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Yes |
No |
| Are you able to invest a minimum of Stg400,000.00 in Australia? |
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| Are you able to demonstrate combined (as applicable) minimum earnings from pensions and/or other investments of Stg22,000.00? |
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| Country of Preference:* |
Australia |
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New Zealand |
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| Personal Details: |
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| Surname* |
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| First Name* |
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| TItle* |
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| Date of Birth* |
(dd/mm/yyyy) |
| Marital Status |
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| Common-Law |
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| Citizenship |
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| Contact Details: |
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| Postal Address* |
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| Email Address* |
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| Home Telephone* |
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| Work Telephone |
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| Mobile Number |
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| Partner's Details: |
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| Surname |
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| First Name |
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| TItle |
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| Date of Birth |
(dd/mm/yyyy) |
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Yes |
No |
| Do you have family permanently resident in Australia? |
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| If 'Yes' please select: |
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| What level of investment are you able to make in Australia? (drop down menu as follows: |
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| What combined annual income do you derive? |
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| In which state in Australia would you wish to settle: (drop down menu as follows: |
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| I have been convicted of a civil offence(s): |
| Yes: |
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| If Yes give brief details : |
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| I have been hospitalised or treated for an illness or disability? |
| Yes: |
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| If Yes give brief details : |
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| Please indicate where you found our contact
information:*
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