Family composition
Department of Immigration and Multicultural and Indigenous Affairs
54
Form
Are you applying for a: Note:
1. You must complete this form in English only.
2. You must give details of all your family members living in your home country and abroad including half, step and adopted brothers, sisters
and children (if not living, write ‘Deceased’ in Home address column. If whereabouts unknown, write ‘Unknown’ in Home address column).
3. If you have been assisted in completing this form, you should only sign the Declaration if the information is true and correct and has been
included with your full knowledge, consent and understanding.
Short stay visitor (676)
Long stay visitor (686)
Sponsored family visitor (679)
Business short stay (456)
Other
Declaration
Given names Date of birth Home address Previous visits to Australia
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Family Family name
composition
Yourself
Spouse
Father
Mother
Brother/sister
Brother/sister
Brother/sister
Son/daughter
Son/daughter
Son/daughter
Marital status
(Married, engaged, de facto, separated,
divorced, widowed or never married)
I declare that:
• the information I have given on this form is complete
and correct.
• in any section of this form which has been completed
with the assistance of another person, the information
as set down is true and correct and has been included
with my full knowledge, consent and understanding.
Signature of applicant
/ /
DAY MONTH YEAR
Date
Signature of witness
/ /
DAY MONTH YEAR
Date
McMILLAN PRINT © COMMONWEALTH OF AUSTRALIA, 2002 54 (Design date 07/02)
DAY MONTH YEAR
