REGISTRATION FORM Please complete the below form to register your arrival in Western Australia * 1. Date Date DD / MM / YYYY * 2. Family name * 3. Given name * 4. State nomination reference number * 5. Visa subclass * 6. Passport nationality * 7. Nominated occupation * 8. Date of arrival in Western Australia Date DD / MM / YYYY * 9. Date of birth Date DD / MM / YYYY Postal address * 10. Street name and number * 11. Suburb * 12. Postcode * 13. State * 14. Mobile * 15. Email * 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
