UNCLASSIFIED
SENSITIVE: PERSONAL
Catalogue No. 45072064 Form No. 1843 (02/2020)
Page 2 of 2
IMPORTANT NOTES FOR THE WITNESSING OF THIS APPLICATION
The witness must be one of the following:
Barrister or Solicitor of the Supreme Court; Clerk of the local Court; Member of Parliament; Legally qualified Medical Practitioner; Alderperson or
Councillor of any municipality; Town Clerk or Shire Secretary; Postal Manager; Manager or Accountant of any bank or building society; Justice of the
Peace; Public Servant of at least five years permanent service; Minister of Religion; School Teacher; Member of the Police Force.
INSTRUCTIONS TO WITNESS
You must sight the applicant's original documents, photocopies are not acceptable. Then you must certify a photocopy of these original documents
for inclusion with this application.
Please tick the appropriate boxes below to show the documents you have sighted.
List 1
An Australian full birth certificate showing parental details, issued by
an Australian Registry of Births, Deaths and Marriages (BDM
commemorative certificates are not acceptable).
An overseas birth certificate showing parental details provided a
passport or an official Australian travel document is also shown.
A current Australian or overseas passport (an expired Australian
passport is also acceptable but only within the last two years).
A Department of Immigration and Citizenship or the Department of
Immigration and Border Protection issued document from the
following list:
· Australian naturalisation or citizenship document
· a Visa Evidence Card
· a Document for Travel to Australia (up to 5 years from the date
of issue on the accompanying visa)
· Evidence of Immigration Status (EIS) ImmiCard (current or expired)
· Permanent Residence Evidence (PRE) ImmiCard
· Residence determination (RDI) ImmiCard
A Department of Foreign Affairs and Trade issued document from
the following list:
· a current consular photo identity card
· a current Certificate of Identity
· a current Document of Identity
· a current Titre de Voyage
A current NSW photo identity card or one that expired in the last
two years
Provide a document/card number for the list 1 item ticked above
List 2
A current Medicare card, Pensioner Concession Card, Department
of Veterans' Affairs entitlement card or any other current
entitlement card issued by the Commonwealth Government.
Change of name documents
(original documents MUST be sighted, copied and certified)
a marriage certificate (issued by the BDM if married in NSW)
a divorce document bearing the name being reverted to
a full birth certificate showing the name at birth and the new name
a change of name certificate issued by the BDM
a deed poll registered with the relevant authority
a completed instrument evidencing Change of Name form that has
been registered in the Land Titles Office.
A Transport for NSW issued NSW photo driver licence or NSW
Photo Card that has been expired more than 2 years but less than 5
years. The licence must display a card number and not have been
revoked or be reported as lost, stolen or destroyed.
A current Mobility Parking Scheme (MPS) permit, with or without a
photo
A current Transport for NSW issued NSW photo Firearm, Security
Industry or Commercial Agents and Private Inquiry Agents
operator licence.
A current photo identity card for the Australian Defence Force,
excluding civilian staff or family.
A current bank, building society, credit union, American Express or
Diners Club International - passbook, account statement (up to
one year old showing your name, residential or mailing address
and account number on institution letterhead or stamp), plastic
credit card or account card (showing in full your family name, first
given name and signature.
A utilites bill - telephone (landline only), gas, electricity, water/
council rates or land valuation notice up to one year old.
An Australian secondary school, TAFE or university issued student
identity card (current and displaying the name/photograph, when
the card has no expiry date, it may be accepted up to two years
from the date of issue) or evidence of course enrolment on the
institution's letterhead up to one year old (must have student's
name and address).
If there has been a change of name you must also sight an original document from the change of name document list on this page and then
certify a photocopy of the original change of name document.
Sight, photocopy and certify two documents, one from List 1 and one from List 2. The name must be the same on both documents.
Ask the applicant to sign in the ‘Declaration’ on the front of this application.
Complete the witness declaration on this page (including official stamp if available).
Proof of Identity documents (original documents MUST be sighted, copied and certified)
WITNESS DECLARATION
I have sighted the supporting document/s as marked. I have witnessed the applicant signing the declaration on the front of this form. I am convinced
of their identity.
Personal Information Collection Notice: our Privacy Statement explains why we are collecting your Personal Information and how we will use and
manage it in accordance with the Privacy and Personal Information Act 1998, and, where relevant, the Health Records and Information Privacy Act
2002. You can obtain a copy of our Privacy Statement at www.transport.nsw.gov.au/privacy-statement or call us on 13 22 13 to request a copy.
Name of witness (PRINT CLEARLY)
Signature of witness
Applicant’s name
Rank/position of witness
Witness telephone number
Witness email address
Date
Day Month Year
/ /
Official stamp of witness (if available) or JP registration
number
A certificate of Aboriginality signed by a Chairperson or Secretary of
an Aboriginal organisation such as the local land council, which
details name, address and date of birth.
