Application for an Australian Travel Document
Statement under the Australian Passports Act 2005FormB-9
Application for an Australian travel document
Child without full parental consentor Australian court order permitting international travel
A priority processing fee will NOT be accepted before this application is approved
Aboutthisform: This statement must be completed and submitted to support an application for apassport for a child (i.e. a person under 18 years who has never married)where a requiredconsent has notbeen obtained from eachperson who has parental responsibility for the child (including persons given rights of residency, custody, access, contact, guardianship, day-to-day or long-term care,welfare or development under a court order issued in relation to the child) and there is no Australian court order which permits the child to travel internationally.
It is your responsibility to obtain the consent ofeach person whose consent is required. This form should be completed only when you have exhausted all efforts to obtain the required consents. A separate form is required for each person with parental responsibility who has not provided their written consent.
Youmustanswerallquestionsinfull.PleaseprintclearlyanduseBLACKINK.
1Child’sdetails
• Allow at least 3- 4 weeks in additiontothe normalprocessingtime of 10workingdays
• Do notmake firm travel bookings or pay for tickets until you know the applicationhas been approved.
• Child’sproposed travel details
Child’s full nameand current address:
Taylah Shee Teone Hill
24 Cooinda Way, Point Cook
Melbourne VIC 3030
If applicable, former name(s):
With whom is the child now living?
Departure date 28 / 03 / 2013
daymonthyear
Return date 13/ 04/ 2013
daymonthyear
Application form No:
Mother (Ngaire Teresa Hart)
With whom is the child travelling?
Mother (Ngaire Teresa Hart)
Destination andreason for travel:
Term Break return to grandparents and family
2YourdetailsYour full name and current address:
Ngaire Teresa Hart
24 Cooinda Way, Point Cook, Melbourne VIC 3030
Nationality: New ZealanderPassport No:AB560247
Your relationship to the child: Mother
3Parents’maritalstatusWere you married to the child’sother parent at the time of birth? YES / NO
What is your currentrelationshipwith the child’sother parent? (please circle oneanswer) Married Defacto Separated Divorced No relationship
If divorced, please provide dateand copy of decree nisi:
/ /
daymonthyear
•This is a referral to an Approved SeniorOfficer with no guaranteethat a passportwillbe approved.
•The special circumstances under which approval may begiven are set out in subsection 11(2)ofthe Australian Passports Act 2005 (theAct) and subsection 2.1 ofthe Australian Passports Determination 2005 (the Determination).The Act and the Determinationare available atwww.passports.gov.au.
•If you have a genuinely urgent needtotravel, please call 131 232 before lodgingthis statement.
•A priority processingfee will NOTbe accepted before this application is approved.
4Otherpersonwith parentalresponsibility / FormB-9Full name and current address of other person with parental responsibility:
Hoani Ross Teone Hill
12 Dan Morgan Drive
Clyde North, Melbourne VIC 3977
If applicable, former name(s) ofother person with parental responsibility:
• Complete a separate form B-9 for eachother person with parental responsibilitywho has
not provided written consent
Relationship to the child: Father
Date of birth: 28/ 10/1963ORapproximate age now:
daymonthyear
Is this person an:Australian CitizenPermanent residentTemporary residentNon-resident
(circle one answer)(Foreign national)
Has this personever visited Australia? YES / NO
If YES, give approximate date(s): / / to/ /
daymonthyeardaymonthyear
What are the last contact detailsyou have for this person?
(include postal,email or socialmedia addresses, phone numbers, friends, relatives or employer’s addresses)
Postal: 12 Dan Morgan Drive, Clyde North, Melbourne, VIC 3977
Email:
Mobile: 0418136548
Employers address: Safeway Storeds522 Wellington Road, Mulgrave VIC 3170
Have you tried to contact this person using any of these contacts? YES/ NO
If YES, what was the result?
I have had a text challenge with him ever since we have arrived back in Melbourne in September 2012
Tonight, 17th February 2013 after Taylah had rung him and he returned her call at 7:17pm to ask to sign the consent forms that we had sent to him last week. Hoani text me back at 8:21 pm “Wasting your time sending any forms won’t sign anything not in Taylahs best interest. Both Taylah & I became instantly distraught and upset hence while we are applying and Taylah had called Hoani’s sister in Auckland who she has a close relationship with to ask her to help her by talking to Hoani to sign. This application is with both Taylah, myself her two brothers Jason Bill Lundon and Beau Jon Lundon and her godfather Herbert Lundons support who all reside at 24 Cooinda Way, Point Cook VIC 3030
If NO, please give reasons:
5Courtordersaffecting rightsinrelationtothechild / If there are courtorders affecting youror anotherperson’s rights in relation to the child you must also complete a Form B-7 and provide the original copies of allcourt orders. NO
6Childsupportpayments / Do you receiveor make any Child Support payments in respect of this child?YES/ NO If YES, please provide details: I have received two child support payments, one in January and another last week. I had applied with Child Support last October. Due to Hoani’s verbal and text conversations it was a very stressful time. Child support collect payments on behalf. I would not accept to receive volunteer payments as I felt threatened by him and become distressed. I had made calls to Child Support inregards to the conversations and texts I was receiving from Hoani at the time.
7Contactbetweenchild andotherpersonwith parentalresponsibility / Describe the nature of the relationship between the child and this person (e.g. give details of the nature and frequency of contact visits, phonecalls, e-mails, text messages, etc.):
There is no frequency of contact visits
Phone calls are Taylah asking to see him because of her passport to be signed
I Ngaie Teresa Hart use to email him pictures of Taylahs progress or text him when living in New Zealand.
When was the last contact between the child andthis person?17/ 02/ 2013
daymonthyear
What was its purpose?
To ask him to sign the Australian Childs Passport Application
8Furtherinformation / FormB-9
The special circumstances under which this application may be approved are defined in subsection 11(2) of the Australian Passports Act 2005 and subsection 2.1 of the Australian PassportsDetermination 2005.
Do you wish to provide any further information?
Taylah has asked me to write this.
I had visited him for one sleep over last weekend. I went to his place because I wanted him to sign my passport. I have being here since September but we live too far away and it doesn’t seem to work. He has a nice family and I am happy because I am happy with my mum. She has always looked after me and takes me everywhere and has always makes me special and puts me first. My Dad says nasty things about my mum and so I don’t want to be around him or visit him. I am very close to my grandparents, uncles and auntys, cousins and my nieces who live in New Zealand I have a very special Poppy who looks after my pet dog and my Poppy is old and I am sad to think if he gets sick I cannot go to him. I like my school very much here and my friends and I am doing very well. Two of my brothers are with me and my godfather, I call my Dad. He flew over from Australia to help my mum with my emergency passport so that I could live here in Australia. My other brother Damian is Hoani’s lives in New Zealand close to my Aunty and they are very nice to me. My mum wants me to travel with her and I would like to go please.
I will talk to you if you would like. I do not remember my dad and when I lived in New Zealand I only came for one holiday when I was 9. Aunty Yvonne and my father’s family in New Zealand are nice to.
9Disclosureof information / The Department of Foreign Affairs and Trade may disclosetheinformation that has been providedin or with
this application to any organisation or individual that can verify the information to establish thechild’s eligibility for an Australian traveldocument. This may includecontacting the person named in Section 4 whose consenthas not been provided.
Your contact details will NOT bedisclosed to that person.
If you have anyobjection to thedepartment contacting that person please state your reasons here:
10Declaration / Declarationbythepersoncompletingthisstatement
I declare that:
•I am aware of the information in the brochureChildren and parental consent*;
•I am aware thatprocessing thisapplication maytake an additional 3 to 4 weeks;
•I am aware that it is a criminaloffence under theAustralian Passports Act 2005 to make false or misleadingstatements. (There are penalties of upto 10 years imprisonment or a fine
of $110 000, or both); and
•the information I have given in this statement iscomplete and correct.
Signature/ /
daymonth year
*CopiesofthebrochureChildrenandparentalconsentareavailableat
passportofficesinAustralia,Australiandiplomaticmissionsandconsulatesoverseas,onlineat www.passports.gov.auorbycalling131232fromanywhereinAustralia.