Consular OnLine Registration Form

1 card per individual
Please fax a copy of the data page of your passport to (08) 8295257

Record ID No.

REGISTRATION CARD                       BRITISH CITIZENS

Surname (in block letters)

Christian or given names

Maiden Name (if applicable)

Date of Registration

Occupation

Place of Birth

Date of Birth

Blood Group

Dates of Renewals

Religious Denomination


Home Address

Tel No.

Mobile No.

Fax No.

Email


Business Address

Tel No.

Mobile No.

Fax No.

Email

Passport No.

Place and Date of Issue

State grounds on which national status in based

Particulars of Naturalisation or Registration Certificate,
From E3A, etc

Other citizenship or nationality (if any)

Next of kin or other person to be notified if necessary

Name

Address

Tel No.

Relationship

Name and nationality of spouse

Please complete a separate card for spouse and each child

Signature of Person Registered

 

When a person is registered without producing a passport particulars should be given here of the documents submitted as proof of British nationality

Reference to Correspondence

Date of Departure and Permanent forwarding Address