REGISTRATION FORM Register your arrival in Western Australia (WA) if you received WA State nomination (190/491) Question Title * 1. Date of arrival in Western Australia (WA). If you already reside in WA, please provide the date your State Nominated visa was granted. Date Date Question Title * 2. Family name Question Title * 3. Given name Question Title * 4. State nomination reference number (NOM-XXXX-XXXXX) Question Title * 5. Nominated occupation Question Title * 6. Visa subclass (190 or 491) Question Title * 7. Date of birth Date Date Postal address Question Title * 8. Street name and number Question Title * 9. Suburb Question Title * 10. Postcode Question Title * 11. State Question Title * 12. Mobile number Question Title * 13. Email As part of your signed Conditions of State Nomination you indicated that you expected to remain living and working in Western Australia for two years after being granted a visa.Please notify the Migration Service team of any changes to your contact details, to ensure you can continue to participate in the post-arrival surveys.For further information on registration, please contact Migration Services:E: migrationservices@dtwd.wa.gov.auT: +61 8 9224 6540 Done