956 (Design date 09/21) - Page 6 © COMMONWEALTH OF AUSTRALIA, 2021
Part C – Declarations
23
Declaration by registered migration agent/
legal practitioner/exempt person
Tick all that apply
Appointment of registered migration agent / legal
practitioner / exempt person – I declare that I have been
appointed by the client named in Part A of this form as a registered
migration agent/legal practitioner/exempt person and that I will act
on the client’s behalf as permitted by law.
Appointment of authorised recipient – I understand that I have
been appointed by the persons named in Part A of this form to
be their authorised recipient; and as the authorised recipient, all
documents that would otherwise be sent to the persons named in
Part A will be sent to me, including by electronic means as indicated
in Question 7 (if applicable).
Ending appointment of registered migration agent / legal
practitioner / exempt person – I declare that I am no longer
acting on behalf of the client named in Part B and I have advised
the client accordingly.
Withdrawal of authorised recipient appointment –
I understand that I am no longer acting as authorised recipient in
this matter.
Signature of registered migration agent/legal practitioner/
exempt person
Date
DAY MONTH YEAR
-
24
Declaration by client
Tick all that apply
Appointment of registered migration agent / legal
practitioner / exempt person – I declare that I have appointed
the registered migration agent/legal practitioner/exempt person
named in PartA of this form to provide assistance with matters as
indicated on this form.
Appointment of authorised recipient – I declare that I have
appointed the person named at Question 2 of this form to receive
all documents relating to the matter indicated at Question 15 on
my behalf.
Ending appointment – I declare that the registered migration
agent/legal practitioner/exempt person named in Part B is no
longer acting on my behalf.
Withdrawal of authorised recipient appointment – I declare
that the registered migration agent/legal practitioner/exempt
person listed at Question 18 on this form is no longer authorised
to receive documents on my behalf.
I understand that future correspondence from the Department will
be sent to the address that I have provided at Question 20.
I will inform the Department of any changes to my address for
correspondence.
Signature of
client
Date
DAY MONTH YEAR
-
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