anayform-1

anayform-1

Warning: Under the Statutory Declarations Act 1959, people
who intentionally make a false statement in a statutory declaration are liable for punishment of 4 years imprisonment. In addition, the Migration Act 1958 (the Act) provides penalties for providing false or misleading statements of 12 months imprisonment or a fine of AUD12,000.
If you are not an Australian citizen or permanent resident and you reside outside Australia, your statement cannot be considered a statutory declaration under Australian law, even if it is made using this form or the template provided by the Attorney-General’s Department. However, under policy, your statement should be witnessed or certified according to the legal practices of the country in which you make the statement. Failing that, it should be witnessed by a person whose occupation or qualification is comparable to those listed above. This person should sign, date and specify their occupation at the bottom of the statement. You should confirm the requirements with the nearest Australian mission overseas when you lodge your application. Contact details for Australian missions are available on the Department’s website www.homeaffairs.gov.au
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/about/corporate/information/forms or offices of the Department. You should ensure that you read and understand form 1442i before completing this form.
Home page www.homeaffairs.gov.au
General enquiry line
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.
About this form This form must be completed by a person who: • knows the visa applicant and their partner or fiancé(e) and the
history of their relationship; • is at least 18 years of age; and • is an Australian citizen or Australian permanent resident. Note: If the visa applicant is outside Australia and is unable to have an Australian citizen or Australian permanent resident complete this form, any person who knows the applicant and their partner or fiancé(e) may also complete this form. The person completing this form must provide evidence of their current name, age and, where applicable, Australian citizenship or Australian permanent residency (for example, a certified copy of the birth certificate, Australian passport or passport containing a permanent visa). All copies must be certified. Note: You may be asked to submit up to 3 separate declarations during the processing of the visa application. You may also be contacted for further comment and/or interview in relation to the information you provide.
Purpose of this form When assessing a Partner or Prospective Marriage visa application, the Department of Home Affairs (the Department) must consider the social aspects of the claimed relationship. The Department will use the information provided in this form (your statements), among other things, to assess these aspects. The Department’s policy is that these statements be provided in the form of statutory declarations. You may use this form, or alternatively, you may use the statutory declaration template, which is available on the Attorney-General’s Department website at www.ag.gov.au/pages/default.aspx In Australia, statutory declarations must be witnessed by a person prescribed by the Statutory Declarations Act 1959 and Statutory Declarations Regulations 2018. Any attachments to the Declaration must be certified by a prescribed person. Prescribed persons include those who are a: • Justice of the Peace; • medical practitioner; • legal practitioner; • civil marriage celebrant or registered minister of religion; • dentist; • nurse; • optometrist; • pharmacist; • physiotherapist; • teacher employed on a permanent full-time or part-time basis
at a school or tertiary education institution;
• bank officer with 5 or more continuous years of service; • permanent employee of the Australian Postal Corporation
with 5 or more continuous years of service;
• police officer; or • public servant engaged on an ongoing basis with 5 or more
years of continuous service.
A full list of prescribed persons can be found on the Attorney-General’s Department website.
Please keep this information page for your reference
888 (Design date 07/19) – Page 1
3
State how you know the applicant and the applicant’s partner or fiancé(e), and indicate how often you have been in contact with them
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. Tick where applicable 3
Details of person making the statutory declaration
I,
Family name
Given names
of
Your residential address
Postcode
Occupation or qualification
Telephone numbers
Office hours
(Area code )
After hours
(Area code )
make the following declaration under the Statutory Declarations Act 1959:
If insufficient space, please attach additional details
4
State whether you believe the relationship of the applicant and his/her partner or fiancé(e) to be genuine and continuing, and give your reasons for your belief
1
Visa applicant’s name
Family name
Given names
How long have you known this person?
2
Name of applicant’s partner or fiancé(e)
Family name
Given names
How long have you known this person?
Office use only
File number
If insufficient space, please attach additional details
888 (Design date 07/19) – Page 3
5
State any other matters you wish to add in support of the visa application
6
Have you attached evidence of your Australian citizenship or Australian permanent residency status? Note: All copies must be certified. No Yes
7 WARNING: Giving false or misleading information is a serious offence. I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959, and I believe that the statements in this declaration are true in every particular.
Your signature –
Declared at

On
Before me,
Day
Month
Year
Signature of qualified person –
Day
Month
Year

Date
Details of person before whom the declaration is made in printed letters
Family name
Given names
Preferred title: Mr
Mrs
Miss
Ms
Other
Contact address
Postcode
Occupation or qualification
Telephone number
Office hours
(Area code )
We strongly advise that you keep a copy of this statutory declaration and all attachments for your records.
If insufficient space, please attach additional details
888 (Design date 07/19) – Page 4

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