Professional Documents
Culture Documents
an authorised recipient
Form
956A
Authorised recipient
Dependent applicants
Home page
General
enquiry line
www.immi.gov.au
Telephone 131 881 during business hours
in Australia to speak to an operator (recorded
information available outside these hours).
Ifyou are outside Australia, please contact
your nearest Australian mission.
Form
Appointment or withdrawal of
an authorised recipient
Please use a pen, and write neatly in English using BLOCK LETTERS.
Tick where applicable
Are you using this form to notify the department that you are:
appointing an
authorised recipient
withdrawing the
appointment of an
authorised recipient
POSTCODE
Telephone numbers
COUNTRY CODE
Office hours
Are you a:
(tick one only)
AREA CODE
) (
NUMBER
)
Mobile/cell
956A
1. Family name
Given names
2. Family name
Given names
3. Family name
Do you have a DIBP Client ID number (CID)?
Given names
No
Full name (For an organisation, provide the name of the contact person)
Title:
No
Mr
Mrs
Miss
Ms
Other
Family name
Yes
Given names
Family name
DAY
DIBP Client ID
number (CID)
Yes
MONTH
Given names
YEAR
Date of birth
If applicable:
Migration Agent Registration
Number (MARN)
7 DIGITS
POSTCODE
Appointment details
15 Full name
Title:
Mr
Mrs
Miss
Ms
Other
Family name
Given names
Type of application
DAY
DAY
MONTH
MONTH
YEAR
16 Date of birth
YEAR
Date lodged
Cancellation process
Subclass of visa
POSTCODE
DAY
MONTH
YEAR
19 Telephone numbers
COUNTRY CODE
Office hours
AREA CODE
) (
NUMBER
)
Mobile/cell
No
Go to Part C
Yes
Give details
COUNTRY CODE
13 Provide the DIBP ID number (if known) attached to the matter listed
in Question 12 in relation to which you are appointing an authorised
recipient
Fax number
Email address
Go to Part C
Yes
AREA CODE
) (
NUMBER
)
Full name (For an organisation, provide the name of the contact person)
Full name
Family name
Family name
Given names
Given names
DAY
MONTH
YEAR
Date of birth
Telephone numbers
COUNTRY CODE
Office hours
AREA CODE
) (
Application process
NUMBER
Type of application
Mobile/cell
DAY
MONTH
YEAR
Date lodged
Cancellation process
Subclass of visa
1. Family name
DAY
MONTH
YEAR
Given names
2. Family name
Given names
3. Family name
Given names
POSTCODE
Telephone number
COUNTRY CODE
Office hours
AREA CODE
) (
NUMBER
POSTCODE
Give details
COUNTRY CODE
Fax number
AREA CODE
) (
NUMBER
)
Email address
COMMONWEALTH OF AUSTRALIA, 2014
Part C Declarations
Authorised recipient declaration
Your declaration
Appointment
Appointment
I understand that:
I have been appointed by the persons named in Part A of this
form to be their authorised recipient; and
as the authorised recipient all documents that would otherwise
be sent to the persons named in Part A will be sent to me,
including by electronic means as indicated in Question20 (if
applicable).
Withdrawal of appointment
I declare that:
I have read the information contained in form 1442i Privacy notice.
DAY
Date
MONTH
YEAR
DAY
MONTH
YEAR
Date
Signatures of other persons 16 years of age or older who are
appointing or withdrawing the appointment of the same authorised
recipient in relation to the same matter
Signature
DAY
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
Date
Signature
DAY
Date
Signature
DAY
Date
Additional details
31
Question number
Additional information