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Immigration Restriction Act 1901.

This is to certify thatofaged years, a [insert trade, calling, or other description] is exempted for a period offrom the date hereof from the provisions of the Immigration Restriction Act 1901.

Dated atthisday of1901.

Minister for External Affairs [or as the case may be]. Printed and Published for the of the of by ROBT. S. BRAIN Government Printer for the State of Victoria