Annex No. 4. 
COMMONWEALTH OF AUSTRALIA. 
Migration and Settlement Office, 
Australia House, 
Strand, London, W.C.2. 
Application for Certificate of Identity. 
i, the undersigned............. 
at present residing ab..........cccoiciiriiiiiiiiin 
hereby apply for a Certificate of ldentity for travelling to.........c..coooveenn. 
eee teveeteieiiivieiiireieeriion. Australia, for the purpose. of taking up my 
jermanent residence there. 
I declare that I have no Certificate of Identity or Passport already in 
my possession, and that I have made no other application for a Certificate 
5f Identity or Passport. 
Signed................. 
And I, the undersigned. .... 
hereby declare that to the best of my knowledge and belief, the above 
statements are true in substance and fact, and that the photograph(s) 
attached hereto is/are true photo(s) of ihe applicant(s) and has/have been 
july certified sas such by me. 
Signature ..... ........- 
This declaration to he signed by a . . 
Justice of the Peace, Clergyman, Medi- Qualification ........ 
-al Practitioner, Post Master, Post Address ... 
Mistress or Sehool Teacher. 
Date ...... 
DEIORIPTION OF APPLICANT. 
DuscrIpTion oF WIFE (if any) oF 
APPTICANT 
Age oestrone 
Height... 
Colour of Eves ...... coon 
Tisibhle Distineouishing Marks ...... 
428 onan 
Height .... 
“olour of Fves .. ... 
Visible Distinguishing Marks ...... 
Birih Plate. cov ne oo 
Nationality ..... 
Particulars of children (if any) under the age of 16 if to be included in 
Cartificate of Identity. 
Name. 
\ oe. 
Xow 
Relationship to 
Applicant.