Form

Declaration of service
1399

Please read the following information Please use a pen, and write neatly in English using BLOCK LETTERS.
• The Department of Immigration and Border Protection (the Tick where applicable 3
department) has authority under the Migration Act 1958 and
the Australian Citizenship Act 2007 and other legislation it
administers, to collect personal information to carry out its
Part A – General information
functions, including administration of applications for
citizenship or visas for entry and/or stay in Australia. 1 Your full name
• This form seeks information from you that will be used by the Family name
department to assess your visa or citizenship application.
Applications for visas or citizenship may require the applicant Given names
to satisfy a character test or show that they are of good
character.
• Please answer the questions as completely as possible. If you 2 Have you been known by any other names?
do not provide sufficient information in your responses, we
(including name at birth, previous married names, aliases)
may request clarification from you which will delay the
processing of your application. No
• If we request clarification and do not receive a response from Yes Give details
you within the set timeframe, a decision on your application
may be made without taking any further action to obtain the Family name
additional information.
Given names
• Documents to support your statements such as military
service or exemption papers (along with translations) must be
submitted as indicated in the relevant questions.
• If you require more space for your answers, use the space 3 Sex Male Female
provided at Part E – Additional details or attach additional
pages. DAY MONTH YEAR

4 Date of birth
Important information about privacy
Your personal information is protected by law, including the 5 Place of birth
Privacy Act 1988. Important information about the collection,
use and disclosure (to other agencies and third parties, Town/city
including overseas entities) of your personal information,
including sensitive information, is contained in form 1442i Country
Privacy notice. Form 1442i is available from the department’s
website www.border.gov.au/allforms/ or offices of the 6 Your present country of citizenship
department. You should ensure that you read and understand
form 1442i before completing this form.

7 Do you hold any other citizenship?

No
Yes Which countries?

8 What is your religion?

9 What is your ethnic group?

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 10 Your family details
Your spouse/partner
Date of death
Family name Given name(s) Country of birth Country of residence Date of birth (if deceased)
DAY MONTH YEAR DAY MONTH YEAR

Your parents (include biological and adoptive parents)

Your siblings (include half, step and adoptive brothers and sisters)

If insufficient space, give details at Part E

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11 Give details of all places where you have lived outside Australia for 6 months or longer
List all countries, including your country of origin and explain the circumstances that led to each move
From To Region/City/Village Country Reason for move
MONTH YEAR MONTH YEAR

If insufficient space, give details at Part E

12 Give details of all your tertiary education

From To Country Name of institution Name of course
MONTH YEAR MONTH YEAR

If insufficient space, give details at Part E

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 13 Give details of your entire employment history, including overseas employment, periods of unemployment and military service
From To Job description Name of employer Address of employer
DAY MONTH YEAR DAY MONTH YEAR

If insufficient space, give details at Part E

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14 Have you ever been a member or supporter of a liberation or militia 17 Have you ever held a senior religious or cultural position in your
group? community? Do not include positions held in Australia.
No Go to Question 16 No
Yes Give details including group name and your role Yes Give details including date, position, location and duties

18 Have you ever been associated with or held membership of a political

15 Are you still a member or supporter of a liberation or militia group? organisation?

No Give details including how and when your involvement ended No

Yes Give details including date, position, location and duties

Yes Give details of your continuing role 19 Have you ever participated in a war or armed conflict in any way?
No
Yes Give details including date, location and how you were
involved

16 Have you ever been a government official (eg. mayor, judge, hospital
administrator)?
No 20 Have you ever participated in war crimes?
Yes Give details including position, location and duties No
Yes Give details including date, location and how you were
involved

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 21 Have you ever participated in any physical or psychological abuse Part B – Service history
against prisoners or civilians?
No 24 Have you ever undertaken any military service?
Yes Give details including a description of the situation, dates, No • Conscription did not exist
location(s) and how you were involved
• Conscription existed but I was exempted
(Please explain how)

• Conscription existed but I did not serve

(Please explain how)

22 Have you ever participated in the capture of civilians in a war or armed

conflict?
No
Yes Give details including description of the situation, dates,
location(s) and how you were involved
Yes • It was compulsory

• I joined voluntarily

25 Have you ever undertaken any other military, paramilitary, security,

intelligence, police or secret police service?
No
Yes

26 Have you ever been a guard/official at a detention centre, prison or

transit camp?

23 Have you ever been detained or arrested during a war or armed conflict? No

No Yes

Yes Give details including by whom, when, where and details of

your release

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27 If you answered ‘Yes’ to Question 24, 25, and/or 26, give details Service history details
below
Unit
Note: You must attach documentation (and translations if applicable) to
support your answers (military book, service papers, discharge papers etc). Battalion
If insufficient space, give details at Part E Brigade

Service 1 Division
Name of
organisation Corps
DAY MONTH YEAR DAY MONTH YEAR

Headquarters Date from to

location
Location
DAY MONTH YEAR

Date recruited Commanding

Rank/Position officers
when recruited/
volunteered
Your rank
Details of
training
received Your duties

Have you been discharged from this organisation?

No • I am still serving/employed by this organisation

• I left the organisation without official discharge What major operations did you take part in?
(Give details including why you left)

DAY MONTH YEAR

Yes Date discharged

Rank/Position when discharged

What was your role and duties in these operations?

If your unit was mobilised to more than one location, give additional
details at Part E

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 Service 2 Service history details
Name of Unit
organisation
Battalion
Headquarters
location Brigade

Division
DAY MONTH YEAR

Date recruited Corps

Rank/Position DAY MONTH YEAR DAY MONTH YEAR
when recruited/ Date from to
volunteered
Location
Details of
training
received Commanding
officers

Your rank

Have you been discharged from this organisation?

No • I am still serving/employed by this organisation Your duties

• I left the organisation without official discharge

(Give details including why you left)

What major operations did you take part in?

DAY MONTH YEAR

Yes Date discharged

Rank/Position when discharged

What was your role and duties in these operations?

If your unit was mobilised to more than one location, give additional
details at Part E

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 Part C – Assistance with this form Part D – Declaration
28 Did you receive assistance in completing this form? WARNING: Giving false or misleading information is a serious offence.
No Go to Part D 32 I declare that:
Yes Please give details of the person who assisted you • the information I have supplied in or with this form is complete,
correct and up-to-date in every detail.
Title: Mr Mrs Miss Ms Other • I have read and understand this document.
Family name • I am aware that the department may share information and/or
documents that I have provided with other Australian agencies or
Given names foreign agencies.
Address • I have attached documentation to support the answers provided to
Questions 27 (if applicable).
• I have read the information contained in form 1442i Privacy notice.
• I understand the department may collect, use and disclose my
POSTCODE personal information (including biometric information and other
sensitive information) as outlined in form 1442i Privacy notice.
Telephone number or daytime contact
• For visa applicants:
COUNTRY CODE AREA CODE NUMBER
– I understand that any information that is false or misleading may
Office hours (            ) (            )
result in the consideration of refusal of my visa application or, if I
Mobile/cell hold a visa, the consideration of cancellation of my visa.
– I understand that if my visa is cancelled after entry to Australia I
may be required to leave.
29 Is the person an agent registered with the Office of the Migration
Agents Registration Authority (Office of the MARA)? – I further understand that visa refusal, cancellation and removal
from Australia may extend to anyone applying for a visa with me,
No or anyone granted a visa as a result of the grant of a visa to me.
Yes Go to Part D • For Citizenship applicants:
– I understand that any false statements or representations
30 Is the person/agent in Australia? (as referred to in section 50 of the Australian Citizenship
No Go to Part D Act 2007) may result in my committing a criminal offence,
the consideration of refusal of my citizenship application or, if
Yes citizenship has been subsequently granted, the consideration of
revocation of my citizenship.
31 Did you pay the person/agent and/or give a gift for this assistance?
No Signature of
applicant
Yes -
DAY MONTH YEAR

Date

We strongly advise that you keep a copy of this form and all
attachments for your records.

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 Part E – Additional details
33 Question number Additional information

If insufficient space, attach additional details

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