Required information for

Chain Migration
To be submitted with application
for GSM State Nomination

Statutory Declaration of immediate family member.

A statutory declaration (example attached) made by the Applicants 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.

Information about applicant and immediate family making Statutory Declaration

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

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

IMMIGRATION SOUTH AUSTRALIA

For further information, please contact us at:
Immigration South Australia, GPO Box 320, Adelaide SA 5001, Australia
Telephone: +61 8 8303 2420
Please Note: Any information about the law in Australia or South Australia is provided as general
information only and is not legal advice. This fact sheet is a starting point only and is not a substitute
for legal or professional advice. While the Department has attempted to ensure the information is accurate at
the time of publishing, no responsibility will be accepted for any errors or omissions and the Government of
South Australia will not be liable for any loss or damage incurred by any person as a consequence of
any use, reference or reliance on this information. Any such use, reference or reliance shall be at the sole risk
of that person who should seek their own legal and or/professional advice if required.

www.migration.sa.gov.au

Last Update: November 2014

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 _______________________

of _____________________________________________,the Applicant for state nomination

(insert full name of Applicant),
I am an Australian permanent resident / Australian Citizen

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

(please circle which one applies)

I have resided in South Australia for the past 12 months

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 ________________________________
in the State of South Australia
this _______ day of ___________________ 20 ____

________________________________
Signature of person making this declaration

before me,

[to be signed in front of an authorised witness]

Signature of authorised Witness / Justice of the Peace

Name of Witness_____________________________
Address of Witness____________________________
____________________________________________
Occupation__________________________________

Please note: The witness / person before whom the declaration is made, must be a person authorised for this
purpose. Such persons include a justice of the peace, notary public, proclaimed members of the S.A. police force and
commissioners for taking affidavits (Oaths Act 1936).