[Handwritten in top right corner:] SYRIA I.A.1

FORM 47 (SPECIAL)[.]

[Underlined heading:] APPLICATION FOR PERMIT TO ENTER AUSTRALIA[.] 

The Officer -in-Charge.

[Underlined:] AUSTRALIAN SELECTION MISSION.

I, ETHEMI Assim

(Full name – Surname to be in block letters)

of I.R.O., BEIRUT, LEBANON.

Adress [sic]

do hereby make application for permission to enter Australia and in support of the

application submit the following information, which I declare to be true: -

(1) Full name: ETHEMI Assim

(2) Nationality: Albanian

(3) Race: Aryan (State also whether Jewish or not) no

(4) I was born at Kos.Mitrovica – Yugoslavia

on the 15th day of August, 1924.

(5) Marital status (single, married, widowed or divorced): single.

(6) I shall be accompanied by the following members of my family. (If unaccompanied by wife and children state "Traveling Unaccompanied".)

[A table with one row labelled 'Wife' and several rows labelled 'Children'. The next four columns are labelled 'Name', 'Sex', 'Date of Birth', and 'Birthplace'. The rest of the table has been left blank.]

(7) My last country of permanent residence was: Albania

(8) My occupation is: Mechanic

(9) The European languages which I can read and write fluently are:- Albanian, Turkish, Yugoslavian.

(10) I attach two photographs of myself and one each of the members of my family who will accompany me.

Signature of applicant: [Handwritten signature:] Assim Ethemi

Dated at DAMASCUS, SYRIA this 2nd day of October, 1949.

WARNING: Any person whose admission has been authorised may be prevented from landing on arrival or may be required to leave Australia aftor [sic] arrival if is found that he has given incorrect or misleading information in his application.