[A typed form letter with handwritten text inserted in blank spaces provided.]

[Handwritten:] Coolgardie, W.A.

[Handwritten:] 8th October, 1902.

Sir,

I beg to apply for a Certificate of Domicile under the Immigration Restriction Act, 1901, and Regulations; and I append a Statutory Declaration containing the facts on which this application is founded.

I wish to visit [handwritten] India Karachi [end handwritten] for [handwritten] twelve [end handwritten] months for the purpose of [handwritten] meeting my family. [end handwritten.]

I enclose [handwritten] three [end handwritten] certificates as to character, an also four carte de visite photographs, two side face and two full face.

If my application is granted, please intimate the fact to me at the above address.

I have the honour to be,

Sir,

Your obedient Servant,

[Handwritten signature:] Naik Mahomet

[Handwritten:] c/o [care of] R. Valjee 160 Bayley Street

[Addressed to:] The Collector of Customs,

[Handwritten:] Fremantle, W.A.

[Handwritten postscript] Please send the permission before the 4th of November 1902 as I want to catch the French boat & oblige —