
offices of the department outside Australia.
Important Please read this information carefully before you
complete your application. Once you have completed your
application we strongly advise that you keep a copy for your
records.

Children
Applications for children under 16 years of age must be made
by a responsible parent.
The Australian Citizenship Act 2007 defines responsible
parent in relation to a child as:
a parent, unless that parent does not have parental
responsibility because of orders made by the Family Court
of Australia, or
any person having responsibility over the child because of
an order made by the Family Court, or
any person who has guardianship or custody of the child
under an Australian law or a foreign law, whether because of
adoption, operation of law, an order of a court or otherwise.

Home page
Citizenship
Information Line

COMMONWEALTH OF AUSTRALIA, 2014

www.citizenship.gov.au
Telephone 131 880 during business hours
in Australia to speak to an operator (recorded
information available outside these hours).
Ifyou are outside Australia, please contact
your nearest Australian mission.
119 (Design date 03/14a) - Page 1

Step 2 Original documents

Children

You will need to provide the department with a range of

documents to prove that you are who you say you are. These
documents are called proof of identity documents.
You will also need to provide additional documents with your
application to provide proof of your Australian citizenship.
These are called supporting documents.

Translations and certified copies

If your documents are not in English, you must provide
official translations. In Australia, you must use translators
accredited by the National Accreditation Authority of
Translators and Interpreters. For more information, see
www.naati.com.au
Unless specified that original documents are required,
certified copies of original documents must be attached to
your application. These copies must be certified by a person
with the appropriate authority. See Identity declarations list
of professions on page 9 for people who may certify
documents.
If you are outside Australia when applying, contact the
Australian diplomatic mission in the country who issued the
documents for advice on acceptable translators, and who can
certify your original documents.

If you are an applicant under 16 years of age, you must

provide the following:
1. Proof of identity documents that show a:
birth name and date of birth
photograph and current name, if available.
2. Proof of change of name, if applicable.
3. Part L Identity declaration completed by a person with
the appropriate authority.
The checklist below will help you identify suitable documents.
If you have difficulty finding suitable documents please call the
Citizenship Information Line or, if outside Australia call your
nearest Australian diplomatic mission, before you complete
and lodge your application.

Proof of identity checklist

Applicants 16 years of age or over
A current document with your photograph
and/or signature
An Australian drivers licence, or
A passport, or

Change of name
If you have changed your name since acquiring Australian
citizenship you must provide official Australian evidence of all
name changes. This will usually be a change of name
certificate issued by an Australian Registry of Births, Deaths
and Marriages (RBDM) or a marriage or divorce certificate
issued by an Australian RBDM.
Overseas documents are not acceptable evidence that you
have changed your name since acquiring your Australian
citizenship.

Proof of identity

A United Nations High Commissioner for Refugees

(UNHCR) document, or
A national identity card, or
Another document containing a signature and
photograph, eg. an air crew identity document,
seafarer identity document, military identity
document or student card
Evidence of your current residential address
A utilities notice eg. electricity, gas or water bill,
bank notice, or

Applicants 16 years of age or over

To prove your identity you must provide the following
documents.
1. Three original documents that collectively show your:
photograph
signature

Rental contracts or rates notice

Evidence of your date of birth, birth name
and any changes of name
A full birth certificate, and

current residential address

Evidence of links between present and previous

names, for example a marriage or divorce
certificate, if applicable, or

birth name, date of birth and gender.

2. Proof of change of name, if applicable.
3. Part L Identity declaration completed by a person with
the appropriate authority.
If you do not provide these documents, your
application will not be accepted and will be returned
to you.

A certificate issued by an Australian Registry of

Births, Deaths and Marriages as evidence of other
changes of name, if applicable
Evidence of your identity in the community
One passport-sized photograph and identity
declaration signed by an Australian citizen with the
appropriate authority

119 (Design date 03/14a) - Page 2

COMMONWEALTH OF AUSTRALIA, 2014

Children

The photograph must be:

The following documents are required if the applicant is a

child under 16 years of age.

no more than 6 months old

A full birth certificate or family register containing

parents details

a full-face view of your head and shoulders (untinted

prescription glasses can be worn a photograph that shows
facial features only is acceptable if you wear a head covering
for religious reasons)

Evidence of links between birth name and current

name, if applicable

of good quality, in colour, against a plain, light coloured

background (laser copies are not acceptable).

Another document showing a photograph and

current name, for example a passport or a student
card

Note: If you are outside Australia when applying you can have
the identity declaration completed by a citizen of your country
of residence who has known you for at least one year and
belongs to a profession on the list on page 9.

One passport-sized photograph and identity

declaration signed by an Australian citizen with the
appropriate authority

Children
The same conditions (see above) apply to the Australian
citizen who signs the childs identity declaration and
photograph, except in the case of children under 6 years of
age. If no Australian citizen has known them for at least one
year, then the declaration can be signed by someone who
belongs to a profession on the list on page 9 who has known
the child for less than one year.

Documents relating to the responsible parent

applying on behalf of a child under
16 years of age
Proof of identification documents that collectively
show a signature, photograph, and a current
residential address, for example:
a passport
drivers licence
credit card or utilities bill

Supporting documents
Depending on how you acquired your Australian citizenship
you may need additional documents to support your
application for evidence of Australian citizenship.

Any orders relating to the custody, guardianship or

parental responsibility for your child, if applicable

You may be required to provide additional documents to

those listed.

Evidence of adoption of your child, if your child

was adopted overseas

Tables A E on pages 4, 5, 6 and 7 provide more detailed

information on when and how you may have acquired
Australian citizenship and the documents you will need to
support your application for evidence of your citizenship.

Identity declaration
Applicants 16 years of age or over

Table A Previously issued with evidence of

Australian citizenship

As well as your proof of identity documents, you will need to

provide an identity declaration and an endorsed passportsized photograph of yourself.

Table B Acquired Australian citizenship by being

born in Australia

The identity declaration must be completed and signed by

an Australian citizen who:

Table C Adopted in Australia

has known you for at least one year and belongs to a

profession on the list on page 9, and

Table D Born in the former Australian Territory of

Papua
Table E Born outside Australia before
26 January 1949

is not related to you by birth, marriage or de facto

relationship, and
is easy to contact by telephone during normal working
hours.
The person who signs the declaration must also write on the
back of your photograph the words: This is a true photograph
of (your full name) and sign the back of the photograph
using the same signature as on the declaration.

The following tables and checklists will help you identify

suitable documents.
Only select the category that relates to your circumstances.

The photograph should be carefully attached to the front of

the application form without obscuring the image, or you can
place the photograph in a plastic sleeve or envelope and
staple it to the form.

COMMONWEALTH OF AUSTRALIA, 2014

119 (Design date 03/14a) - Page 3

Table A
You were previously issued with evidence of
Australian citizenship after:

Supporting documents needed

migrating to Australia and becoming an Australian citizen

(this includes children who are on a parents evidence of
citizenship), or

If you still have your citizenship certificate,

extract, or your name is included on your
parents certificate, you need to provide this
document

registration by descent, following your birth overseas to an

Australian citizen, or
adoption under full and permanent Hague arrangements and
becoming an Australian citizen, or

If you are requesting a new certificate you

must surrender the old one unless other
people are named on it

resumption, if you lost your Australian citizenship and then

re-acquired it, or
notification. From 1 May 1970 to 31 May 1974, British subjects
could acquire Australian citizenship by notification provided
they had been living in Australia for the 5 years before
notifying their intention to become citizens

119 (Design date 03/14a) - Page 4

COMMONWEALTH OF AUSTRALIA, 2014

Table B
You acquired Australian citizenship by being born
in Australia:

Supporting documents needed

before 26 January
1949 and you were
a British subject on
25January 1949

You became an Australian citizen on

26January 1949 unless your father was a
foreign diplomat

No additional documents required

between 26 January
1949 and 19 August
1986

You became an Australian citizen at birth

unless your father was a foreign diplomat

on or after 20 August
1986

You became an Australian citizen at birth if

at least one of your parents was an
Australian citizen or permanent resident of
Australia at the time of your birth, or

Evidence of one parents Australian

citizenship (if available), for example an
Australian passport issued after 1 July 2005,
a certificate of Australian citizenship, or an
Australian birth certificate, or
Evidence of one parents permanent
residence in Australia (if available), for
example a passport with a visa granting
permanent residence or permanent entry
stamp
Note: Form 1391 Request for confirmation
of Australian citizenship status of a
deceased person cannot be used to obtain
this information.

You may have become an Australian citizen

on your 10th birthday if:
you lived in Australia for the first 10years
of your life, and
neither of your parents were entitled to
diplomatic privileges during this time.

Evidence of both parents status at the time

of your birth (if available), for example a
passport, and
Evidence of your residence in Australia
for 10 years since your birth, for example
immunisation certificates, a passport,
baptismal certificate, school reports, club
memberships, banking records etc

You may be an Australian citizen (unless your

parents were entitled to diplomatic
privileges) if you were:
born in Australia between 26 January 1949
and 19 August 1986 (Note: children born
in Australia between 20 August 1986 and
31 August 1994 generally did not acquire
Australian citizenship by birth), or
born in Australia between 1September
1994 and 26 February 2001 and at least
one of your parents held a permanent
residence visa or a Special Category visa,
or
born in Australia on or after 27February
2001 and at least one of your parents held
an Australian permanent residence visa, or
born in Australia on or after 27February
2001 to New Zealand citizen parents
present in Australian on a Special Category
visa if at least one parent:
was in Australia on 26 February 2001, or
had been in Australia for a period, or
periods that total, at least one year in
the 2 years immediately before
26 February 2001, or
had been issued with a Centrelink
certificate stating they were resident in
Australia on a particular date

Evidence of the New Zealand citizenship

of the parent present in Australia at the
time of your birth, for example a New
Zealand passport, certificate of New Zealand
citizenship, and
A Centrelink certificate (if applicable), or
Evidence of Australian permanent residence
of the parent present in Australia at the
time of your birth (eg. a passport showing a
permanent visa or permanent entry stamp)

to New Zealand
citizen parents

COMMONWEALTH OF AUSTRALIA, 2014

119 (Design date 03/14a) - Page 5

Table C
If you were adopted in Australia:

Supporting documents needed

on or after
22November 1984

Adoption papers, and

You became an Australian citizen at the

time of adoption in Australia if you
were adopted by an Australian citizen
and you were a permanent resident in
Australia at the time of adoption

Evidence of your Australian parents

citizenship, and
Evidence of your permanent residence at the
time of your adoption

Table D
If you were born in the former Australian Territory
of Papua:
before 16 September
1975

119 (Design date 03/14a) - Page 6

You may be an Australian citizen from

the date of your birth or, if born before
26 January 1949 you acquired Australian
citizenship on 26 January 1949.
Persons born in the former Australian
Territory of Papua prior to
16September 1975 who have at least 2
grandparents born in Papua New
Guinea (PNG) or adjacent areas
automatically became PNG citizens and
consequently lost Australian citizenship
when PNG gained independence on
16September 1975 unless:
they had been granted the right of
permanent residence in Australia, or
they possessed another citizenship
(other than Australian or Papua New
Guinean) when they were under
19years of age

Supporting documents needed

Evidence of your right to permanent
residence in Australia, or
Evidence of citizenship other than Australian
or Papua New Guinean, or
Evidence of your paternal and maternal
grandparents place of birth, for example your
parents full birth certificate, or
A signed statutory declaration indicating if,
and when, you made a declaration of loyalty
to Papua New Guinea

COMMONWEALTH OF AUSTRALIA, 2014

Table E
Under special transitional provisions of the Australian
Citizenship Act 1948 if you were born outside Australia
before 26 January 1949 and were:

Supporting documents needed

a British subject on
You became an Australian citizen on
25 January 1949 and
26 January 1949
you lived in Australia
for the 5 year period
from 26January 1944
until 25January 1949

Evidence of your British subject status

usually a full birth certificate, and
Evidence of your residence in Australia
during this period, for example passports,
school reports, employment records, club
memberships, banking records etc

a British subject
born overseas to
an Australian father
before 26 January
1949

You became an Australian citizen

on 26 January 1949 if you entered
Australia before 26 January 1949 on
an unrestricted basis or you were
granted permanent residence in
Australia before that date, or
You became an Australian citizen on
the date of arrival in Australia if you
entered Australia between 26January
1949 and 5 May 1966 as a permanent
resident, or between 6 May 1966
and 30 April 1987 as a permanent
resident

Evidence of your British subject status,

usually a full birth certificate, and
Your fathers full birth certificate

a woman who was

a British subject
on 25 January 1949
and you married an
Australian before
26January 1949

You became an Australian citizen on

26January 1949 if you entered Australia
and were granted permanent residence
before 26 January 1949

Evidence of your British subject status,

usually a full birth certificate, and
Your marriage certificate, and
Evidence of husbands Australian citizenship

you were born in

You became an Australian citizen on
New Guinea and you 26January 1949
were a British subject
on 25 January 1949

Evidence of your British subject status,

usually a full birth certificate

COMMONWEALTH OF AUSTRALIA, 2014

119 (Design date 03/14a) - Page 7

Step 3 Copy and certify your documents

Do not post original documents to the department.
If you have to get documents from overseas this can take time.
You will not be able to complete the application process
without these documents.
In Australia If you lodge your application at an office of the
department, bring your original documents with you.
If you are posting your application to the department,
certified copies are required with your application. Copies of
documents should be certified by a person who has known
you for at least one year and belongs to a profession on the list
on page 9.
Outside Australia You can have your original documents
certified and the identity declaration completed by a citizen of
your country of residence who has known you for at least one
year and belongs to a profession on the list on page 9.

Step 4 Complete and lodge your

application form

Part K Proof of identity Part K requires you to list the

documents you are providing to prove your identity. See
page2 for information about this page of the application.
Part L Identity declaration Part L is not to be completed by
the applicant. See page 3 for information about who should
complete the Identity declaration and sign the back of the
photograph.
Part M Nomination of representative Part M allows you to
nominate another person who can make enquiries about your
application on your behalf. Make sure you sign the
authorisation at Part M if you want this to happen.

Part N Payment details To make a payment, please pay by

credit card, debit card, bank cheque or money order made
payable to the Department of Immigration and Border
Protection. Credit card is the preferred method of payment.
Generally, fees are not refundable.
Outside Australia Credit card payments or Australian
dollars (AUD) bank cheques are accepted. If you do not have
access to a credit card or AUD bank cheque, contact your
nearest Immigration Office outside Australia to find out about
alternative forms of payment.
Part O Declaration Carefully read and make sure you

Please use a pen, and write neatly in English using BLOCK

LETTERS. Corrections made with liquid paper are not
acceptable.

Part A Your details Part A requires you to provide your

personal details.
If you change address during the application process
you must tell the department your new address. See
form 929 Change of address and/or passport details.

Part B Citizenship details Part B requires you to provide

information about your current citizenship status.

understand the terms of this declaration before signing it. If

the applicant is under 16 years of age, the responsible parent
must sign the declaration on page 17 on behalf of the child.

Lodging your application

If you are in Australia, your application, certified copies of
documents and the fee should be mailed to the department at
the following address:
Evidence Processing Unit Parramatta
Department of Immigration and Border Protection
GPO Box 9984
SYDNEY NSW 2001

Part C Replacing evidence Part C should only be completed

if you have previously been issued with evidence or included
in an Australian citizenship certificate. See Table A for
information about this part of the application.

If you are outside Australia, your application, certified

copies of documents and the fee should be sent by post or
courier to the following address:

Part D Obtaining your first evidence of Australian citizenship

Overseas Citizenship Unit

Department of Immigration and Border Protection
GPO Box 717
CANBERRA ACT 2601
AUSTRALIA

Complete this part if you are applying for an Australian

citizenship certificate for the first time.

Part E Born in Australia You should complete Part E if you

were born in Australia. See Table B for information about this
part of the application.
Part F Born in Australia to New Zealand citizen parents PartF
should be completed if you were born in Australia to New
Zealand citizen parents. See Table B for information about this
part of the application.

Part G Adopted in Australia Part G should be completed if

you were adopted. See Table C for information about this part
of the application.

Postal address:

Courier access:
Overseas Citizenship Unit
Department of Immigration and Border Protection
3 Lonsdale Street
BRADDON ACT 2612
AUSTRALIA

Pre-lodgement checklist

Part H Born in Papua Part H should be completed if you

were born in the former Australian Territory of Papua before
16September 1975. See Table D for information about this
part of the application.

Completed application form

Part I British subject born outside Australia Part I should be

completed if you were a British subject on 26 January 1949.
See Table E for information about this part of the application.

One passport-sized photograph and identity

declaration signed by an Australian citizen with the
appropriate authority

Part J Your parents/adoptive parents Part J requires all

Supporting documents as required

applicants to provide the personal details of both their

parents including whether they have been known by any other
names.

The application fee

119 (Design date 03/14a) - Page 8

Proof of identity documents

COMMONWEALTH OF AUSTRALIA, 2014

Notification
If your application is approved you will be notified in writing.
You will also receive evidence of your Australian citizenship.
If a decision is made not to approve your application you will
be notified in writing.

Identity declarations list of professions

People from the following list of professions and occupations
can certify copies of original documents, complete identity
declarations and endorse photographs. They must:
be an Australia citizen, or
a citizen of your country of residence if no Australian citizen
is known to you and you are applying overseas
AND
have known you for at least one year
not be related to you by birth, marriage or de facto
relationship
be easy to contact by telephone during normal working
hours.
1. Australian Consular Officer or Australian Diplomatic
Officer (within the meaning of the Consular Fees
Act1955)
2. Bailiff
3. Bank officer with 5 or more years of continuous service
4. Building society officer with 5 or more years of continuous
service
5. Chiropractor (licensed or registered)
6. Clerk of court
7. Commissioner for Affidavits
8. Commissioner for Declarations
9. Credit union officer with 5 or more years of continuous
service
10. Dentist (licensed or registered)
11. Fellow of the National Tax Accountants Association
12. Finance company officer with 5 or more years of
continuous service
13. Judge of a court
14. Justice of the peace
15. Legal practitioner (licensed or registered)
16. Magistrate
17. Marriage celebrant licensed or registered under Subdivision C of Division 1 of Part IV of the Marriage Act1961
18. Master of a court
19. Medical practitioner (licensed or registered)
20. Member of Chartered Secretaries Australia
21. Member of Engineers Australia, other than at the grade of
student
22. Member of the Association of Taxation and Management
Accountants
23. Member of the Australian Defence Force with 5 or more
years of continuous service
24. Member of the Institute of Chartered Accountants in
Australia, the Australian Society of Certified Practicing
Accountants or the National Institute of Accountants

25. Member of the Parliament of the Commonwealth, a State,

a Territory Legislature, or a local government authority of
a State or Territory
26. Minister of religion licensed or registered under Subdivision
A of Division 1 of Part IV of the Marriage Act1961
27. Nurse (licensed or registered)
28. Optometrist (licensed or registered)
29. Permanent employee of Commonwealth, State or local
government authority with at least 5 or more years of
continuous service
30. Permanent employee of the Australian Postal Corporation
with 5 or more years of continuous service
31. Pharmacist (licensed or registered)
32. Physiotherapist (licensed or registered)
33. Police officer
34. Psychologist (licensed or registered)
35. Registrar, or Deputy Registrar, of a court
36. Sheriff
37. Teacher employed on a full-time basis at a school or
tertiary education institution
38. Veterinary surgeon (licensed or registered).

Important information about privacy

Your personal information is protected by law, including the
Privacy Act 1988. Important information about the collection,
use and disclosure (to other agencies and third parties,
including overseas entities) of your personal information,
including sensitive information, is contained in form 1442i
Privacy notice. Form 1442i is available from the departments
website www.immi.gov.au/allforms/ or offices of the
department. You should ensure that you read and understand
form 1442i before completing this form.
Personal identifiers collected under the Australian Citizenship
Act 2007 are photographs and signatures. The department and
the Department of Foreign Affairs and Trade (DFAT) have
signed an arrangement in accordance with the Australian
Citizenship Act 2007 that permits disclosure of your personal
identifiers for the purposes of administering the Australian
Passport Act 2005. When your application for Australian
citizenship is approved, your photograph, client number,
name, date of birth and gender will be provided to DFAT.

Consent to communicate electronically

The department may need to convey sensitive information
about your application to you. Electronic communication,
unless adequately encrypted, is not secure and may be viewed
by others or interfered with. The Australian Government
accepts no responsibility for the security or integrity of any
information sent to the department over the internet or by
other electronic means.

Home page
Citizenship
Information Line

www.citizenship.gov.au
Telephone 131 880 during business hours
in Australia to speak to an operator (recorded
information available outside these hours).
Ifyou are outside Australia, please contact
your nearest Australian mission.

Please keep these information pages for your reference

COMMONWEALTH OF AUSTRALIA, 2014

119 (Design date 03/14a) - Page 9

This page is intentionally blank

Form

Application for evidence of

Australian citizenship

You must attach the endorsed

photograph of the applicant to
this page.

Please use a pen, and write neatly in English using BLOCK LETTERS.

The photograph must be

attached without obscuring the
image, or can be placed in a
plastic sleeve and stapled to
this page.

Part A Your details

1

Preferred title

Mr

Mrs

Miss

ICSE
Client ID

PHOTOGRAPH

Please read the information pages before completing this application

Tick where applicable

Box File
Number

To be completed by an applicant aged 16 years or over

or by a responsible parent on behalf of an applicant
under 16 years of age.

119

Ms

Other

Your full name (this will appear on your evidence of citizenship)

Family name

Given names
(including all
middle names)

Place of birth
Town/city
Country

Your name when Australian citizenship was originally acquired

(if same as your present name, write AS ABOVE)

Current residential address

Note: You must tell the department if your address
changes after you lodge this form.

Family name
Given names

Reason for
change
Other

Change of name certificate

Marriage

POSTCODE

Have you been known by any other names?

(including name at birth, previous married names, aliases,
alternative spellings or full spelling of all names)

Current postal address

(If the same as your residential address, write AS ABOVE)
Note: You must tell the department if your address
changes after you lodge this form.

No
Yes

Give details
POSTCODE

Family name
Given names

10 Telephone numbers

Reason for
change of
name
If you have been known by more than one other name,
attach additional details on a separate sheet.

Sex

Male

Work

(AREA CODE

Home

(AREA CODE

Mobile/cell

11 Do you agree to the department communicating with you by fax,

email or other electronic means?

Female

No
DAY

Date of birth

MONTH

YEAR

Yes

Give details

Fax number

(AREA CODE

Email address
COMMONWEALTH OF AUSTRALIA, 2014

119 (Design date 03/14a) - Page 11

Part B Citizenship details

Part D Obtaining your first evidence

of Australian citizenship

12 Do you hold the citizenship of any other country?

No

19 The documents and evidence you need to obtain a citizenship

Yes

Give details

certificate depend on your personal circumstances.

Which circumstance applies to you? (Tick one box only)

Country

Born in Australia

Go to Part E

Born in Australia to New Zealand citizen parents

Go to Part F

Date acquired

Adopted in Australia on or after

22 November 1984

Go to Part G

Place acquired

Born in Papua before 16 September 1975

Go to Part H

A British subject born outside Australia who

acquired citizenship on 26 January 1949

Go to Part I

Citizenship
acquired by:

Birth

Descent

Naturalisation

Adoption

DAY

MONTH

Other

YEAR

13 To be answered ONLY if you were born outside Australia and naturalised,

or registered as an Australian citizen, before 8 October 1951.
Were you absent from Australia for a continuous period of
7 years or more between 26 January 1949 and 8 October 1958?

Part E Born in Australia

20 How did you acquire your citizenship?

No
Yes

Show period absent

DAY

MONTH

British subject born in Australia before 26 January 1949

YEAR

From

DAY

MONTH

YEAR

to

Born in Australia on or after 20 August 1986

DAY

14 If you were born outside Australia,

MONTH

YEAR

21 You must provide proof of identity documents (see page 2) and

provide date you first arrived in Australia

supporting documents in Table B on page 5, to obtain evidence of

your Australian citizenship.

Part C Replacing evidence

Go to Part J

15 How did you acquire Australian citizenship?

Birth

Descent

Naturalisation

Adoption

DAY

MONTH

Born in Australia between 26 January 1949 and 19 August 1986

Other

YEAR

Part F Born in Australia to a New

Zealand citizen parent
Your Australian citizenship may depend on the status of your New
Zealand parent in Australia at the time of your birth.

Date acquired
Place acquired

16 Have you ever had, or been included in a certificate that says you are

22 When were you born in Australia?

Between 26 January 1949 and 19 August 1986

an Australian citizen?

Between 20 August 1986 and 31 August 1994

Go to Part D

No

Between 1 September 1994 and 26 February 2001

Yes

On or after 27 February 2001

17 What happened to the certificate?

23 Did you live in Australia for the first 10 years of your life?

Lost

No

Stolen

Yes

Destroyed
Other

Give details

24 At the time of your birth was your New Zealand parent a holder of
either a permanent residence or Special Category visa?
No
Yes

18 You must provide proof of identity documents (see page 2) and

supporting documents in Table A on page 4, to obtain a replacement
certificate.
Go to Part J

119 (Design date 03/14a) - Page 12

25 Was your New Zealand parent in Australia on 26 February 2001?

No
Yes

COMMONWEALTH OF AUSTRALIA, 2014

26 Was your New Zealand parent in Australia for a period that totalled at
least one year in the 2 years immediately before 26 February 2001?
No
Yes

Part H Born in Papua before

16 September 1975
33 Provide details of each of your grandparents

27 Was your New Zealand parent issued with a Centrelink certificate

1. Family name

stating that he/she was residing in Australia on a particular date?

Given names

No
Yes

Place of birth
Town/city

28 If you ticked Yes to Question 23, 24, 25, 26 or 27, you must provide

Country

proof of identity documents (see page 2) and supporting documents in

Table B on page 5, to obtain evidence of your Australian citizenship.
Go to Part J

2. Family name
Given names

Part G Adopted in Australia on

or after 22 November 1984
DAY

MONTH

Place of birth
Town/city

YEAR

Country

29 Date of adoption
30 Were you a permanent resident on the date of adoption?

3. Family name

No

Given names

Yes
Place of birth

31 Were you born outside Australia?

No
Yes

Town/city
DAY

MONTH

YEAR

Country

Date you first arrived

in Australia

32 You must provide proof of identity documents (see page 2) and

4. Family name

supporting documents in Table C on page 6, to obtain evidence of

your Australian citizenship.

Given names

Go to Part J and provide details of your adoptive parents

Place of birth
Town/city
Country

34 Were 2 or more of your grandparents born in Papua or New Guinea or

in an adjacent area?
No

Go to Question 37

Yes

35 Did you have a right to permanent residence in Australia prior to

16September 1975?
Advice of this would have been issued by the then Australian
Comptroller of Customs, Customs and Migration Division, Port Moresby.
No
Yes

COMMONWEALTH OF AUSTRALIA, 2014

119 (Design date 03/14a) - Page 13

36 Did you possess another citizenship on 16 September 1975?

Part J Your parents/adoptive parents

No
Yes

Provide details of one parent/adoptive parent at Question 43

and the other parent/adoptive parent at Question 44

Give details

Country

43 Parent/adoptive parent
DAY

MONTH

YEAR

Sex

Date acquired

Male

Female

Parents/adoptive parents full name

Citizenship acquired by:

Birth

Family name

Naturalisation

Given names

Descent
Adoption
Other

DAY

MONTH

YEAR

Date of birth

Give details

Place of birth
Town/city
Country

37 You must provide proof of identity documents (see page 2) and

supporting documents in Table D on page 6, to obtain evidence of
your Australian citizenship.

Citizenship(s) held by this parent/adoptive parent at the time

of your birth
1.
2.
3.

Go to Part J

Part I British subject born outside

Australia who may have acquired
citizenship on or after 26 January 1949
38 Were you a British subject on 25 January 1949 who lived in Australia

Was this parent/adoptive parent born outside Australia and

naturalised, or registered as an Australian citizen before
8October 1951?
No

Go to Question 44

Yes

No

Was this parent/adoptive parent absent from Australia for a

continuous period of 7years or more between 26 January 1949
and 8 October 1958?

Yes

No

for the 5 year period from 26 January 1944 until 25 January 1949?

Yes

39 Were you a British subject born to an Australian father before

DAY

26January 1949?

MONTH

YEAR

DAY

to

No
Yes

40 Are you a woman who was a British subject on 25 January 1949 who
married an Australian citizen before 26 January 1949?
No
Yes

41 Were you born in New Guinea and a British subject on

25January1949?
No
Yes

42 You must provide proof of identity documents (see page 2) and

supporting documents in Table E on page 7, to obtain evidence of your
Australian citizenship.

119 (Design date 03/14a) - Page 14

Period absent

COMMONWEALTH OF AUSTRALIA, 2014

MONTH

YEAR

44 Parent/adoptive parent
Sex

Male

Part K Proof of identity

Female

45 If you are 16 years of age or over, you must provide at least

Parents/adoptive parents full name

3documents which collectively contain your:

photograph
signature
current address
birth name, date of birth and gender.

Family name
Given names

Date of birth

You must also provide proof of any changes of name, if applicable, and
a completed Part L Identity declaration.

Place of birth

If you do not provide these documents your application will not

be accepted and will be returned to you.

DAY

MONTH

YEAR

Town/city

Do not post original documents to the department. If you are

posting your application attach certified copies.

Country

Please list the documents you are providing as proof of your identity
(see Step 2 Original documents on page 2)

Citizenship(s) held by this parent/adoptive parent at the time

of your birth

Applicants 16 years of age or over

1.

A current document with your photograph and signature

2.
3.

Evidence of your current residential address

Was this parent/adoptive parent born outside Australia and
naturalised, or registered as an Australian citizen before
8October 1951?
No

Evidence of your date of birth, birth name and any changes of name

Go to Question 45

Yes

Evidence of your identity in the community

Part L Identity declaration

Was this parent/adoptive parent absent from Australia for a

continuous period of 7years or more between 26 January 1949
and 8 October 1958?

Children

No

Evidence of the childs date of birth and birth name

Yes

Period absent
DAY

MONTH

YEAR

DAY

to

MONTH

YEAR

A document with the childs photograph and current name

Evidence of any changes of name, if applicable

Evidence of the childs identity in the community

Part L Identity declaration

COMMONWEALTH OF AUSTRALIA, 2014

119 (Design date 03/14a) - Page 15

Part L Identity declaration

Part M Nomination of representative

46 The identity declaration IS NOT TO BE COMPLETED BY THE

47 Do you want to nominate a person to make enquiries or receive

APPLICANT (See Identity declaration on page 3)

information on your behalf about your application?

I declare that I have known (full name of the applicant)

No

Go to Part N

Yes

Give details below

Family name

Nominated person

Given names
for

Family name
year(s) and vouch for his/her identity.

Given names

I have endorsed the back of his/her photograph

Signature
of person
making this
declaration

DAY

MONTH

YEAR

Date of birth
Relationship to
main applicant

DAY

MONTH

Telephone numbers

YEAR

Date
Details of person making this declaration
Family name

Work

(AREA CODE

Home

(AREA CODE

Mobile/cell

Given names

48 Authority to disclose information

Telephone numbers
Work

(AREA CODE

Home

(AREA CODE

I hereby authorise the Department of Immigration and Border

Protection to release information about my application to the person
named above. I understand that the authority will remain effective until
my application is finalised and should I wish to cancel or change this
authorisation I may do so by advising the department in writing.

Mobile/cell
Are you an Australian citizen?

No

Yes

Profession or occupation group number from page 9

Signature of
applicant

The photograph IS NOT TO BE SIGNED BY THE APPLICANT

The person who has completed the Identity declaration above should
also endorse the photograph.

Example of photograph requirements

PHOTOGRAPH FRONT

PHOTOGRAPH BACK

Min 32mm

Max 36mm

This is a true
photograph of

JOHN CITIZEN
(full name of applicant)

PSmith
(signature)

SIZE

119 (Design date 03/14a) - Page 16

COMMONWEALTH OF AUSTRALIA, 2014

DAY

Date

MONTH

YEAR

Part N Payment details

Part O Declaration

49 How will you pay your application fee?

WARNING: It is an offence under section 50 of the Australian

Citizenship Act 2007 to deliberately make, or cause to make,
a false or misleading statement, or conceal circumstances in
relation to an application.

Note: A surcharge may apply to payments made by credit card.

Further information is available from
www.immi.gov.au/fees-charges/how-to-pay.htm
If applying in Australia, credit card is the preferred method of
payment. Debit cards cannot be used for applications lodged by mail.
If paying by bank cheque or money order please make payable to the
Department of Immigration and Border Protection.
If applying from outside Australia, credit card payments or Australian
dollars (AUD) bank cheques are accepted. If you do not have access to
a credit card or AUD bank cheque, contact your nearest Immigration
Office outside Australia to find out about alternative forms of payment.
Bank cheque
Money order
Debit card

Cannot be used for applications lodged by mail

Credit card

Give details below

Payment by (tick one box)

Diners Club

American Express

JCB

Complete this declaration if you are the main applicant and are aged
16 years or over.
I declare that the information I have supplied in this form is
complete, truthful and correct in every detail.
I declare that this application constitutes an application for evidence
of Australian citizenship.
I have read the information contained in form 1442i Privacy notice.
I understand the department may collect, use and disclose my
personal information (including biometric information and other
sensitive information) as outlined in form 1442i Privacy notice.
Signature of
applicant

Australian Dollars

MasterCard

50 Please read the following carefully before signing.

DAY

AUD

MONTH

YEAR

Date

Visa
Credit card number
:

MONTH

YEAR

Expiry date

I declare that I am the responsible parent of the applicant.

I declare that this application constitutes an application for evidence
of Australian citizenship.

Cardholders name

Telephone
number
Address

COUNTRY CODE
(

AREA CODE
) (

I declare that the information I have supplied in this form is

complete, truthful and correct in every detail.

NUMBER

I have read the information contained in form 1442i Privacy notice.

I understand the department may collect, use and disclose my

personal information (including biometric information and other
sensitive information) as outlined in form 1442i Privacy notice.
POSTCODE

As the cardholder I acknowledge and accept that a credit card

surcharge may apply to the transaction.
Signature of
cardholder

Children
The responsible parent is to complete the following declaration if the
applicant is under 16 years of age.

Signature of
responsible
parent

DAY

MONTH

YEAR

Date

Full name of responsible parent

Credit card information will be used for fee paying purposes only.

We strongly advise that you keep a copy of your application

and all attachments for your records.

Office use only

Telephone numbers
COUNTRY CODE

AREA CODE

NUMBER

Work

) (

Home

) (

Mobile/cell

Name of
decision maker
Signature of
decision maker
DAY

MONTH

YEAR

Date
Approved

Not approved
COMMONWEALTH OF AUSTRALIA, 2014

119 (Design date 03/14a) - Page 17