[Handwritten in red ink at top of the page:] With 12/667

Form No. 17.

[Stamped in purple ink: 'DEPARTMENT OF EXTERNAL AFFAIRS', with handwritten file number 'B/5239.']

State[:] Victoria

[Heading:]APPLICATION FOR DOMICILE CERTIFICATE.

Name[:] Munshie Kreem Bux

Length of residence in Commonwealth[:]  7 yrs

Proceeding to[:] India for (period)[:] 20 Months 

Purpose of journey[:] Settling private affairs, parents having died recently.

Occupation[:] Hawker, Dealer in fancy goods etc.

Family[:] None

Where resident[:] [no response]

Whether naturalized[:] No

Interests in Commonwealth[:] Stock & Pack Horse, £50; Outstanding debt due to applicant £40. & Cask £40.

Intended length of stay in Commonwealth[:] Permanently

Recommended by[:] 10 Certfs. [certificates] Character[.] Holds an Electors Right No 235448 for Gippsland South "Foster" for 1903.

Police [the words ‘and Customs’ are crossed out] Reports[:] give applicant good character & value Stock and Pack Horse at £40.

Action taken-

Appd [Approved.]

[Handwritten initials:] A.S.S.

18.9.3