1195 (Design date 03/24) - Page 1© COMMONWEALTH OF AUSTRALIA, 2024
Form
1195
Identity declaration
Department of Home Affairs
What the photograph requirements are
You will need to submit a passport-size photograph with this
form. The person who completes Questions 2 and 3 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 at Question 3.
The photograph must be:
• no more than 6 months old, and
• 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), and
• of good quality, in colour, against a plain, light coloured
background (laser copies are not acceptable).
“This is a true
photograph of”
JOHN CITIZEN
(full name of applicant)
PSmith
(signature)
PHOTOGRAPH BACK
SIZE
Max 36mm
Min 32mm
PHOTOGRAPH FRONT
Example of photograph
Photograph to be no more than 6 months old
How to submit this form and photograph
If you are applying online for citizenship or evidence of
citizenship, 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, in
colour, and attached to your online application.
If you are applying for citizenship on a paper form, submit this
form with your paper form. Place the endorsed photograph in
a plastic sleeve or envelope and staple it to this form.
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)
Who should use this form
Form 1195 Identity declaration is to be completed and
provided to the Department of Home Affairs (the
Department) if:
• you are applying online for citizenship or evidence of
citizenship – a separate form1195 must be completed for
yourself and each person included in the online application,
or
• you are applying for citizenship on a paper form and have
more children than the space on your application form
allows – a separate form 1195 must be completed for each
additional child.
An application for Australian citizenship or evidence of
citizenship cannot be approved where a person’s identity is
not able to be verified.
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 programs. 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.
Who can complete the Identity declaration
Questions 1 and 4 of this form must be completed by
the person who is applying for citizenship or evidence of
citizenship (the applicant).
Questions 2 and 3 of this form must be completed, and the
photograph endorsed and 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 and do
not know an Australian citizen, Questions 2 and 3 can be
completed, and the photograph endorsed and signed 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 1–2, and is not related to you by
birth, marriage or de facto relationship.
For children under 6 years of age, Questions 2 and 3 can be
completed by an Australian citizen (or citizen of the child’s
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 1–2,
and is not related by birth, marriage or de facto relationship.
1195 (Design date 03/24) - Page 2 © COMMONWEALTH OF AUSTRALIA, 2024
11. Fellow of the National Tax Accountant’s 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
SubdivisionC of Division 1 of Part IV of the Marriage
Act1961
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
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
Act1961
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. Registered migration agent (where registration is not
suspended or subject to a caution)
36. Registrar, or Deputy Registrar, of a court
37. Sheriff
38. Teacher employed on a full-time basis at a school or
tertiary education institution
39. Veterinary surgeon (licensed or registered).
Important information about privacy
The Privacy Act 1988 contains 13 Australian Privacy
Principles which regulate the way that the Department
collects and handles personal information. Information about
how the Department collects, uses and discloses personal
information for its key functions can be found in form 1442i
Privacy notice. More information about the Department’s
general information handling practices (including form
1442i) can be found in the Department’s Privacy policy at
www.homeaffairs.gov.au/access-and-accountability/our-
commitments/privacy
Personal identifiers collected under the Australian Citizenship
Act 2007 are generally photographs. 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.
More information on personal identifiers is contained in
information form 1243i Your personal identifiers. Information
form 1243i is available from the Department’s website
www.homeaffairs.gov.au/allforms
Citizenship testing by Services Australia
Citizenship appointments are conducted at selected offices of
Services Australia (Centrelink).
Test administrators at Services Australia 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 Services Australia 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.
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 Department’s 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 Home Affairs contact details
See your paper application form for the postal address of the
office of the Department closest to you.
Please keep these information pages for your reference
www.homeaffairs.gov.au/citizenship
Telephone 131 880 during business hours
in Australia to speak to an operator (recorded
information available outside these hours).
If you are outside Australia, telephone
+61 2 6196 0196.
Home page
Citizenship
Information
Line
1195 (Design date 03/24) - Page 3© COMMONWEALTH OF AUSTRALIA, 2024
Form
1195
Identity declaration
Department of Home Affairs
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.
1
Details of the person who is applying
for citizenship or evidence of
citizenship (the applicant)
Date of birth
DAY MONTH YEAR
Current residential address
Note: You must tell the Department if your address changes after you
lodge this form.
POSTCODE
Family name
Given names
Current postal address
(If the same as your residential address, write ‘AS ABOVE’)
POSTCODE
Telephone numbers
Work
Home
(AREA CODE )
(AREA CODE )
Note: You must tell the Department if your address changes after you
lodge this form.
Transaction Reference Number (the number that you were given when
you lodged your online application)
Note: You (the applicant) must also complete the Declaration(s)
(Question4) on page4.
Mobile/cell
IMPORTANT – Questions 2 and 3 must be completed by a person
who:
• is an Australian citizen, and
• has known the applicant for at least one year, and
• is currently working in a profession or occupation listed on
pages1–2, and
• is not related to the applicant by birth, marriage or de facto
relationship, and
• is easy to contact by telephone during normal working hours.
The person will also need to endorse and sign a passport-size
photograph of the applicant as described on page 1.
3
Identity declaration
I declare that I have known (full name of the applicant who is applying
for citizenship)
I have endorsed the back of the applicant’s photograph with the words
‘This is a true photograph of [name of applicant]’ and signed the
photograph.
Date
DAY MONTH YEAR
Signature
of person
making this
declaration
-
Details of the person who is making the
identity declaration (not the applicant)
Address (home or business)
POSTCODE
What is your profession or occupation group number from
pages 1 and 2?
Telephone numbers
Work
Home
(AREA CODE )
(AREA CODE )
Mobile/cell
Are you an Australian citizen?
NoYes
2
Family name
Given names
Family name
Given names
3
Tick where applicable
for year(s) month(s) and vouch for their identity.
1195 (Design date 03/24) - Page 4 © COMMONWEALTH OF AUSTRALIA, 2024
Declaration by the applicant who is
applying for citizenship or evidence of
citizenship
4
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 for citizenship aged 18 years or over only –
I acknowledge that I electronically signed my application for
Australian citizenship and in doing so consented to a Nationally
Coordinated Criminal History Check (NCCHC) under the terms of the
National Police Checking Service (NPCS).
Date
DAY MONTH YEAR
Signature of
applicant
-
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.
Applicants for citizenship aged 16 or 17 years – responsible
parent declaration
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 applicant’s personal information being provided to
the National Police Checking Service (NPCS) for the purpose of the
NPCS conducting a Nationally Coordinated Criminal History Check
(NCCHC) 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 applicant’s 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 have read the information contained in form 1442i Privacy notice.
• I understand the Department may collect, use and disclose the
applicant’s personal information (including biometric information and
other sensitive information) as outlined in form 1442i Privacy notice.
See www.homeaffairs.gov.au/citizenship for information about the
Offences provision, spent convictions and the National Police Checking
Service – General Information.
Signature of
responsible
parent
Date
DAY MONTH YEAR
Full name of responsible parent
Telephone numbers
Work
Home
( ) ( )
( ) ( )
COUNTRY CODE AREA CODE NUMBER
Mobile/cell
-
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 have read the information contained in form 1442i Privacy notice.
• I understand the Department may collect, use and disclose the
applicant’s personal information (including biometric information and
other sensitive information) as outlined in form 1442i Privacy notice.
Signature of
responsible
parent
Date
DAY MONTH YEAR
Full name of responsible parent
Telephone numbers
Work
Home
( ) ( )
COUNTRY CODE AREA CODE NUMBER
( ) ( )
Mobile/cell
-
We strongly advise that you keep a copy of your application
and all attachments for your records.