1. Indicate if you are applying outside Australia or in Australia:

Outside Australia Go to Question 2

In Australia Go to Question 5

Applicants outside Australia

2. When do you wish to visit Australia?

3. How long do you wish to stay in Australia?

Up to 3 months

Up to 6 months

Up to 12 months

4. Do you intend to enter Australia on more than one occasion?

No Go to Question 7

Yes Give details

Give details:

Applicants in Australia

5. Specify the date you wish to extend your stay to:

6. Provide detailed reasons for requesting this further stay:

7. Give the following details exactly as they appear in your passport Make sure your passport is valid for the period of stay you are applying for.

Family Name :

Sex

Male

Female

Date of birth :

Passport number :

Country of passport :

Nationality of passport holder :

Date of issue :

Date of expiry :

Place of issue :

Issuing Authority :

Town/city :

State/province :

Country :

9. Relationship status:

Married

Separated

Engaged

Divorced

Defacto

Widowed

Never Married

10. Are you or have you been known by any other name?

Yes

11. Do you currently hold an Australian visa?

Yes

12. Have you applied for a Parent (subclass 103) visa?

Yes

Please provide your queue date :

13. Do you currently hold, or have you applied for, an APEC Business Travel Card (ABTC)?

Yes

14. Are you a citizen of any other country?

Yes

List countries :

15. Do you have other current passports?

Yes

Passport number :

Country of passport :

16. Do you hold an identity card or identity number issued to you by your government?

Yes

Family name :

Given names :

Type of document :

Identity Number :

Country Issue :

17. In what country are you currently located?

18. What is your legal status in your current location?

Citizen

Permanent resident

Visitor

Student

Work Visa

No legal status

Other

Give details

20. Your current residential address?

Address:

Post Code:

Country:

21. Address for correspondence:

Correspondence Address:

Postal Code:

Country:

22. Contact telephone numbers

Home:

Office:

Mobile/cell:

23. Communicating with you by email and/or fax?

Yes

Email address:

Fax number:

24. Are you travelling to, or are you currently in, Australia with any family members?

Yes

Full Name:

Relationship to You:

Name of sponsor (if applicable):

25. Do you have a partner, any children, or fiancé who will NOT be travelling, or has NOT travelled, to Australia with you?

Yes

Full Name:

Date Of Birth:

Relationship to You:

Their address while you are in Australia:

26. Is it likely you will be travelling from Australia to any other country?

Yes

itinerary details:

27. Do you have any relatives in Australia?

Yes

Full name:

Date of birth:

Relationship to you:

Address:

Citizen or permanent resident of Australia ?

Yes

28. Do you have any friends or contacts in Australia?

Yes

Full name:

Date of birth:

Relationship to you:

Address:

Citizen or permanent resident of Australia ?

Yes

29. Why do you want to visit Australia?

30. Do you intend to do a course of study while in Australia?

Yes

Name of the course:

Name of the institution:

How long will the course last?:

In the last 5 years, have you visited or lived outside your country of passport for more than 3 consecutive months?

31. Do not include time spent in Australia.

Yes

Country(1):

Date:

Country(2):

Date:

Country(3):

Date:

32. Do you intend to enter a hospital or health care facility ?

Yes

Give details:

33. Do you intend to work as, a doctor, dentist, nurse or paramedic during your stay in Australia?

Yes

Give details:

34. Ever had, or currently have, tuberculosis / ever had a chest x-ray which showed an abnormality?

Yes

Give details:

35. During your proposed visit to Australia, do you expect to incur medical costs, or require treatment or medical follow up for: blood disorder/cancer/heart disease/HIV Infection;

Yes

Give details:

36. Do you require assistance with mobility or care due to a medical condition?

Yes

Give details:

37. Have you undertaken a health examination for an Australian visa in the last 12 months?

Yes

Give details:

been charged with any offence that is currently awaiting legal action?

Yes

been convicted of an offence in any country (including any conviction which is now removed from official records)?

Yes

been the subject of an arrest warrant or Interpol notice?

Yes

been found guilty of a sexually based offence involving a child (including where no conviction as recorded)?

Yes

been named on a sex offender register?

Yes

been acquitted of any offence on the grounds of unsoundness of mind or insanity?

Yes

been found by a court not fit to plead?

Yes

been directly or indirectly involved in, or associated with, activities which would represent a risk to national security in Australia or any other country?

Yes

Been charged with, or indicted for: genocide, war crimes, crimes against humanity, torture, slavery, or any other crime that is otherwise of a serious international concern?

Yes

been associated with a person, group or organisation that has been/is involved in criminal conduct?

Yes

been associated with an organisation engaged in violence or engaged in acts of violence (including war, insurgency, freedom fighting, terrorism, protest) either overseas or in Australia?

Yes

served in a military force, police force, state sponsored/private militia or intelligence agency (including secret police)?

Yes

undergone any military/paramilitary training, been trained in weapons/explosives or in the manufacture of chemical/biological products?

Yes

Been involved in people smuggling or people trafficking offences?

Yes

been removed, deported or excluded from any country (including Australia)?

Yes

Overstayed a visa in any country (including Australia)?

Yes

Had any outstanding debts to the Australian Government or any public authority in Australia?

Yes

39. What is your employment status?

Employed/self-employed

Retired

Student

Other

Unemployed

Employer/Business Name:

Address:

Postcode:

Telephone Number:

Position you hold :

How long have you been employed by this employer/business? :

Give details Your current course:

Name of educational institution:

How long have you been studying at this institution?:

Explain why you are unemployed and give details of your last employment (if applicable) :

40. Give details of how you will maintain yourself financially while you are in Australia:

41. Is your sponsor or someone else providing support for your visit to Australia?

Yes

Full Name :

Date of birth :

Relationship to You :

Their address while you are in Australia :

Type of support provided

Financial

Accommodation

Other

42. Ibeen in Australia and not complied with visa conditions or departed Australia outside your authorised period of stay?

Yes

If you answered ‘Yes’ to any of the above questions, give details :

43. Did you receive assistance in completing this form?

Yes

Family name :

Given names :

Address :

POSTCODE :

Telephone number or daytime contact Office hours:

Telephone number or daytime contact Mobile/cell:

44. Is the person an agent registered with the Office of the Migration Agents Registration Authority (Office of the MARA)?

Yes

45. Is the person/agent in Australia?

Yes

46. Did you pay the person/agent and/or give a gift for this assistance?

Yes

47. All written communications about this application should be sent to: (Tick one box only)

Myself

Authorised Recipient

Migration agent

Exempt person

48. Important: You must refer to the department’s website at www.immi.gov.au/fees-charges to complete this part of your application. The website shows reference tables with the Visa Application Charges applicable to each visa subclass.

* Visa subclass you are applying for :

* Base Application Charge :

* Non-internet Application Charge (if applicable) :

* Additional Applicant Charge aged 18 years or over at the time your application is lodged :

Write the amount shown on the reference table for your visa subclass :

Number of additional applicants aged 18 years or over :

Total :

* Subsequent Temporary Application Charge (if applicable) :

Write the amount shown on the reference table for your visa subclass :

Number of applicants :

Total :

* Total (1) + (2) + (3) + (4) + (5) :

General Details :

Applicants outside Australia

Applicants in Australia

Part A – Your details :

7. Give the following details exactly as they appear in your passport Make sure your passport is valid for the period of stay you are applying for.

8. Place of birth

20. Your current residential address?

21. Address for correspondence:

22. Contact telephone numbers

Part B – Family travelling to Australia with you

Part C – Family NOT travelling to Australia with you

Part D – Details of your visit to Australia

Part E – Health details

Part F – Character details

Part G – Employment status

Part H – Funding for stay

Part I – Previous applications

Part J – Assistance with this form

Part K – Options for receiving written communications

Part L – Payment details

Part M – Application checklist

Part M – Application checklist

Part O – Additional information

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