Attachment G – Request for Specimen Signature

Please use block letters

I, …………………………………………...…………………………………….

(Given names in full) (Family name)

do hereby certify that the following specimen signature and details are true and correct.

Title or Position:……………………………………………………………………..

Company/Organisation:……………………………………………………………

Address:……………………………………………………………………………

Telephone number:………………………………………………………………….

Professional Registration Number (if applicable) ………………………………

Specimen Signature:…………………………………………………………….…

Seal or Stamp (if applicable):

The information provided is retained on file for future reference at the Department of Foreign Affairs and Trade (DFAT), and is used solely for the purposes of authenticating documents for use outside Australia. This information enables DFAT to compare and verify documents bearing your signature, reducing the possibility of fraudulent use or forged documents being tendered internationally. This is a service provided to bearers of Australian documents being used internationally, and is a requirement of respective foreign governments and not the Australian Government.

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