Commonwealth Numbered Regulations

1992 No. 96 MIGRATION REGULATIONS (AMENDMENT) - REG 14

14.1 Form 4:
Omit the form, substitute:
                 "FORM 4            Regulation 182

COMMONWEALTH OF AUSTRALIA
Migration Act 1958
DOCUMENT ISSUED IN ACCORDANCE WITH ANNEX 9 OF THE ICAO
CONVENTION ON INTERNATIONAL CIVIL AVIATION This document is issued by the
Australian Government under subsection 114(2) of the Migration Act 1958 of the
Commonwealth of Australia. TO: Immigration or appropriate authority:
Airport:...........Country:.............................
.................................
Attach
photograph
(if available) The person to whom this document is issued is claiming the
following identity: Surname: Given Name(s): Date of
Birth:................................... Place of Birth:
Nationality:.......................................
Residence:.............................................. This person arrived
in Australia on.............................. at............... Airport on
flight number................................ from................... Airport.
The person named in this document:

*is being deported from Australia/*was refused entry to Australia and the
incoming carrier has been instructed to remove *him/*her from the territory of
this Country on flight number............................. departing
at.................................hours
on......................................................
.............from....................................... .......Airport. At
the time of attempting entry to Australia this person was:

* (1) Not in possession of any *travel/*identification documentation.

* (2) In possession of the *photocopied/*attached documentation.
A brief description of the offending documentation follows -

* fraudulent/*falsified/*counterfeit

*passport/*identity card/*other document
Number:.............................................
Country in whose name documentation was
issued:..............................................

* (3) The documentation produced has been impounded for return to the
appropriate authorities of the issuing country. According to Annex 9 of the
ICAO Convention on International Civil Aviation, the last Country in which a
passenger previously stayed and most recently travelled from, is invited to
accept *him/*her for re-examination when

*he/*she has been refused admission to another country.
I,...................................................... .........., a
delegate of the Secretary of the Department of Immigration, Local Government
and Ethnic Affairs, issue this document under subsection 114(2) of the
Migration Act 1958. Signature and Official Title:
Date:.......................................
Airport:................................................
........................... Country: Australia
Telephone:....................... Telex:..............................
Facsimile:................................."

*delete as appropriate