Application 1
Application 1
Application 1
Personal Privacy
Current location
Personal Privacy
OFFICIAL: Sensitive
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OFFICIAL: Sensitive
Personal Privacy
Application for a Visitor Short Stay Visa
Town / City:
State / Province:
Country of birth:
Relationship status
Relationship status:
Other names / spellings
Is this applicant currently, or have they ever been known by any other names?
Citizenship
Does this applicant have any other passports or documents for travel?
Has this applicant undertaken a health examination for an Australian visa in the last 12 months?
Critical data confirmation
All information provided is important to the processing of this application.
If the information included on this page is incorrect, it may lead to denial of permission to board an
aircraft to Australia, even if a visa has been granted.
Confirm that the following information is correct and that it is in the correct fields.
Family name:
Given names:
Sex:
Personal Privacy
OFFICIAL: Sensitive
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Personal Privacy
Application for a Visitor Short Stay Visa
Date of birth:
Country of birth:
Passport number:
Country of passport:
Country of residence
Office:
Residential address
Note that a street address is required. A post office address cannot be accepted as a residential
address.
Country:
Address:
Suburb / Town:
State or Province:
Postal code:
Contact telephone numbers
Enter numbers only with no spaces.
Home phone:
Business phone:
Mobile / Cell phone:
Personal Privacy
OFFICIAL: Sensitive
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Personal Privacy
Application for a Visitor Short Stay Visa
Postal address
Email address:
Authorised recipient
Does the applicant authorise another person to receive written correspondence on their behalf?
This authorises the department to send the authorised person all written correspondence that would
otherwise be sent directly to the applicant.
This person is referred to as the 'authorised recipient'.
Non-accompanying members of the family unit
Does the applicant have any members of their family unit not travelling to Australia who are not
Australian citizens or Australian permanent residents?
Entry to Australia
Does the applicant intend to enter Australia on more than one occasion?
Study while in Australia
Will the applicant visit any relatives, friends or contacts while in Australia?
Financial support
Funding details
Personal Privacy
OFFICIAL: Sensitive
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Personal Privacy
Application for a Visitor Short Stay Visa
Does any applicant intend to work, study or train within aged care or disability care while in Australia?
Has any applicant:
• ever had, or currently have, tuberculosis?
• been in close contact with a family member that has active tuberculosis?
• ever had a chest x-ray which showed an abnormality?
During their proposed visit to Australia, does any applicant expect to incur medical costs, or require
treatment or medical follow up for:
• blood disorder
• cancer
• heart disease
• hepatitis B or C and/or liver disease
• HIV infection, including AIDS
• kidney disease, including dialysis
• mental illness
• pregnancy
• respiratory disease that has required hospital admission or oxygen therapy
• other?
Does any applicant require assistance with mobility or care due to a medical condition?
Character declarations
If the applicant answers ‘Yes’ to any of the character declarations they must give all relevant details.
For combined applications, state which applicant the declaration applies to.
If the matter relates to a criminal conviction, provide:
• the date and nature of the offence
• full details of the sentence
• dates of any period of imprisonment or other detention.
Has any applicant ever been charged with any offence that is currently awaiting legal action?
Has any applicant ever been convicted of an offence in any country (including any conviction which is
now removed from official records)?
Has any applicant ever been the subject of a domestic violence or family violence order, or any other
order, of a tribunal or court or other similar authority, for the personal protection of another person?
Has any applicant ever been the subject of an arrest warrant or Interpol notice?
Has any applicant ever been found guilty of a sexually based offence involving a child (including
where no conviction was recorded)?
Has any applicant ever been named on a sex offender register?
Has any applicant ever been acquitted of any offence on the grounds of unsoundness of mind or
insanity?
Has any applicant ever been found by a court not fit to plead?
Has any applicant ever been directly or indirectly involved in, or associated with, activities which
would represent a risk to national security in Australia or any other country?
Personal Privacy
OFFICIAL: Sensitive
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Personal Privacy
Application for a Visitor Short Stay Visa
Has any applicant ever 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?
Has any applicant ever been associated with a person, group or organisation that has been or is
involved in criminal conduct?
Has any applicant ever 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?
Has any applicant ever served in a military force, police force, state sponsored / private militia or
intelligence agency (including secret police)?
Has any applicant ever undergone any military/paramilitary training, been trained in weapons/
explosives or in the manufacture of chemical/biological products?
Has any applicant ever been involved in people smuggling or people trafficking offences?
Has any applicant ever been removed, deported or excluded from any country (including Australia)?
Has any applicant ever overstayed a visa in any country (including Australia)?
Has any applicant ever had any outstanding debts to the Australian Government or any public
authority in Australia?
Visa history
Has the applicant held or does the applicant currently hold a visa to Australia or any other country?
Has the applicant ever been in Australia or any other country and not complied with visa conditions or
departed outside their authorised period of stay?
Has the applicant ever had a visa for Australia or any other country refused or cancelled?
Declarations
Warning:
Giving false or misleading information is a serious offence.
The applicants declare that they:
Have read and understood the information provided to them in this application.
Have provided complete and correct information in every detail on this form, and on any attachments
to it.
Understand that if any fraudulent documents or false or misleading information has been provided
with this application, or if any of the applicants fail to satisfy the Minister of their identity, the
application may be refused and the applicant(s), and any member of their family unit, may become
unable to be granted a visa for a specified period of time.
Understand that if documents are found to be fraudulent or information to be incorrect after the grant
of a visa, the visa may subsequently be cancelled.
Will inform the Department in writing immediately as they become aware of a change in
circumstances (including change of address) or if there is any change relating to information they
have provided in or with this application, while it is being considered.
Have read the information contained in the Privacy Notice(Form 1442i).
Personal Privacy
OFFICIAL: Sensitive
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OFFICIAL: Sensitive
Personal Privacy
Application for a Visitor Short Stay Visa
Understand that the department may collect, use and disclose the applicant's personal information
(including biometric information and other sensitive information) as outlined in the Privacy
Notice(Form 1442i).
Understand that if a no further stay 8503 condition is imposed on this visa, it will limit the ability to
remain in Australia beyond the authorised period of stay of the visa.
Agree not to undertake study or training for more than three months.
Agree to leave Australia on or before the expiry of the period of stay of the visa.
Give consent to the collection of their fingerprints and facial image if required.
Understand that, if required to provide their fingerprints and facial image, the applicant's fingerprints
and facial image and biographical information held by the Department may be given to Australian law
enforcement agencies to help identify the applicant and determine eligibility for grant of the visa being
applied for, and for law enforcement purposes.
Give consent to Australian law enforcement agencies disclosing the applicant's biometric,
biographical and criminal record information to the Department to help identify the applicant, to
determine eligibility for grant of a visa and for law enforcement purposes.
Understand that the Visitor visa does not permit them to work in Australia.
Give consent to the Department using the applicant's biometric, biographical and criminal record
information obtained for the purposes of the Migration Act 1958 or the Citizenship Act 2007.
As an applicant:
I understand that if my visa ceases to be in effect and I do not hold another visa to remain in Australia
at that time, I will be an unlawful non-citizen under the Migration Act 1958. As such, I will be expected
to depart from Australia, and be subject to removal under the Migration Act 1958.
Personal Privacy
OFFICIAL: Sensitive
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