Form

(600)

1.
2.

3.

THAI

54

Sothon

THAI

Tho

10-May-1959
/
/

KHOT

Morn

30-Oct-1952
/
/

No.24 Wat Ounalom Sangkat Chey Chumneah

Khan Daun Penh, Phnom Penh, Cambodia.

02-Feb-1982
/
/

Phteah Chek Village, Chheu Tom Commune

Krakor District, Pursat Province, Cambodia.
Phteah Chek Village, Chheu Tom Commune
Krakor District, Pursat Province, Cambodia.

01-Apr-2010
/
/

M =
E =
F =
S =
D =
W = /
N =

15-Sep-2014
COMMONWEALTH OF AUSTRALIA, 2013

15-Sep-2014
54 (Design date 04/13)

Form

Family composition

Note: 1. You must complete this form in English only.

Are you applying for a: Visitor visa (600)

2. You must give details of all your family members living in your home country and abroad including half, step and adopted brothers, sisters and children (if not living, write
Deceased in Home address column. If whereabouts unknown, write Unknown in Home address column).
3. If you have been assisted in completing this form, you should only sign the Declaration if the information is true and correct and has been included with your full knowledge,
consent and understanding.

Other

Family
composition

Yourself

Family name

Given names

Date of birth
DAy month

THAI

54

Sothon

Relationship status

02-Feb-1982
/
/

Spouse

De facto

Home address

Previous visits to Australia

(use codes below)

Year

DAy month

No.24 Wat Ounalom Sangkat Chey Chumneah

Khan Daun Penh, Phnom Penh, Cambodia.

Father/Mother

THAI

Tho

10-May-1959
/
/

Father/Mother

KHOT

Morn

30-Oct-1952
/
/

Phteah Chek Village, Chheu Tom Commune

Krakor District, Pursat Province, Cambodia.
Phteah Chek Village, Chheu Tom Commune
Krakor District, Pursat Province, Cambodia.

Year

01-Apr-2010
/
/

Brother/sister

Brother/sister

Brother/sister

Son/daughter

Son/daughter

Son/daughter

Relationship status codes

M = Married
E = Engaged
F = De facto
S = Separated
D = Divorced
W = Widowed
N = Never married or been in
a de facto relationship

Declaration

Signature of applicant

I declare that:
the information I have given on this form is complete and correct.
in any section of this form which has been completed with the
assistance of another person, the information as set down is
true and correct and has been included with my full knowledge,
consent and understanding.

DAY

MONTH

15-Sep-2014

COMMONWEALTH OF AUSTRALIA, 2013

YEAR

Signature of witness

DAY

MONTH

YEAR

15-Sep-2014
54 (Design date 04/13)