Statutory Declaration of immediate family member

This person must be currently an Australian citizen OR a permanent resident of Tasmania AND must have lived in Tasmania for approximately 12 months. By signing the form, the applicant’s relative is agreeing to support them when they arrive in Tasmania and to assist them in the process of gaining employment.
Information about applicant and immediate family making statutory declaration

  1. Personal details (main applicant’s family member in Tasmania)

Firstname / Click here to enter applicant’s first name /
Familyname / Click here to enter applicant’sfamily name /
Date ofbirth / Eg. 31/Eg. January/Eg. 1991
Phonenumber / Click here to enter applicant’s contact phone number /
Emailaddress / Click here to enter applicant’s email /
Passport number,OR
Tasmaniandriver’slicensenumber / Click here to enter applicant’s passport number / TAS drivers license number /
  1. Details of family member applying for General Skilled Migration state nomination

Firstname / Click here to enter family member’s first name
Familyname / Click here to enter family member’s family name /
Date ofbirth / Eg. 1st/Eg. January/Eg. 1991

I,Click here to enter the full name and occupation of person making the declaration
(FULL NAME AND OCCUPATION OF PERSON MAKING THE DECLARATION)
OfClick here to enter the Tasmanian address of person making the declaration
(TASMANIAN ADDRESS OF PERSON MAKING THE DECLARATION)

in the State of Tasmania do solemnly and sincerely declare that:

  • I am theClick here to enter the relationship status
    (relationship status – for example, father, sister, step mother)
    of Click here to enter the full name of Applicant,
    the Applicant for state nomination(full name of Applicant),
  • I am anChoose an item.
  • I have resided in Tasmania for the past 12 months☐Yes / No ☐

I make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions of the Oaths Act 2001.

Declared at Click here to enter the place

in the State of Tasmania

thisClick here to enter today’s date of Month /Year

before me,

Signature ______

Name ______

Qualification (Circle one) JP / Commissioner for Declarations / Authorised Person

OccupationClick here to enter the occupation of a Commissioner for Declarations


Please note: The witness / person before whom the declaration is made, must be a person authorised for this purpose. Such persons include a justice of the peace, notary public, proclaimed members of the Tasmanian.Police force and commissioners for taking affidavits (Oaths Act 2001).