1195

Form
Identity declaration
Form 1195 Identity declaration is to be completed and

provided to the Department of Immigration and Border
Protection (the department):
for each additional child if you have more children than the
space on your citizenship application form allows, or
if you have applied for citizenship online. A separate
form1195 must be provided for each person included in
the online application.
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 programmes. 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.
An application for Australian citizenship cannot be approved
where a persons identity is not able to be verified.
The completed identity declaration and endorsed photograph
must be 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, the identity
declaration can be completed 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 and 2, and is not related to you by birth, marriage or
de facto relationship.
For children under 6 years of age, the identity declaration
can be completed by an Australian citizen (or citizen of the
childs 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 and2,
and is not related by birth, marriage or de facto relationship.
1195
Photograph requirements
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.
If applying for citizenship online, 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 and attached to your online application.
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).
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)
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 SubdivisionC
of Division 1 of Part IV of the Marriage Act1961
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
COMMONWEALTH OF AUSTRALIA, 2014
1195 (Design date 11/14) - Page 1
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 Act1961
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 departments
website www.immi.gov.au/allforms/ or offices of the
department. You should ensure that you read and understand
form 1442i before completing this form.
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 departments 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 Immigration and Border Protection

contact details
Australian Capital Territory
Thursday Island Office
GPO Box 717

CANBERRA ACT 2601
PO Box 299
THURSDAY ISLAND QLD 4875
New South Wales
South Australia
GPO Box 9984

SYDNEY NSW 2001
GPO Box 2399

ADELAIDE SA 5001
Northern Territory
Tasmania
GPO Box 864

DARWIN NT 0801
GPO Box 794

HOBART TAS 7001
Queensland
Victoria
Queensland state office
GPO Box 241

MELBOURNE VIC 3001
GPO Box 9984

BRISBANE QLD 4001
Western Australia
Cairns office
Locked Bag 7
NORTHBRIDGE WA 6865
PO Box 1269
CAIRNS QLD 4870
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.
Home page
Citizenship
Information Line
www.citizenship.gov.au
Telephone 131 880 during business hours
in Australia to speak to an operator (recorded
information available outside these hours).
Ifyou are outside Australia, please contact
your nearest Australian mission.
Please keep these information pages for your reference

Form
1195
PHOTOGRAPH
Please use a pen, and write neatly in English using BLOCK LETTERS.
Corrections made with liquid paper are not acceptable.
The endorsed photograph of the applicant must be attached to this

page without obscuring the image. It can also be placed in a plastic
sleeve and stapled to this page.
Details of the person who is applying

for citizenship (the applicant)
1
If applying for citizenship online, the front and back of the endorsed
photograph must also be separately scanned and attached to the
applicants online application.
Family name
The photograph IS NOT TO BE SIGNED BY THE APPLICANT

The person who has completed the Identity declaration must also
endorse the photograph. See Photograph requirements on page 1.
Given names
DAY
MONTH
YEAR
Date of birth
Example
PHOTOGRAPH FRONT
Current residential address
PHOTOGRAPH BACK
Note: You must tell the department if your address changes after you
lodge this form.
Min 32mm
POSTCODE
Max 36mm
This is a true
photograph of
JOHN CITIZEN
(full name of applicant)
PSmith
Current postal address

(If the same as your residential address, write AS ABOVE)
Note: You must tell the department if your address changes after you
lodge this form.
(signature)
SIZE
Photograph to be no more than 6 months old

Telephone numbers
POSTCODE
Telephone numbers
Work
(AREA CODE
Home
(AREA CODE
(AREA CODE
Home
(AREA CODE
Mobile/cell
Are you an Australian citizen?
Mobile/cell
Yes
No
Profession or occupation group number from pages 1 or 2
Transaction Reference Number (the number that you were given when
you lodged your online application)
3
Details of the person who is making the

identity declaration
2
Work
I declare that I have known (full name of the applicant)

Family name
Given names
for
Family name
year(s) and vouch for his/her identity.
I have endorsed the back of his/her photograph.
Given names
Signature
of person
making this
declaration
Address (home or business)
DAY
MONTH
YEAR
Date
POSTCODE
Declaration by the applicant who is

applying for citizenship
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.
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 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).
Signature of
applicant
DAY
MONTH
YEAR
Date
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 understand the department may collect, use and disclose the
applicants personal information (including biometric information and
other sensitive information) as outlined in form 1442i Privacy notice.
Signature of
responsible
parent
See www.citizenship.gov.au for information about the Offences

provision, spent convictions and the National Police Checking Service
General Information.
Signature of
responsible
parent
DAY
DAY
MONTH
YEAR
Full name of responsible parent

MONTH
YEAR
Telephone numbers
Full name of responsible parent
COUNTRY CODE
Telephone numbers
COUNTRY CODE
AREA CODE
NUMBER
Work
) (
Home
) (
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 applicants 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 applicants 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 understand the department may collect, use and disclose the
applicants personal information (including biometric information and
other sensitive information) as outlined in form 1442i Privacy notice.
Date
Date
Mobile/cell
Applicants aged 16 or 17 years responsible parent declaration
AREA CODE
NUMBER
Work
) (
Home
) (
Mobile/cell
We strongly advise that you keep a copy of your application

and all attachments for your records.

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Form

Form 1195 Identity declaration is to be completed and

List of professions and occupations

COMMONWEALTH OF AUSTRALIA, 2014

1195 (Design date 11/14) - Page 1

24. Member of the Institute of Chartered Accountants in

Important information about privacy

At the conclusion of your test appointment, the test

Department of Immigration and Border Protection

Thursday Island Office

GPO Box 717

New South Wales

GPO Box 9984

GPO Box 2399

GPO Box 864

GPO Box 794

Queensland state office

GPO Box 241

GPO Box 9984

Personal identifiers collected under the Australian Citizenship

Citizenship testing in regional Australia by the Department of

Please keep these information pages for your reference

COMMONWEALTH OF AUSTRALIA, 2014

The endorsed photograph of the applicant must be attached to this

Details of the person who is applying

The photograph IS NOT TO BE SIGNED BY THE APPLICANT

Current residential address

Current postal address

Photograph to be no more than 6 months old

Profession or occupation group number from pages 1 or 2

Details of the person who is making the

I declare that I have known (full name of the applicant)

year(s) and vouch for his/her identity.

I have endorsed the back of his/her photograph.

Address (home or business)

COMMONWEALTH OF AUSTRALIA, 2014

1195 (Design date 11/14) - Page 3

Declaration by the applicant who is

Please read the following carefully before signing.

See www.citizenship.gov.au for information about the Offences

Full name of responsible parent

Full name of responsible parent

1195 (Design date 11/14) - Page 4

The responsible parent is to complete the following declaration if the

Applicants aged 16 or 17 years responsible parent declaration

We strongly advise that you keep a copy of your application

COMMONWEALTH OF AUSTRALIA, 2014

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