* denotes mandatory field

 

Applicant Details

Personal Details
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Title
 
*
First Name
 
 
Other Name(s)
*
Family Name
 
 
Previous Family Name
*
Date of Birth
 
*
Gender
 


Citizenship and Residency
If you were not born in Australia (or New Zealand if you are applying as a New Zealand Citizen) you must provide proof of your citizenship/residency status. If your Citizenship/Residency documentation is in a previous name you must also provide proof of your name change (e.g. Marriage Certificate)

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Are you an Australian Citizen?
 
*
Are you the holder of a Permanent Humanitarian Visa (within Australia)?
 
*
Are you an Australian Permanent Resident (Hold Permanent Visa)?
 
*
Are you a New Zealand Citizen?
 
*
Country of Birth
 


Registration E-mail address
Your reference number and all correspondence regarding this application will be sent to your email address (below). Also, if you forget your reference number, you can request that it be re-sent to this email address.
*
E-mail address is
 
*
Confirm E-mail address
 
 
Security
Password must consist of a minimum of 8 characters including at least one number.

*
Password
 
*
Confirm Password