Form

54

1.
(676) (456)
2.
(679)
3.

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© COMMONWEALTH OF AUSTRALIA, 2007 54 (Design date 07/07)
 Form

Family composition
54
Are you applying for a: Note:
1. You must complete this form in English only.
Tourist visa (676) ✔ Business short stay (456)
2. You must give details of all your family members living in your home country and abroad including half, step and adopted brothers, sisters
Sponsored family visitor (679) Other 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.

Family Family name Given names Date of birth Marital status Home address Previous visits to Australia
composition (Married, engaged, de facto, separated,
DAY MONTH YEAR divorced, widowed or never married) DAY MONTH YEAR

NAHIA#:4, BEAZ-E-EKMALATI AREA,

Yourself SHINWARI HABIB RAHMAN 12-Mar-1975
/ / MARRIED / /
JALALABAD CITY NANGARHAR/AFG
NAHIA#:4, BEAZ-E-EKMALATI AREA,
Spouse SHINWARI JAMAL BIBI 22-Apr-1995
/ / MARRIED / /
JALALABAD CITY NANGARHAR/AFG
JALALABAD ON 22 AUGUST 2013
Father SHINWARI ABDUL RAHMAN / / / /
NAHIA#:4, BEAZ-E-EKMALATI AREA,
Mother SHINWARI GULMARA BIBI 01-Jan-1955
/ / WIDOWED / /
JALALABAD CITY NANGARHAR/AFG
Brother/sister / / jkjkjkjkjk / /
Brother/sister / / / /
Brother/sister / / / /
NAHIA#:4, BEAZ-E-EKMALATI AREA,
Son/daughter SHINWARI FAZAL RAHMAN 30-Aug-1992
/ / MARRIED / /
JALALABAD CITY NANGARHAR/AFG
NAHIA#:4, BEAZ-E-EKMALATI AREA,
Son/daughter SHINWARI GAWHAR RAHMAN 09-Apr-1997
/ / NEVER MARRIED / /
JALALABAD CITY NANGARHAR/AFG
Son/daughter
NAHIA#:4, BEAZ-E-EKMALATI AREA,
SHINWARI ZAKIR RAHMAN 02-Mar-1995
/ / NEVER MARRIED / /
JALALABAD CITY NANGARHAR/AFG

Declaration
I declare that:
• the information I have given on this form is complete
and correct.
Signature of applicant Signature of witness
• in any section of this form which has been completed
with the assistance of another person, the information DAY MONTH YEAR DAY MONTH YEAR
as set down is true and correct and has been included
with my full knowledge, consent and understanding.
/
Date 25-Sep-2019/ /
Date 25-Sep-2019/
© COMMONWEALTH OF AUSTRALIA, 2007 54 (Design date 07/07)