Bsbhrm506a

Application for State Nomination;
Required information for chain migration
A. STATUTORY DECLARATION OF IMMEDIATE FAMILY MEMBER
A statutory declaration (example attached) made by the Applicant’s immediate family member.
This person must be currently an Australian Citizen OR a permanent resident of South Australia
AND must have resided in South Australia for the last 12 months and be currently residing in
South Australia.

B. INFORMATION ABOUT APPLICANT AND IMMEDIATE FAMILY MEMBER MAKING
STATUTORY DECLARATION

B.1 Personal details (main applicant’s family member in South Australia)
First name
Family name
Date of Birth
Contact Telephone Number
Email address
Passport number, OR
SA Drivers Licence number

B.2 Details of family member applying for General Skilled Migration state nomination
First name
Family name
Date of Birth

STATUTORY DECLARATION
State of South Australia – Oaths Act 1936
I,_______________________________________________________________________________________
(FULL NAME OF PERSON MAKING THE DECLARATION)

Of______________________________________________________________________________________
______________________________________________________________________________________
(SOUTH AUSTRLIAN ADDRESS OF PERSON MAKING THE DECLARATION)

in the State of South Australia do solemnly and sincerely declare that:
•

I am the _______________________

(relationship status – for example, father, sister, step mother)

•

of _____________________________________________,the Applicant for state nomination
(insert full name of Applicant),
I am an Australian permanent resident / Australian Citizen

•

I have resided in South Australia for the past 12 months

(please circle which one applies)

The section below is to be completed before an authorised person

And I make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions of the Oaths Act 1936.

Declared at