SUPPLEMENTARY FORM INFORMATION
FAAMATALAGA FAAOPOPO
You must fully complete this sheet and submit it with your visa application. We are under no
obligation to request further information from you and your application will be considered on
the basis of the information submitted with your visa application at the time of lodgement
Please provide full details of Spouse/Children/Brothers/Sisters/Parents living in Samoa and Overseas. Also
include full details of half, step and adopted relatives.
(Faamolemole ia tuuina mai faamatalaga auiliili o le Toalua/Fanau/Uso ma Tuafafine/Matua o loo nonofo I Samoa
I Sisifo ma Atunuu I fafo. Ia aofia ai foi ma faamatalaga auiliili atoatoa o uso/tuafafine/ e eseese Tama/Tina
faapea foi ma tagata ua uma ona faatulafonoina e avea ma tagata moni e faia ia te oe.
PARENTS OF APPLICANT (See notes above)
(MATUA O LE O LOO TALOSAGA) (Tagai I faamatalaga o loo I luga)
SPOUSE OF APPLICANT (Toalua a le o loo talosaga)
First Name
Igoa Muamua
Surname
Faaiu
Date of Birth
Aso fanau
Relationship
Faia
Residing
Atunuu o loo nofo ai
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ALL BROTHERS AND SISTERS OF APPLICANT (See notes above)
USO MA TUAFAFINE UMA O LE O LOO TALOSAGA (Tagai I faamatalaga o loo I luga)
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ALL CHILDREN OF APPLICANT (See notes above)
TAMAITI UMA A LE O LOO TALOSAGA (Tagai I faamatalaga o loo I luga)
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I certify that this is a complete list of my family including half step and relatives
(Ua ou faamaonia e faapea o lenei lisi o se lisi maea lelei o lou aiga ma o ai uso ma tuafafine e eseese
o matou Tama/Tina, faatasi ai ma I latou ua maea faaliliu faaletulafono e avea ma tagata moni e faia
ia te au)
Declaration:
Ta’utinoga:
I declare that the information I have given on this form is complete and correct
Oute ta’utino atu o faamaumauga uma I luga o lenei pepa e moni
SIGNATURE OF APPLICANT: _____________________________ DATE: ______________________