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Last name (as shown on your passport)
{Your family/last name(s) as shown on your passport
:5}
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First name(including your middle name)
{Your given name(s) including your middle name as shown on your passport:6}
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Have you ever been known by a different name?
{Have you ever been known by a different name?:7}
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Other family/last name
{Other family/last name:8}
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Other given name(s)
{Other given name(s):9}
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Gender
{Your gender as shown on your passport:10}
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Date of birth
{Your date of birth as shown on your passport:11}
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Place of birth
{Your place of birth:12}
-
Country of birth
{Your country of birth:13}
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National Identity Number (if you have one)
{Your National Identity Number, if you have one:14}
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Email address
{Your email address:15}
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Are you an Australian permanent resident?
{Are you an Australian permanent resident?:16}
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Will you be staying in New Zealand?
{Will you be staying in New Zealand?:17}