Australians Detained Abroad: Seek Assistance

Your Information
Please provide us with information on the person submitting this form below.
Title*
Other Title*
Name*
First Last
Where do you currenty reside?*
In what country outside Australia do you reside?*
What is your current citizenship status?*
Please describe your citizenship status further*
What is your relationship to the detainee?*
Please describe your relationship to the detainee further*
Eg: Cousin, Uncle etc.
What is your preferred method of contact?
- Phone
- Email
Email
Phone number*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Information