Australian De Facto Visa Application Form

Title*

First Name*

Surname*

Date of Birth*

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Country of Birth*

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Address*

Emergency contact number*

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Mobile Number*

Do you want to apply for a birth certificate?*

Do you want to apply for a marriage certificate?*

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Please enter the result*

914156-16= 2 4-89 =-2+164/ 4-6-+=5