REGISTRATION FORM Please complete the below form to register your arrival in Western Australia Date Question Title * 1. Date Date Family name Question Title * 2. Family name Given name Question Title * 3. Given name State nomination reference number Question Title * 4. State nomination reference number Visa subclass Question Title * 5. Visa subclass Passport nationality Question Title * 6. Passport nationality Nominated occupation Question Title * 7. Nominated occupation Date of arrival in Western Australia Question Title * 8. Date of arrival in Western Australia Date Date of birth Question Title * 9. Date of birth Date Postal address Street name and number Question Title * 10. Street name and number Suburb Question Title * 11. Suburb Postcode Question Title * 12. Postcode State Question Title * 13. State Mobile Question Title * 14. Mobile Email Question Title * 15. Email I would like to subscribe to the Migration Services newsletter Question Title * 16. I would like to subscribe to the Migration Services newsletter Yes No As part of your signed Conditions of State Nomination you indicated that you expected to remain living and working in Western Australia for two years after being granted a visa.Please notify the Settlement Service team of any changes to your contact details, to ensure you can continue to participate in the post-arrival surveys.For further information on registration, please contact Settlement Services:E: settlementservices@dtwd.wa.gov.auT: +61 8 9224 6540 Done
