Fillable Form 164 Application for evidence of resident status

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Form 164 Application for evidence of resident status

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The Form 164 Application for evidence of resident status form is 4 pages long and contains:

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  • 99 other fields

Country of origin: AUSTRALIA
File type: PDF

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164 (Design date 04/11) - Page 1© COMMONWEALTH OF AUSTRALIA, 2011
What is a Certificate of Evidence of Resident Status
(CERS)?
A CERS is documentary evidence of the date on which you were
granted Australian permanent resident status. It is not an
identity document. It can also confirm that you are not an
Australian citizen.
Who should use this form?
If you are currently an Australian permanent resident, you
acquired that status on or after your arrival in Australia,
and you want documentary evidence of your status, you can
apply for a CERS. If you require evidence that you are not an
Australian citizen, a CERS can provide this.
A CERS cannot be issued to an Australian citizen.
Australian citizens requiring evidence of their Australian
citizenship must apply for evidence of Australian citizenship by
completing form 119 Application for evidence of Australian
citizenship.
New Zealand citizens who have not applied for and been
granted a permanent resident visa cannot be issued a CERS.
About this form
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.
How to apply
Complete the form in English using BLOCK LETTERS.
Please ensure you sign the form and include all required
supporting documents.
If your documents are not in English you must provide an
English translation that has been completed by an accredited
translator. If you provide photocopies of original documents,
they must be certified as true copies by an authorised person.
In Australia, authorised people include a magistrate, Justice of
the Peace, Commissioner of Declarations, Commissioner of
Affidavits, solicitor, registered medical practitioner, bank
manager or a State or Public Service officer with at least 5 years
service.
This application should be lodged by registered post or in
person, with the required payment, at the nearest office of the
Department of Immigration and Citizenship (the department).
More information on where to lodge this application is available
from the department’s website
www.immi.gov.au/contacts/offices/htm
Form
164
Application for evidence of
resident status in Australia
Charges
Payment must accompany your application and is generally not
refunded if the application is unsuccessful.
Fees may be subject to adjustment at any time. Application
charges may be subject to adjustment on 1 July each year. This
may increase the cost of a CERS.
To check the application charge, see form 990i Charges available
from the department’s website
www.immi.gov.au/allforms/990i.htm or check with the
nearest office of the department.
Fee exemption
There are only 2 categories which are eligible for a CERS fee
exemption:
• British Child Migration Scheme (BCMS); and
• Victorian Bushfires (7 Febr
uary 2009).
More information is available from the department’s website
www.immi.gov.au/migrants/cers/applying-cers.htm
Method of payment
In Australia
To make a payment, please pay by credit card, debit card, bank
cheque or money order made payable to the Department of
Immigration and Citizenship. Debit card and credit card are the
preferred methods of payment.
Outside Australia
Before making a payment outside Australia, please check with
the Australian Government office where you intend to lodge
your application as to what methods of payment and currencies
they can accept and to whom the payment should be made
payable.
Integrity of application
The department is committed to maintaining the integrity of
the visa and citizenship programs. Please be aware that if you
provide us with fraudulent documents or claims, this may result
in processing delays and possibly your application being refused.
Please keep this information page for your reference
Telephone 131 881 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.
General
enquiry line
Home page
www.immi.gov.au
What documents do you need?
You will need to provide the following documents with your
application:
• Proof of your identity, eg. passport, driver’s licence.
• Proof of change of name, if applicable, eg. marriage cer
tificate,
deed poll.
• If available, the passport or travel document you used when
you first travelled to Australia, and any other passports issued
since your arrival.
• If lodging this application by post, certified copies of the
above documentation should be provided.
• If someone is acting on your behalf, they must provide proof
of their identity and Question 16 must be completed.
Requesting a CERS in the name of deceased person
If you are applying for a CERS in the name of a deceased person,
you may be asked to provide a legitimate reason for requesting
the CERS, for example evidence of Power of Attorney. You will
also be asked to provide a certified true copy of the death
certificate for the deceased person, proof of relationship and
proof of your identity.
This form should be completed in the deceased person’s name
and you should attach a covering letter and supporting
documentation outlining your reasons for requesting the CERS.
A CERS will not be issued if the deceased person was an
Australian citizen.
About the information you give
The information provided will be used for assessing your
eligibility for evidence of resident status and for other purposes
relating to the administration of the Migration Act. The storage,
use and disclosure by the department of the information you
provide in this form is governed by the Privacy Act 1988. If you
want more information about this, you should see the
information form 993i, Safeguarding your personal
infor
mation, available from any office of the depar
tment.
The department is authorised under the Migration Act 1958
, in
certain circumstances, to collect a range of personal identifiers
including a facial image, fingerprints and a signature from
non-citizens. The department requires personal identifiers to
assist in assessing your identity. The department is authorised
to disclose your personal identifiers and information relating to
your name and other relevant biographical data to a number of
agencies including law enforcement and health agencies and to
other agencies who may need to check your identity with this
department. Where the department obtains personal identifiers
they will become part of your official record with the department.
© COMMONWEALTH OF AUSTRALIA, 2011164 (Design date 04/11) - Page 2
The department is involved in international information
exchanges with a number of countries, including the United
Kingdom, the United States of America, Canada and New
Zealand. These international information exchanges may
involve the sharing of personal identifiers, including facial
images and fingerprint data, collected by immigration agencies
such as this department. If, as a result of this sharing between
countries, there is a match with your personal identifiers, the
department will disclose your biographical data, copies of
travel and other identity documents or infor
mation from such
documents, your immigration status and immigration history
(which may include any immigration abuse and offences) and
any criminal histor
y information relevant to immigration
purposes. The purpose of such disclosure would be to help
confir
m your identity and determine if you have presented to
the depar
tment and the other agency under the same identity
and with similar claims.
For more detailed information you should read information
form 1243i Your personal identifying information, which is
available from the department’s website
www.immi.gov.au/allforms/ or from any office of the
department or Australian mission overseas.
164 (Design date 04/11) - Page 3© COMMONWEALTH OF AUSTRALIA, 2011
11
Do you agree to the department communicating with you by fax, e-mail,
or other electronic means?
E-mail address
Fax number
(
AREA CODE
)
Your name as shown in your travel document on entry to Australia
(If the same as your present name, write ‘AS ABOVE’)
2
Family name
Given names
Reason for change:
Other
Your full name
1
Family name
Given names
Are you an Australian citizen?
6
DAY MONTH YEAR
Do you hold any other citizenship?
7
Current residential address
8
Address for correspondence
(If the same as your residential address, write ‘AS ABOVE’.)
9
Telephone numbers
10
Office hours
After hours
(
AREA CODE
)
(
AREA CODE
)
Country of birth
5
Date of birth
4
DAY MONTH YEAR
Have you been known by any other names?
(including name at birth, previous married names, aliases)
3
Family name
Given names
Reason for change:
Other
If you have been known by any other names, attach a page giving the
required details
Details of entry to Australia
12
Place of arrival
Flight number/name
of ship (if known)
Date of first arrival
DAY MONTH YEAR
Citizenship on arrival
Form
164
Application for evidence of
resident status in Australia
MarriageDeed poll
Deed poll Marriage
No
Yes Give details
No
Yes Date granted
No
Yes Which countries?
Yes
No
Give details
POSTCODE
POSTCODE
Tick where applicable
Please use a pen, and write neatly in English using BLOCK LETTERS.
You cannot be issued a CERS. Australian citizens requiring
evidence of their Australian citizenship must apply for
evidence of Australian citizenship by completing
form 119
Application for evidence of Australian citizenship
.
164 (Design date 04/11) - Page 4 © COMMONWEALTH OF AUSTRALIA, 2011
If you arrived as a child (under 18) and no longer hold the passport
or travel document you used on your first arrival, please provide the
details of both your parents
13
Parent’s full name
Parent’s former name
(if applicable)
Parent’s date of birth
DAY MONTH YEAR
Parent’s full name
Parent’s date of birth
DAY MONTH YEAR
Why do you require evidence of resident status in Australia?
14
Do you want the certificate posted to you?
15
Certificate will be posted to the address
given at Question 9
No
Yes
Male
Female
Male
Female
Parent’s former name
(if applicable)
Declaration
WARNING: Giving false or misleading information is a serious offence.
• I declare that the information I have supplied in this form is,
complete, correct and up-to-date in every detail.
18
Signature of
applicant
Date
DAY MONTH YEAR
Complete this section if you require another person to collect your
certificate on your behalf. Your certificate will not be given to your
representative unless you provide this authorisation.
16
Name of representative
Signature of
representative
Date
DAY MONTH YEAR
Signature of
applicant
Date
DAY MONTH YEAR
I authorise the person named above to collect my certificate.
How will you pay your application charge?
If applying in Australia, debit card or credit card are the preferred
methods of payment. Debit cards cannot be used for applications lodged
by mail. If paying by bank cheque or money order please make payable
to the Department of Immigration and Citizenship.
If applying outside Australia, please check with the Australian
Government office where you intend to lodge your application as to what
methods of payment and currencies they can accept and to whom the
payment should be made payable.
17
Payment by
(tick one box)
MasterCard
Visa
Diners Club
JCB
Australian Dollars
AUD
Expiry date
Credit card information will be used for charge paying purposes only.
Signature of
cardholder
Address
Telephone
number
Cardholder’s name
Credit card number
Bank cheque
Money order
Credit card Give details below
American Express
::::::::::::::::::
Debit card
:
MONTH YEAR
:
( )
COUNTRY CODE AREA CODE
( )
NUMBER
POSTCODE
Cannot be used for applications lodged by mail
We strongly advise that you keep a copy of your application
and all attachments for your records.
Sex
Sex
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164 (Design date 04/11) - Page 5© COMMONWEALTH OF AUSTRALIA, 2011
Action taken
Signature of
Issuing Officer
Date
DAY MONTH YEAR
Date
DAY MONTH YEAR
Certificate
returned by mail Signature of returning officer
Date
DAY MONTH YEAR
Held for collection Signature of applicant or representative
Data reference
Date of issue
DAY MONTH YEAR
Certificate number
Date of issue
DAY MONTH YEAR
Official receipt
number
Office use only
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Completed 21 February 2020

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