1195 (Design date 06/18) - Page 1© COMMONWEALTH OF AUSTRALIA, 2018
Form
1195
Identity declaration
Department of Home Affairs
What the photograph requirements are
You will need to submit a passport-size photograph with this
form. The person who completes Questions 2 and 3 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 at Question 3.
The photograph must be:
no more than 6 months old, and
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), and
of good quality, in colour, against a plain, light coloured
background (laser copies are not acceptable).
“This is a true
photograph of”
JOHN CITIZEN
(full name of applicant)
PSmith
(signature)
PHOTOGRAPH BACK
SIZE
Max 36mm
Min 32mm
PHOTOGRAPH FRONT
Example of photograph
Photograph to be no more than 6 months old
How to submit this form and photograph
If you are applying online for citizenship or evidence of
citizenship, pages 3 and 4 of this form must be scanned and
attached to your online application. The front and back of
your endorsed photograph must also be separately scanned, in
colour, and attached to your online application.
If you are applying for citizenship on a paper form, submit this
form with your paper form. Place the endorsed photograph in
a plastic sleeve or envelope and staple it to this form.
List of professions and occupations
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)
Who should use this form
Form 1195 Identity declaration is to be completed
and provided to the Department of Home Affairs (the
Department) if:
you are applying online for citizenship or evidence of
citizenship – a separate form 1195 must be completed for
yourself and each person included in the online application,
or
you are applying for citizenship on a paper form and have
more children than the space on your application form
allows – a separate form 1195 must be completed for each
additional child.
An application for Australian citizenship or evidence of
citizenship cannot be approved where a person’s identity is
not able to be verified.
Important – Please read this information carefully before you
complete this form. Once you have completed this form we
strongly advise that you keep a copy for your records.
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
may 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 after you become an Australian
citizen, you may be prosecuted and may be subject to
revocation of your Australian citizenship.
Who can complete the Identity declaration
Questions 1 and 4 of this form must be completed by
the person who is applying for citizenship or evidence of
citizenship (the applicant).
Questions 2 and 3 of this form must be completed, and the
photograph endorsed and signed, by a person who:
is an Australian citizen, and
has known you for at least one year, and
is currently working in a profession or occupation listed on
pages 1 and 2, and
is not related to you by birth, marriage or de facto
relationship, and
• is easy to contact by telephone during normal working hours.
Note: If you are applying from outside Australia and do
not know an Australian citizen, Questions 2 and 3 can be
completed, and the photograph endorsed and signed by
a citizen of your country of residence who has known you
for at least one year, is currently working in a profession or
occupation listed on pages 1–2, and is not related to you by
birth, marriage or de facto relationship.
For children under 6 years of age, Questions 2 and 3 can be
completed by an Australian citizen (or citizen of the child’s
country of residence if applying from outside Australia) who
has known the child for less than 12 months, is currently
working in a profession or occupation listed on pages 1–2, and
is not related by birth, marriage or de facto relationship.
1195 (Design date 06/18) - Page 2 © COMMONWEALTH OF AUSTRALIA, 2018
11. Fellow of the National Tax Accountant’s 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
Subdivision 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.
Citizenship testing in regional Australia by the Department of
Human Services
Under the Australian Citizenship Act 2007, the Department
has authorised selected officers of the Department of Human
Services to be citizenship test administrators and conduct
citizenship appointments on behalf of the Department in
selected regional centres.
Test administrators are authorised to collect and access
your identifying information such as your photograph and
signature, and use it along with personal and identifying
information provided to the Department of Human Services
by the Department to verify your identity and confirm that you
are eligible to sit the citizenship test. Personal and identifying
information includes your name, date of birth, address,
photograph, signature and copies of identity documents.
At the conclusion of your test appointment, the test
administrator will electronically transmit the documents
and photograph that were used to verify your identity, to
the Department for storage in the Department’s records
management system. The test administrator will then securely
destroy the personal and identifying information, including
electronic records, except for a record of your name, date of
birth and the date of your appointment.
Department of Home Affairs contact details
Please keep these information pages for your reference
Australian Capital Territory
GPO Box 9984
SYDNEY NSW 2001
New South Wales
GPO Box 9984
SYDNEY NSW 2001
Northern Territory
GPO Box 2399
ADELAIDE SA 5001
Queensland
Queensland state office
GPO Box 9984
BRISBANE QLD 4001
Cairns office
PO Box 1269
CAIRNS QLD 4870
Thursday Island Office
PO Box 299
THURSDAY ISLAND QLD
4875
South Australia
GPO Box 2399
ADELAIDE SA 5001
Tasmania
GPO Box 794
HOBART TAS 7001
Victoria
GPO Box 241
MELBOURNE VIC 3001
Western Australia
Locked Bag 7
NORTHBRIDGE WA 6865
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
1195 (Design date 06/18) - Page 3© COMMONWEALTH OF AUSTRALIA, 2018
Form
1195
Identity declaration
Department of Home Affairs
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.
1
Details of the person who is applying for
citizenship or evidence of citizenship (the
applicant)
Date of birth
DAY MONTH YEAR
Current residential address
Note: You must tell the Department if your address changes after you
lodge this form.
POSTCODE
Family name
Given names
Current postal address
(If the same as your residential address, write
‘AS ABOVE’)
POSTCODE
Telephone numbers
Work
Home
(AREA CODE )
(AREA CODE )
Note: You must tell the Department if your address changes after you
lodge this form.
Transaction Reference Number (the number that you were given when
you lodged your online application)
Note: You (the applicant) must also complete the Declaration(s)
(Question 4) on page 4.
Mobile/cell
IMPORTANT – Questions 2 and 3 must 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
pages 1–2, 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.
The person will also need to endorse and sign a passport-size
photograph of the applicant as described on page 1.
3
Identity declaration
I declare that I have known (full name of the applicant who is applying
for citizenship)
for year(s) and vouch for his/her identity.
I have endorsed the back of the applicant’s photograph with the words
‘This is a true photograph of [name of applicant]’ and signed the
photograph.
Date
DAY MONTH YEAR
Signature
of person
making this
declaration
-
Details of the person who is making the
identity declaration (not the applicant)
Address (home or business)
POSTCODE
What is your profession or occupation group number from
pages 1 and 2?
Telephone numbers
Work
Home
(AREA CODE )
(AREA CODE )
Mobile/cell
Are you an Australian citizen?
NoYes
2
Family name
Given names
Family name
Given names
3
Tick where applicable
dd mmm yyyy
click to sign
signature
click to edit
dd mmm yyyy
1195 (Design date 06/18) - Page 4 © COMMONWEALTH OF AUSTRALIA, 2018
Declaration by the applicant who is
applying for citizenship or evidence of
citizenship
4
Please read the following carefully before signing.
Applicants aged 16 years and over
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.
For applicants for citizenship aged 18 years or over only –
I acknowledge that I electronically signed my application for Australian
citizenship and in doing so consented to a National Police Check
under the terms of the National Police Checking Service (NPCS).
Date
DAY MONTH YEAR
Signature of
applicant
-
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.
Applicants for citizenship aged 16 or 17 years – responsible
parent declaration
The responsible parent is to complete the following declaration if the
applicant is aged 16 or 17 years.
I declare that I am the responsible parent of the applicant.
I consent to the applicant’s personal information being provided to
the National Police Checking Service (NPCS) for the purpose of the
NPCS conducting a National Police check in relation to the applicant
as part of their application for Australian citizenship.
I understand that this is for the purposes of assessing whether the
Offences provision, as defined in section 24(6) of the Australian
Citizenship Act 2007, applies to the applicant.
I understand that more than one police check may be requested by
the Department, including a further check that may be undertaken if
the applicant is not approved as an Australian citizen and an appeal
of the decision is requested.
I acknowledge that the applicant’s personal information will be
disclosed to Australian police agencies for them to use for their
respective law enforcement purposes including the investigation of
any outstanding criminal offences.
I acknowledge that I have read the National Police Checking
Service – General Information and understand the spent convictions
legislation.
I understand that spent convictions of specific offences (5 years
from the date of conviction for juvenile offenders) will be disclosed
to the Department by Australian police agencies for the purposes
outlined above.
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.
See www.homeaffairs.gov.au/citizenship for information about the
Offences provision, spent convictions and the National Police Checking
Service – General Information.
Signature of
responsible
parent
Date
DAY MONTH YEAR
Full name of responsible parent
Telephone numbers
Work
Home
( ) ( )
( ) ( )
COUNTRY CODE AREA CODE NUMBER
Mobile/cell
-
Applicants aged under 16 years – responsible parent declaration
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 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
-
We strongly advise that you keep a copy of your application
and all attachments for your records.
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
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