Fillable Form 119: Australian citizenship Step 1 Eligibility Application (Department of Home Affairs)

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Form 119: Australian citizenship Step 1 Eligibility Application (Department of Home Affairs)

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Country of origin: AUSTRALIA
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119 (Design date 05/20) - Page 1© COMMONWEALTH OF AUSTRALIA, 2020
Form
119
Application for evidence of
Australian citizenship
Department of Home Affairs
Important
Have you considered applying online? Applying online will
ensure your application and payment is received by the
Department of Home Affairs (the Department) in a timely
manner. Check if you can apply online at
www.homeaffairs.gov.au/citizenship
If you apply using this paper form
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
. Form 1391
is available from the Department’s website
www.homeaffairs.gov.au/allforms
If you are seeking citizenship information that is more than
30 years old and it is for genealogy or family research
purposes contact the National Archives of Australia
www.naa.gov.au
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 Department’s
website www.
homeaffairs
.gov.au/allforms
Please read the information pages carefully. Pre-pay through
ImmiAccount before posting your application to the
Department (see page 17).
We strongly advise that you keep a copy of your application for
your records.
There are 4 steps in the citizenship application process to
obtain evidence of your citizenship.
Step 1
Eligibility – determine if you are eligible
Step 2 Original documents – gather your original
documents
Step 3 Copy and certify your documents
Step 4 Complete this application form, pay online and
lodge your application
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
Act 2007. 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.
Step 1 – Eligibility
You can apply for evidence of your Australian citizenship if you
were:
• previously issued with an Australian citizenship certificate
or extract (this includes children on a parent’s citizenship
certificate)
• 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
• adopted in Australia and acquired Australian citizenship
• born in the former Australian Territory of Papua before
16 September 1975 acquired Australian citizenship and
did not subsequently lose Australian citizenship on
Independence Day
• born outside Australia after 26 January 1949 and acquired
Australian citizenship by descent
• born outside Australia before 26 January 1949 and acquired
Australian citizenship.
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.
Step 2 – Original documents
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 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.
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.
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
119 (Design date 05/20) - Page 2 © COMMONWEALTH OF AUSTRALIA, 2020
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 correct authority. See Identity declarations – list of
professions on page 9 for people who can certify documents.
Further information on certifying documents is available on
the Department’s website
https://immi.homeaffairs.gov.au/help-support/applying-
online-or-on-paper/on-paper/certified-copy
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.
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.
Identity documents
Applicants 16 years of age or over
You must provide the following identity documents.
1. Three original documents that collectively show your:
• photograph
• signature
• current residential address
• 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 correct authority.
If you do not provide these documents, your
application will not be accepted and will be returned
to you.
Children
If you are an applicant under 16 years of age, you must
provide the following:
1. 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 correct 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.
Identity document checklist
Applicants 16 years of age or over
A current document with your photograph
and/or signature
An Australian driver’s licence, or
A passport, or
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
Rental contracts or rates notice
Evidence of your date of birth, birth name
and any changes of name
A full birth certificate, and
Evidence of links between present and previous
names, for example an official marriage or divorce
certificate, if applicable, or
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
correct authority
Children
The following documents are required if the applicant is a
child under 16 years of age.
A full birth certificate or family register containing
parent’s details
Evidence of links between birth name and current
name, if applicable
Another document showing a photograph and
current name, for example a passport or a student
card
One passport-sized photograph and identity
declaration signed by an Australian citizen with the
correct authority
119 (Design date 05/20) - Page 3© COMMONWEALTH OF AUSTRALIA, 2020
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
• driver’s licence
• credit card or utilities bill
Any orders relating to the custody, guardianship or
parental responsibility for your child, if applicable
Evidence of adoption of your child, if your child was
adopted overseas
Identity declaration
Applicants 16 years of age or over
As well as your identity documents, you will need to provide
an identity declaration and an endorsed passport-sized
photograph of yourself.
The identity declaration must be completed and signed by
an Australian citizen who:
• has known you for at least one year and belongs to a
profession on the list on page 9, and
• 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 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.
The photograph must be:
• no more than 6 months old
• 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)
• of good quality, in colour, against a plain, light coloured
background (laser copies are not acceptable).
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.
Children
The same conditions (see above) apply to the Australian
citizen who signs the child’s 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, the declaration can be signed by a person who belongs
to a profession on the list on page 9 who has known the child
for less than one year.
Supporting documents
Depending on how you acquired your Australian citizenship
you may need additional documents to support your
application for evidence of Australian citizenship.
You may be required to provide additional documents to
those listed.
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.
Table A Previously issued with evidence of
Australian citizenship
Table B Acquired Australian citizenship by being
born in Australia
Table C Adopted in Australia
Table D Born in the former Australian Territory of
Papua
Table E Born outside Australia before
26 January 1949
The following tables and checklists will help you identify
suitable documents.
Only select the category that relates to your circumstances.
119 (Design date 05/20) - Page 4 © COMMONWEALTH OF AUSTRALIA, 2020
Table A
• migrating to Australia and becoming an Australian citizen
(this includes children who are on a parent’s evidence of
citizenship), or
• registration by descent, following your birth overseas to an
Australian citizen, or
You were previously issued with evidence of
Australian citizenship after:
Supporting documents needed
• If you still have your citizenship certificate,
extract, or your name is included on your
parent’s certificate, you need to provide this
document
• If you are requesting a new certificate you
must surrender the old one unless other
people are named on it
• adoption under ‘full and permanent’ Hague arrangements and
becoming an Australian citizen, or
• 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 05/20) - Page 5© COMMONWEALTH OF AUSTRALIA, 2020
Table B
• before 26 January
1949 and you were
a British subject on
25 January 1949
You acquired Australian citizenship by being born
in Australia:
Supporting documents needed
No additional documents required
You became an Australian citizen on
26 January 1949 unless your father was a
foreign diplomat
• 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
• Evidence of one parent’s 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 parent’s 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 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 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 have become an Australian citizen
on your 10th birthday if:
• you lived in Australia for the first 10 years
of your life, and
• neither of your parents were entitled to
diplomatic privileges during this time.
• to New Zealand
citizen parents
• 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)
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 1 September
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 27 February
2001 and at least one of your parents held
an Australian permanent residence visa, or
• born in Australia on or after 27 February
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
119 (Design date 05/20) - Page 6 © COMMONWEALTH OF AUSTRALIA, 2020
Table C
• on or after
22 November 1984
If you were adopted in Australia: Supporting documents needed
• Adoption papers, and
• Evidence of your Australian parent’s
citizenship, and
• Evidence of your permanent residence at the
time of your adoption
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
Table D
• before 16 September
1975
If you were born in the former Australian Territory
of Papua:
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
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
16 September 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
16 September 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
19 years of age
119 (Design date 05/20) - Page 7© COMMONWEALTH OF AUSTRALIA, 2020
Table E
• a British subject on
25 January 1949 and
you lived in Australia
for the 5 year period
from 26 January 1944
until 25 January 1949
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
• 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
• You became an Australian citizen on
26 January 1949
• a British subject
born overseas to
an Australian father
before 26 January
1949
• Evidence of your British subject status,
usually a full birth certificate, and
• Your father’s full birth certificate
• 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 26 January
1949 and 5 May 1966 as a permanent
resident, or between 6 May 1966
and 30 April 1987 as a permanent
resident
• a woman who was
a British subject
on 25 January 1949
and you married an
Australian before
26 January 1949
• Evidence of your British subject status,
usually a full birth certificate, and
• Your marriage certificate, and
• Evidence of husband’s Australian citizenship
You became an Australian citizen on
26 January 1949 if you entered Australia
and were granted permanent residence
before 26 January 1949
• you were born in
New Guinea and you
were a British subject
on 25 January 1949
• Evidence of your British subject status,
usually a full birth certificate
You became an Australian citizen on
26 January 1949
119 (Design date 05/20) - Page 8 © COMMONWEALTH OF AUSTRALIA, 2020
Step 3 – Copy and certify your documents
Certified copies of all of your required documents must be
attached to your application. A ‘certified copy’ is a copy of an
original document that has been authorised (or stamped) as
being a true copy of the original document.
The copies must be certified by a person with the correct
authority. See Identity declarations – list of professions on
page 9 for people who may certify documents.
Do not post original documents to the Department,
unless specified otherwise.
Step 4 – Complete this application form,
pay online and lodge your application
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.
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.
Part D – Obtaining your first evidence of Australian citizenship –
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 – Part F
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.
Part H – Born in Papua – Part H should be completed if you
were born in the former Australian Territory of Papua before
16 September 1975. See Table D for information about this
part of the application.
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.
Part J – Your parents/adoptive parents – Part J requires all
applicants to provide the personal details of both their parents
including whether they have been known by any other names.
Part K – Identity documents – Part K requires you to list your
identity documents. See pages 2–3 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 – Method of payment – Make your payment electronically
through the ‘My Payments’ section of ImmiAccount.
Sign into, or create, your ImmiAccount and select
My Payments>Manage Payments>Pre-Pay Paper Service, at
www.homeaffairs.gov.au/immiaccount
If you are outside Australia and cannot pay online in
ImmiAccount, check the Department’s website for alternative
payment methods for your location
www.homeaffairs.gov.au/locations
Part O – Declaration – Carefully read and make sure you
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
Send your application, certified copies of documents and
payment receipt to:
Evidence Processing Unit Parramatta
Department of Home Affairs
GPO Box 9984
SYDNEY NSW 2001
AUSTRALIA
If you were born
in Papua New Guinea prior to
16 September 1975
or if you were born outside Australia
and obtained citizenship by descent on the basis of a
parent born in Papua New Guinea prior to
16 September 1975, send your application, certified copies
of documents and payment receipt to:
Citizenship – PNG Unit
Department of Home Affairs
GPO Box 9984
BRISBANE QLD 4001
AUSTRALIA
Pre-lodgement checklist
Completed application form
Identity documents
One passport-sized photograph and identity
declaration signed by an Australian citizen with the
correct authority
Supporting documents as required
The application payment receipt
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.
119 (Design date 05/20) - Page 9© COMMONWEALTH OF AUSTRALIA, 2020
Identity declarations – list of professions
People currently working in a profession or occupation listed
below can complete identity declarations and endorse
photographs.
They must:
• be an Australian citizen, or
• if applying from outside Australia, a citizen of your country
of residence if no Australian citizen is known to you
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
Act 1955)
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 Sub-
division C of Division 1 of Part IV of the Marriage Act 1961
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 Institute of Public 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 Act 1961
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 Department’s
website www.homeaffairs.gov.au/privacy 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. If 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.
Please keep these information pages for your reference
www.homeaffairs.gov.au/citizenship
Telephone 131 880 during business hours
in Australia to speak to an operator (recorded
information available outside these hours).
If you are outside Australia, please contact
your nearest Australian mission.
Home page
Citizenship
Information
Line
This page is intentionally blank
119 (Design date 05/20) - Page 11© COMMONWEALTH OF AUSTRALIA, 2020
Form
119
Application for evidence of
Australian citizenship
Department of Home Affairs
ICSE
Client ID
Box File
Number
1
Part A – Your details
Family name
Given names
(including all
middle names)
2
4
Your full name (this will appear on your evidence of citizenship)
Preferred title
Mr Mrs Miss Ms
Other
Have you been known by any other names?
(including name at birth, previous married names, aliases,
alternative spellings or full spelling of all names)
No
Yes Give details
Family name
Given names
Reason for
change of
name
If you have been known by more than one other name,
attach additional details on a separate sheet.
5
6
Sex
Date of birth
DAY MONTH YEAR
7
Place of birth
Town/city
Country
8
Current residential address
Note: You must tell the Department if your address
changes after you lodge this form.
POSTCODE
9
Current postal address
(If the same as your residential address, write
‘AS ABOVE’)
POSTCODE
10
Telephone numbers
Work
Home
(AREA CODE )
(AREA CODE )
Note: You must tell the Department if your address
changes after you lodge this form.
Mobile/cell
PHOTOGRAPH
You must attach the endorsed
photograph of the applicant to
this page.
Attach the photo by placing it
in a plastic sleeve and stapling
the sleeve to this page.
Do not apply tape, glue or
staples directly to the photo.
3
Tick where applicable
Please open this form using Adobe Acrobat Reader.
Either type (in English) in the fields provided or print this form
and complete it (in English) using a pen and BLOCK LETTERS.
Please read the information pages before completing this application
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.
Family name
Given names
3
Your name when Australian citizenship was originally acquired
(if same as your present name, write ‘AS ABOVE’)
Reason for
change
Change of name certificate Marriage
Other
Give details
No
Yes
Email address
11
Male
Female
Indeterminate /
Intersex / Unspecified
Do you agree to the Department communicating with you by email or
other electronic means?
Note: If consent to use electronic communication is not provided, delays
will occur including notification of the outcome of this application.
119 (Design date 05/20) - Page 12 © COMMONWEALTH OF AUSTRALIA, 2020
DAY MONTH YEAR
Part E – Born in Australia
20
How did you acquire your citizenship?
12
Do you hold the citizenship of any other country?
No
Yes Give details
Country
Citizenship
acquired by:
Birth
Naturalisation
Descent
Adoption
Other
Part B – Citizenship details
Date acquired
Place acquired
16
Have you ever had, or been included in a certificate that says you are
an Australian citizen?
No
Yes
Part C – Replacing evidence
Go to Part D
17
What happened to the certificate?
Lost
Stolen
Destroyed
Other Give details
Go to Part J
You must provide identity documents (see page 2) and supporting
documents in Table A on page 4, to obtain a replacement certificate.
Part D – Obtaining your first evidence
of Australian citizenship
19
The documents and evidence you need to obtain a citizenship
certificate depend on your personal circumstances.
Which circumstance applies to you? (Tick one box only)
Born in Australia
Go to Part E
Born in Australia to New Zealand citizen parents
Go to Part F
Adopted in Australia on or after
22 November 1984
Go to Part G
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
British subject born in Australia before 26 January 1949
Born in Australia between 26 January 1949 and 19 August 1986
Born in Australia on or after 20 August 1986
Go to Part J
You must provide identity documents (see page 2) and supporting
documents in Table B on page 5, to obtain evidence of your
Australian citizenship.
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.
22
When were you born in Australia?
Between 26 January 1949 and 19 August 1986
Between 20 August 1986 and 31 August 1994
Between 1 September 1994 and 26 February 2001
On or after 27 February 2001
23
Did you live in Australia for the first 10 years of your life?
No
Yes
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
25
Was your New Zealand parent in Australia on 26 February 2001?
No
Yes
18
21
14
15
If you were born outside Australia,
provide date you first arrived in Australia
How did you acquire Australian citizenship?
DAY MONTH 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?
Show period absent
No
Yes
From
DAY MONTH YEAR
to
DAY MONTH YEAR
DAY MONTH YEAR
Birth
Naturalisation
Descent
Adoption
Other
Date acquired
Place acquired
119 (Design date 05/20) - Page 13© COMMONWEALTH OF AUSTRALIA, 2020
DAY MONTH YEAR
29
Part G – Adopted in Australia on
or after 22 November 1984
Date of adoption
31
Were you born outside Australia?
Date you first arrived
in Australia
No
Yes
DAY MONTH YEAR
Go to Part J and provide details of your adoptive parents
You must provide identity documents (see page 2) and supporting
documents in Table C on page 6, to obtain evidence of your Australian
citizenship.
32
Part H – Born in Papua before
16 September 1975
33
Provide details of each of your grandparents
Family name
Given names
Place of birth
1.
Family name2.
Given names
Place of birth
Town/city
Country
Town/city
Country
Family name3.
Given names
Place of birth
Town/city
Country
Family name4.
Given names
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
Yes
Go to Question 37
35
Did you have a right to permanent residence in Australia prior to
16 September 1975?
Advice of this would have been issued by the then Australian
Comptroller of Customs, Customs and Migration Division, Port Moresby.
No
Yes
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
27
30
Was your New Zealand parent issued with a Centrelink certificate
stating that he/she was residing in Australia on a particular date?
Were you a permanent resident on the date of adoption?
No
No
Yes
Yes
Go to Part J
If you ticked ‘Yes’ to Question 23, 24, 25, 26 or 27, you must provide
identity documents (see page 2) and supporting documents in Table B
on page 5, to obtain evidence of your Australian citizenship.
28
119 (Design date 05/20) - Page 14 © COMMONWEALTH OF AUSTRALIA, 2020
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
25 January 1949?
No
Yes
You must provide identity documents (see page 2) and supporting
documents in Table E on page 7, to obtain evidence of your Australian
citizenship.
42
Part J – Your parents/adoptive parents
No
Yes
Was this parent/adoptive parent born outside Australia and
naturalised, or registered as an Australian citizen before
8 October 1951?
Go to Question 44
Family name
Given names
43
Date of birth
DAY MONTH YEAR
Place of birth
Town/city
Country
Provide details of one parent/adoptive parent at Question 43
and the other parent/adoptive parent at Question 44
Parent/adoptive parent
Parent’s/adoptive parent’s full name
Citizenship(s) held by this parent/adoptive parent at the time
of your birth
No
Yes
Was this parent/adoptive parent absent from Australia for a
continuous period of 7 years or more between 26 January 1949
and 8 October 1958?
Period absent
DAY MONTH YEAR
to
DAY MONTH YEAR
DAY MONTH YEAR
36
Did you possess another citizenship on 16 September 1975?
No
Yes Give details
Country
Citizenship acquired by:
Birth
Naturalisation
Descent
Adoption
Other
Date acquired
Give details
Go to Part J
You must provide identity documents (see page 2) and supporting
documents in Table D on page 6, to obtain evidence of your Australian
citizenship.
37
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
for the 5 year period from 26 January 1944 until 25 January 1949?
No
Yes
39
Were you a British subject born to an Australian father before
26 January 1949?
No
Yes
1.
2.
3.
Sex Male Female
Indeterminate /
Intersex / Unspecified
119 (Design date 05/20) - Page 15© COMMONWEALTH OF AUSTRALIA, 2020
Part K – Identity documents
45
No
Yes
Was this parent/adoptive parent born outside Australia and
naturalised, or registered as an Australian citizen before
8 October 1951?
Go to Question 45
44
Date of birth
Place of birth
Town/city
Country
Parent/adoptive parent
Citizenship(s) held by this parent/adoptive parent at the time
of your birth
No
Yes
Was this parent/adoptive parent absent from Australia for a
continuous period of 7 years or more between 26 January 1949
and 8 October 1958?
Period absent
DAY MONTH YEAR
to
DAY MONTH YEAR
1.
2.
3.
If you are 16 years of age or over, you must provide at least
3 documents which collectively contain your:
• photograph
• signature
• current address
• birth name, date of birth and gender.
You must also provide proof of any changes of name, if applicable, and
a completed Part L – Identity declaration.
If you do not provide these documents your application will not
be accepted and will be returned to you.
Do not post original documents to the Department. If you are
posting your application attach certified copies.
Please list the identity documents you are providing (see Step 2 –
Original documents on page 1)
Children
Evidence of the child’s date of birth and birth name
Evidence of the child’s identity in the community
Part L – Identity declaration
A document with the child’s photograph and current name
Evidence of any changes of name, if applicable
A current document with your photograph and signature
Evidence of your current residential address
Evidence of your date of birth, birth name and any changes of name
Evidence of your identity in the community
Part L – Identity declaration
Applicants 16 years of age or over
Family name
Given names
DAY MONTH YEAR
Parent’s/adoptive parent’s full name
Sex Male Female
Indeterminate /
Intersex / Unspecified
119 (Design date 05/20) - Page 16 © COMMONWEALTH OF AUSTRALIA, 2020
Part M – Nomination of representative
47
Do you want to nominate a person to make enquiries or receive
information on your behalf about your application?
Give details below
No
Yes
Go to Part N
Nominated person
Family name
Given names
Relationship to
main applicant
DAY MONTH YEAR
Date of birth
Telephone numbers
Mobile/cell
Home
Work
Authority to disclose information
I hereby authorise the Department of Home Affairs 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.
Signature of
applicant
Date
DAY MONTH YEAR
(AREA CODE )
(AREA CODE )
48
-
Part L – Identity declaration
46
This part is NOT to be completed by the applicant
See Identity declaration on page 3 for more information including
photograph requirements.
“This is a true
photograph of”
JOHN CITIZEN
(full name of applicant)
PSmith
(signature)
PHOTOGRAPH BACK
SIZE
Max 36mm
Min 32mm
PHOTOGRAPH FRONT
Example
I declare that I have known (full name of the applicant)
Family name
Given names
for year(s) and vouch for his/her identity.
I have endorsed the back of his/her photograph
Signature
of person
making this
declaration
Date
DAY MONTH YEAR
Family name
Given names
Details of person making this declaration
Telephone numbers
Work
Home
Mobile/cell
What is your profession or occupation group number from
page 9?
(AREA CODE )
(AREA CODE )
-
Are you an Australian citizen? No Yes
This part is to be completed by a person who:
• is an Australian citizen, and
• has known the applicant for at least one year, and
• is currently working in a profession or occupation listed on
page 9, and
• is not related to the applicant by birth, marriage, or de facto
relationship, and
• is easy to contact by telephone during normal working hours,
should we need to make contact.
The person who completes this declaration must also endorse the
applicant’s photograph, which must be no more than 6 months old.
119 (Design date 05/20) - Page 17© COMMONWEALTH OF AUSTRALIA, 2020
Part O – Declaration
50
Please read the following carefully before signing.
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.
Date
DAY MONTH YEAR
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.
Signature of
applicant
The responsible parent is to complete the following declaration if the
applicant is under 16 years of age.
• I declare that I am the responsible parent of the applicant.
• I declare that this application constitutes an application for evidence
of Australian citizenship.
• I declare that the information I have supplied in this form is
complete, truthful and correct in every detail.
• I have read the information contained in form 1442i Privacy notice.
• I understand the Department may collect, use and disclose the
applicant’s personal information (including biometric information and
other sensitive information) as outlined in form 1442i Privacy notice.
Signature of
responsible
parent
Date
DAY MONTH YEAR
Full name of responsible parent
Telephone numbers
Work
Home
( ) ( )
( ) ( )
COUNTRY CODE AREA CODE NUMBER
Mobile/cell
Children
Date
DAY MONTH YEAR
Office use only
Signature of
decision maker
Name of
decision maker
Approved
Not approved
We strongly advise that you keep a copy of your application
and all attachments for your records.
-
-
Part N – Payment details
49
Attach a copy of your printed receipt.
Payment details
Make your payment electronically through the ‘My Payments’ section of
ImmiAccount. Sign into, or create, your ImmiAccount and select
My Payments>Manage Payments>Pre-Pay Paper Service, at
www.homeaffairs.gov.au/immiaccount
Do not provide credit card details on this form. Make your credit
card payment electronically through the ‘My Payments’ section of
ImmiAccount.
If you are outside Australia and cannot pay online in ImmiAccount,
check the Department’s website for alternative payment methods for
your location www.homeaffairs.gov.au/locations
Payment receipt number from the ‘My Payments’ section of ImmiAccount
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Form 119: Australian citizenship Step 1 Eligibility Application (Department of Home Affairs)

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Completed 12 December 2020

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