Fillable Form 128: Australian citizenship Application for renunciation of (Department of Home Affairs)

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Form 128: Australian citizenship Application for renunciation of (Department of Home Affairs)

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Country of origin: AUSTRALIA
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128 (Design date 05/20) - Page 1© COMMONWEALTH OF AUSTRALIA, 2020
Form
128
Application for renunciation of
Australian citizenship
Department of Home Affairs
This information is provided to help you complete the
application form and guide you through the application
process.
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.
There are 4 steps in the application process to renounce your
Australian 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 of Home Affairs (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.
Step 1 – Eligibility
Australian citizens 18 years and over can apply to renounce
their Australian citizenship.
Australia is a signatory to the United Nations Convention
on the Reduction of Statelessness. Consequently, your
application to renounce your Australian citizenship will not be
approved unless you provide evidence that you are a citizen of
another country, or that on renunciation you will acquire the
citizenship of another country.
Citizenship ceases on the date the application is approved.
Children
Children can apply to renounce Australian citizenship, only if
they were born or are ordinarily resident in a foreign country
and are not entitled, under the law of that country, to acquire
the nationality or citizenship of that country because they are
Australian citizens.
Applications for children under 16 years of age must be made
by a responsible parent.
If you are the responsible parent of a child when your
Australian citizenship ceases, consideration may be given
to revoking the citizenship of any children under the age of
18 years, unless:
• the other responsible parent is still an Australian citizen, or
• doing so would render them stateless.
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 that show
evidence of your Australian citizenship and your citizenship of
another country. 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
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 5 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.
128 (Design date 05/20) - Page 2 © COMMONWEALTH OF AUSTRALIA, 2020
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 E – 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 E – Identity declaration completed by a person with
the correct authority.
The checklist below will help you identify suitable documents.
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 you are under
16 years of age
A full birth certificate or family register containing
parent’s details
Passport or travel document, if any
Evidence of links between birth name and current
name, if applicable
One passport-sized photograph and identity
declaration signed by an Australian citizen with the
correct authority
128 (Design date 05/20) - Page 3© COMMONWEALTH OF AUSTRALIA, 2020
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 5, 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 5.
Children
An identity declaration and endorsed photograph are required
if you are an applicant under 16 years of age.
The declaration and photograph should be signed by an
Australian citizen who has known your child for at least one
year and belongs to a profession on the list on page 5.
In the case of children under 6 years of age, if no Australian
citizen has known them for one year, the declaration can be
signed by a person who has known them for less than one
year and belongs to a profession on the list on page 5.
The photograph should be 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.
Supporting documents
To renounce Australian citizenship you will also need to
provide documents listed below. You may also be asked to
provide additional documents to those listed.
• Evidence of your Australian citizenship for
example an Australian birth certificate or
Australian citizenship certificate or descent
extract, and
• Evidence that you acquired, or will acquire,
citizenship of another country for example a
naturalisation certificate or statement from the
relevant authorities, and
• Your Australian passport and Australian
citizenship certificate or descent extract, if you
have them
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
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 5 for people who may certify documents.
Do not post original documents to the Department,
unless specified otherwise.
128 (Design date 05/20) - Page 4 © COMMONWEALTH OF AUSTRALIA, 2020
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.
Part C – Your child – If you are a responsible parent applying on
behalf of your child aged under 16 years, Part C requires you
to provide further details of your child.
Part D – Identity documents – Part D requires you to list your
identity documents. See page 2 for information about this part
of the application.
Part E – Identity declaration – Part E 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 F – Supporting documents – Part F requires you to list
the supporting documents you are providing with your
application. See page 3 for information about this part of the
application.
Part G – Nomination of representative – Part G allows you to
nominate another person who can make enquiries about
your application on your behalf. Make sure you sign the
authorisation at Part G if you want this to happen.
Part H – 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
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 I – 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 11 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
Pre-lodgement checklist
Completed application form
Identity documents
One endorsed passport-sized photograph and
identity declaration, signed by a person with
the correct authority for yourself and each child
included in your application
Current Australian passport and citizenship
certificate or descent extract
Supporting documents as required
The application payment receipt
Notification
If your application is approved you will be notified in writing.
You will cease to be an Australian citizen on the day your
application is approved.
If your application is refused
If your application is refused you have the right to ask for the
decision to be reviewed by the Administrative Appeals Tribunal
(AAT). Your letter of notification will advise you where you
can lodge an application for review. You should lodge your
application with the AAT as soon as possible.
Travel after Australian citizenship has ceased
If you renounce your Australian citizenship while in Australia,
you will automatically become the holder of an ex-citizen visa.
This visa allows you to remain in Australia but does not allow
you to re-enter if you leave.
If you renounce your Australian citizenship while overseas you
cannot re-enter Australia without a valid visa. You must apply
for a visa if you intend to re-enter Australia.
You will need a Resident Return visa if you travel overseas
and intend to return to Australia. More information on return
travel documents is available from the Department’s website
www.homeaffairs.gov.au
Circumstances when an application cannot be
approved
Your application to renounce Australian citizenship cannot be
approved if:
• your identity cannot be verified, or
• you would become stateless if your application was
approved.
128 (Design date 05/20) - Page 5© COMMONWEALTH OF AUSTRALIA, 2020
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.
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
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
128 (Design date 05/20) - Page 7© COMMONWEALTH OF AUSTRALIA, 2020
Form
128
Application for renunciation of
Australian citizenship
Department of Home Affairs
Please read the information pages before completing this application.
ICSE
Client ID
Box File
Number
1
Part A – Your details
Family name
Given names
(including all
middle names)
2
3
Your full name
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
4
5
Sex Male Female
Date of birth
DAY MONTH YEAR
Reason for
change of
name
If you have been known by more than one other name,
attach additional details on a separate sheet.
6
Place of birth
Town/city
Country
7
Current residential address
Note: You must tell the Department if your address
changes after you lodge this form.
POSTCODE
8
Current postal address
(If the same as your residential address, write
‘AS ABOVE’)
POSTCODE
9
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
Give details
No
Yes
Email address
10
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.
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.
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.
128 (Design date 05/20) - Page 8 © COMMONWEALTH OF AUSTRALIA, 2020
11
Part B – Citizenship details
If insufficient space, attach additional details
How did you acquire your Australian citizenship?
12
Country of citizenship
What foreign citizenship do you hold or will you acquire?
DAY MONTH YEAR
Date acquired
Place acquired
How was it acquired (eg. birth, descent, marriage)?
Birth
Conferral/grant
Descent
Adoption
Born in Papua prior
to independence
DAY MONTH YEAR
Date acquired
Place acquired
Naturalisation
Other
Note: Please attach a statement from a relevant authority as
evidence of your foreign citizenship.
13
Please state your reasons for renouncing Australian citizenship
Part C – Your child
14
Are you applying for a child under 16 years of age that you are the
responsible parent of?
No
Go to Part D – Identity documents
Yes
15
Is there a parenting order giving responsibility for the child named in
this application to another person?
Give details of the child and person(s)
No
Yes
Note: Documents must be provided.
Part D – Identity documents
16
If you are 16 years of age or over, you must provide at least
3 documents which collectively contain your:
• photograph
• signature
• current address
• date of birth, birth name and gender.
You must also provide proof of any changes of name, if applicable, and
a completed Part E – 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 pages 1–2)
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 E – Identity declaration
Applicants 16 years of age or over
Evidence of the child’s date of birth and birth name
A document with the child’s photograph and current name
Evidence of any changes of name, if applicable
Evidence of the child’s identity in the community
Part E – Identity declaration
Children
128 (Design date 05/20) - Page 9© COMMONWEALTH OF AUSTRALIA, 2020
Part E – Identity declaration
17
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
Part F – Supporting documents
Evidence of your Australian citizenship
You are required to provide supporting documents for yourself
or your child
18
What type of documents are you attaching?
Evidence that you acquired or will acquire the citizenship
of another country
Australian passports or Australian citizenship certificate,
if held
Other passports held, if any
Evidence of any name change and links between names,
if applicable
Proof of identification documents for responsible parent
applying on behalf of the child
Documents relating to a responsible parent if applying
on behalf of a child under 16 years of age
Any order relating to the custody, guardianship or
parental responsibility for the child, if applicable
Evidence of adoption of the child, if applicable
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 5?
(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 5, 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.
128 (Design date 05/20) - Page 10 © COMMONWEALTH OF AUSTRALIA, 2020
Part G – Nomination of representative
19
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 H
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 )
-
Part H – Payment details
20
21
Attach a copy of your printed receipt.
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
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
128 (Design date 05/20) - Page 11© COMMONWEALTH OF AUSTRALIA, 2020
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 I – Declaration
22
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 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
Signature of
applicant
-
The responsible parent is to complete the following declaration for an
applicant under 16 years of age.
• I declare that I am the responsible parent of the applicant.
• I declare that the information I have supplied in this form is
complete, truthful and correct in every detail.
• I consent to the renunciation of Australian citizenship for my child
with my full acceptance of the consequences resulting from that
renunciation status under law.
• 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.
Full name of responsible parent
Telephone numbers
Work
Home
( ) ( )
( ) ( )
COUNTRY CODE AREA CODE NUMBER
Mobile/cell
Signature of
responsible
parent
Date
DAY MONTH YEAR
Children
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.
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Form 128: Australian citizenship Application for renunciation of (Department of Home Affairs)

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Completed 6 January 2021

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