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MONTH YEAR DAY MONTH YEAR Date of birth Country of passport Passport number B. Family name Given names Date of birth Country of passport Passport number C. Family name Given names Date of birth Country of passport Passport number D. Family name Given names Date of birth Country of passport Passport number If insufficient space, attach additional details Continued on the next page COMMONWEALTH OF AUSTRALIA, 2009 1229 (Design date 03/09) - Page 3 Part B Details of Parent(s)/Pers.

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