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Print and fax to (691) 320 5449 or post to P.O. Box S, Kolonia, Pohnpei FM
96941
REGISTRATION OF AUSTRALIAN CITIZENS IN POHNPEI
All sections must be completed in BLOCK letters or typed
SURNAME _______________________ GIVEN NAMES __________________________
DATE OF BIRTH ___________________PLACE OF BIRTH ________________________
OCCUPATION ____________________________________________________________
TITLE/POSITION __________________________________________________________
HOME ADDRESS __________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
BUSINESS ADDRESS _______________________________________________________
__________________________________________________________________________
__________________________________________________________________________
OFFICE TELEPHONE _________________ HOME TELEPHONE ___________________
PASSPORT NUMBER __________________ DATE OF ISSUE ______________________
PLACE OF ISSUE __________________________________________________________
OTHER NATIONALITY OR CITIZENSHIP, IF ANY ______________________________
DATE OF ARRIVAL IN POHNPEI _____________________________________________
DATE OF INTENDED DEPARTURE FROM POHNPEI ____________________________
- PARTICULARS OF FAMILY RESIDENT WITHIN JURISDICTION OF POST IN
POHNPEI
-
- SPOUSE NAME ______________________ NATIONALITY _______________________
- DATE OF BIRTH _____________________ PLACE OF BIRTH _____________________
- PASSPORT NUMBER _________________ NUMBER OF CHILDREN_______________
- NEXT OF KIN OR RELATIVES IN AUSTRALIA _________________________________
- __________________________________________________________________________
- __________________________________________________________________________
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