1419 - Application for a Visitor visa - Tourist stream±kKYrTak´TgCamYykariyal&yEdlpþl´TidðakarenaH. elakGñkBMuKYrsnµt´zakar pøas´bþÚrTaMgLaycMeBaHsæanPaBGenþaRbevsn¾rbs´elakGñk

1419 KHM (Design date 02/17) - Page 1© COMMONWEALTH OF AUSTRALIA, 2017

Form

1419 KHMKHMER

GMBIhV&menHsMxan´; sUmGanB&t(mandUcteTAenHedayykcitþTukdak´ munnwgelakGñkcabépþIm bMeBjBaküsMurbsélakGñk. bnÞab´BIelakGñk:nbMeBjBaküsMurbsélakGñkrYc ehIy eyIgsUmCUnOvaTelakGñkyägmaMmYnza elakGñkRtUvrkSaTukesckþIcmøgmYy c|ab´sRmabĆakMNt´RtarbsélakGñk.sMNYrBak´B&nÆTaMgGsélIh&VmenHKYrEt:neqøIy nigP¢ab´mkCamYynUvB&t(manNamYy Edl:nesñIsMu. RksYgGenþaRbevsn¾ nigkarkarBarRBMEdn‘RksYg’ GacseRmcesc kþIelIBaküsMurbsélakGñk edayEpÁkelIB&t(manpþlóelIBaküsMurbsélakGñk.h&VmTaMgGs´manpþlĆUnenAtamvuibsayrbs´RksYg www.border.gov.au/allforms/

etInrNaKYreRbIh&VmenH/sUmeRbIhV&menHedIm|Idak´BaküsMuTidðakarGñkmkelg - EpñkeTscrN¾ edIm|Imkelg ßsñakénAkñúgRbeTsGURsþalIsRmabéTscrN¾ ßskmµPaBkMsanþdéTeT[t‘karQb´ sMrak dMeNIrTsSnakMsanþ mUlehtusg<m ßkarelgkMsanþ ßedIm|IeTAsYrsuxTuk¡jati snþan ßmitþPkþi’.RbsinebIelakGñkmanbMNg; • mkRbeTsGURsþalIedIm|IsYrsuxTuk¡smaCikRKYsar ehIyelakGñkmansmaCik RKYsarEdlmansiTÆi nigmanbMNgZanap<t´p<gélakGñk elakGñkGaceRbIh&Vm 1418 Application for a Visitor visa – Sponsored Family stream; ‘hV&m 1418 BaküsMuTidðakarGñkmkelg – EpñkRKYsarEdlRtUv:nZanap<t´p<g´´’

• mkRbeTsGURsþalIedIm|IBüa:leraK elakGñkKYreRbIhV&m 48ME Application for a Medical Treatment visa;‘hV&m 48ME BaküsuMTidðakaredIm|IBüa:l eraK’

• mkRbeTsGURsþalIsRmab´kareZVIdMeNIrEpñkBaNiC¢kmµry;eBlxøI elakGñkKYreRbI h&Vm 1415 Application for a Visitor visa – Business Visitor stream; ‘hV&m 1415 BaküsuMTidðakarGñkmkelg – GñkmkelgEpñkBaNiC¢kmµ’

• sikSakñúgRbeTsGURsþalIyUrCag3Ex elakGñkKYrdak´BaküsMuTidðakarsisS. sUm Tak´TgCamYykariyal&yTidðakarGURsþalIEdlenACitelakGñkCageK ßkariya l&yrbs´RksYgsRmab´B&t(manGMBIkardak´BaküsMuTidðakarsisS manrYmTaMghV&m dak´BaküsMuEdlRtwmRtUvpgEdr.

Gñkdak´BaküsMumñak´>manrYmTaMgkUnekµgkñúgbnÞúk RtUvdak´BaküsMuelIhV&msRmab´xøÜneK pÞal´. elakGñkRtUvbMeBjsMNYrTaMgGsÉdlmanenAkñúgEpñkTaMgGs´. karxkxanBuM :neqøIycMeBaHsMNYrNamYyTaMgRsug nigo:nRtwmRtUv GacnaMomankarbdiesZ cMeBaHBaküsMu ßmankarlubecalTidðakarenAézáeRkay.

esckþIsucriténBaküsMu RksYg:nebþC\aedIm|IrkSaesckþIsucriténkmµviZITidðakar nigsJ¢ati. Tak´TinnwgBaküsuM enH RbsinebIelakGñk ßsmaCikNamñak´énRkumRKYsarrbsélakGñk;• pþló ß:npþlóenAkñúgBaküsuMBIelIkmunnUvÉksarEkøgbnøM ßxus ßB&t(man EdlnaMoyl´xus ‘eTaHza:ndwg ßBuM:ndwgkþI’ nig/ß

• xkxanBuM:nbMeBjtambMNg ß:nxkxanBuM:nbMeBjtambMNgrbs´rdðmRnþI nUvGtþsBa¦aNrbsélakGñk ßrbs´GñkÉeT[tenAkñúgBaküsuMBIelIkmun.

BaküsuMTidðakarenHGacRtUveKbdiesZ ehIyelakGñk ßsmaCikÉeT[tNamñak´én RkumRKYsarrbsélakGñkGacnwgBuM:neKecjonUvTidðakarNamYysRmab´GMLúgeBl Cak´lakŃamYyeLIy dUcEcgenAkñúgc|ab´GenþaRbevsn¾.

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suBlPaBénTidðakarTidðakarenH CaTUeTAGnuJ¦atosñakénAkñúgRbeTsGURsþalIBI3 eTA6Ex eTaHCaya¨g NakþI GacpþlókarsñakénArhUtdl´12Ex. k*büEnþry;eBlénTidðakarRtUv:nkM NtédayEpÁkelIkrNInImYy> ehIyGacticCagry;eBlEdlelakGñk:nesñI sMu. karsñakénAelIsBI12ExRtUv:npþlóEteBlNaman ²kal;eTs;xusEbøk BIZmµta³ büeNÑaH.TidðakarGacpþlósRmab´karecjcUlEtmþg ßeRcIndgkñúgry;eBlEdl:nbJ¢ak´ c|as´las´. CaTUeTA TidðakarenHGnuJ¦atomnusScUlmkRbeTsGURsþalIkñúgrgVgéBl 12Ex Kitcab´BIézápþl´Tidðakar.

l&k¡x&NÐTidðakarGñkmkelgRbeTsGURsþalIGñkmkelgRbeTsGURsþalIRtUvmancitþcg´ ehIyeZVItaml&k¡x&NÐEdlmancuHdUcxag eRkamenH kñúgkalEdleKkMBugsñakénAkñúgRbeTsGURsþalI. RbsinebIelakGñkBuMman citþcg´ ßBuMGaceZVItaml&k¡x&NÐTaMgenHeT elakGñkminKYrdak´BaküsMuTidðakareLIy. RbsinebIelakGñkmin:neZVItaml&k¡x&NÐTaMgenHeT TidðakarrbsélakGñkGacRtUveK lubecal ßelakGñkGacsæitenAeRkamkarBin&yeTasÉeT[t. RbsinebIelakGñkman sMNYr ßkgVlŃamYyGMBIl&k¡x&NÐTaMgenH elakGñkKYrsaksYrB&t(manbEnæmeT[tBI kariyal&yTidðakarGURsþalI ßkariyal&yrbs´RksYgenAkñúgRbeTsGURsþalI.RbsinebIelakGñkRtUv:npþlóTidðakar sUmEqkemIlB&t(manlMGit nigl&k¡x&NÐelI lixitEdlR:bélakGñkodwgGMBIkarpþl´TidðakarrbsélakGñk.RbsinebIelakGñkmankþIkgVl´ ßsMNYrTaMgLayGMBItRmUvkar ßkarkMritTaMgLay elakGñkKYrTak´TgCamYykariyal&yEdlpþl´TidðakarenaH. elakGñkBMuKYrsnµt´zakar pøas´bþÚrTaMgLaycMeBaHsæanPaBGenþaRbevsn¾rbsélakGñk GaceZVI:nkñúgkalkMBug sñakénAkñúgRbeTsGURsþalIenaHeLIy.

l&k¡x&NÐénTidðakarl&k¡x&NÐdUcteTAenHnwgGnuvtþcMeBaHTidðakarrbsélakGñk;l&k¡x&NÐénTidðakar 8101

elakGñkminRtUveZVIkarenAkñúgRbeTsGURsþalIeLIy.

l&k¡x&NÐénTidðakar 8201

elakGñkminRtUvsikSaohYsBI3ExeLIy kñúgkalkMBugsñakénAkñúgRbeTsGURsþalI.

l&k¡x&NÐdUcteTAenHGacGnuvtþcMeBaHTidðakarrbsélakGñk;l&k¡x&NÐénTidðakar 8503

minosñakénAteTAeT[teT.bnÞab´BIkar:¨n´sÞg´BaküsMurbsélakGñkehIy buK<likcatÉcgTidðakarGacsMercdak´ l&k¡x&NÐ 8503 BIelITidðakarrbsélakGñk. l&k¡x&NÐ 8503 ‘ßminosñakénA teTAeT[teT’ mann&yzaGñkkan´TidðakarEdlmancuHl&k¡x&NÐenH eRkayBI:ncUlmk dl´RbeTsGURsþalIehIy nwgminmansiTÆiTTYlykTidðakarNamYyeT[teLIykñúgkal EdlGñkkan´TidðakarkMBugsñakénAkñúgRbeTsGURsþalI.«TÆiBlénl&k¡x&NÐTidðakarenHKWza vanwgminGacoelakGñkdak´BaküsMusñakénAkñúg RbeTsGURsþalIelIsBIry;eBlénkarsñakénA énTidðakarrbsélakGñkEdl:nGnuJ¦at eLIy. vaCakarsMxanŃas´ RbsinebIkareZVIdMeNIrmkelgRbeTsGURsþalIrbsélak GñkKWedIm|ImkcUlrYmenAkñúgRBwtþikarN¾Cak´lakŃamYy elakGñkRtUver[bcMkareZVIdM eNIrrbsélakGñk kñúgEbbyägNaedIm|IoelakGñkGacmkcUlrYmkñúgRBwtþikarN¾ TaMgenHenAkñúgry;eBlsñakénAEdlelakGñkRtUv:nGnuJ¦ato edayehtuzaelak GñknwgminGacbnþeBlsñakénAkñúgRbeTsGURsþalI:neT[teLIy.RbsinebIl&k¡x&NÐ 8503 RtUv:ndak´kMritelITidðakarrbsélakGñk vanwgbgØajR:b´ enAelIlixitEdlbJ¢ak´R:bélakGñk GMBIkarpþlónUvTidðakarrbsélakGñkCamYy nwgBakü 8503 – minosñakénAteTAeT[teT.

Application for a Visitor visa – Tourist stream

BaküsMuTidðakarGñkmkelg – EpñkeTscrN¾

1419 KHM (Design date 02/17) - Page 2 © COMMONWEALTH OF AUSTRALIA, 2017

viZIdak´BaküsMuelakGñkGacer[bcMoCnmñakéT[tCYybMeBjBaküsMuenHCUnelakGñk k*büEnþelakGñk RtUvcuHhtæelxaelIBaküsMu. RbsinebImaneKCYyelakGñkbMeBjBaküsMu elakGñkKYr cuHhtæelxaelIesckþIRbkas RbsinebIB&t(mankñúgenaHBitR:kd nigRtwmRtUvbüeNÑaH.

eRkARbeTsGURsþalI RbsinebIelakGñkdak´BaküsuMBIeRkARbeTsGURsþalI elakGñk ßGñktMNagrbsélak GñkGacdak´BaküsuMrbsélakGñk bg´ézøBaküsuMTidðakar nigÉksarKaMRTTaMgLay kñúglMnaMNamYydUcteTA;• tamEbbeGLikRtUnikenAtamGIuneZINit RbsinebIelakGñkmansiTÆinwgeZVIdUecñaH. edIm|IEqkemIlPaBmansiTÆirbsélakGñk sUmcUlemIlviubsayrbs´RksYg www.border.gov.au/trav/visa-1/600-

• edaypÞal´xøÜn ßtaméRbsNIy¾enAtamkariyal&yTidðakarGURsþalI ßkariyal&y rbs´RksYgEdlenACitelakGñkCageK. RbsinebIelakGñkdak´BaküedaypÞal´xøÜn elakGñkRbEhlCatRmUveZVIkarNatĆYbmYy. edIm|IEqkemIlzaetItRmUvomankar NatĆYbßGt´ sUmcUlemIlviubsayrbs´RksYg www.border.gov.au/about/contact/offices-locations ß

• tamry;édKUcatÉcgesvakmµ (SDP) . SDP pþlĆUnesvadak´BaküsuMTidðakar kñúgnamRksYgenAtambNþaRbeTsnana. sRmab´B&t(manBisþarbEnæm nigedIm|I EqkemIlzaetIman SDP enAtamRbeTsrbsélakGñkEdrßGt´ sUmcUlemIl TMB&rviubsayrbs´ Contact Us enAtamviubsayrbs´RksYg www.border.gov.au/about/contact/offices-locations

kñúgRbeTsGURsþalIRbsinebIelakGñkdak´BaküsuMkñúgRbeTsGURsþalI elakGñk ßGñktMNagrbsélak GñkGacdak´BaküsuMrbsélakGñk bg´ézøBaküsuMTidðakar nigÉksarKaMRTTaMgLay kñúglMnaMNamYydUcteTA;• tamEbbeGLikRtUnikenAtamGIuneZINit• taméRbsNIy¾ ‘edaydak´P¢ab´mkCamYynUvtémøéRbsNIy¾RtwmRtUvEdl:nbg´ rYceRsc’; Onshore Visitor Visa Processing, Adelaide GPO Box 2399 ADELAIDE SA 5001

• tamry;esvadwknaMsMbuRt Onshore Visitor Visa Processing, Adelaide 4th floor 70 Franklin Street ADELAIDE SA 5000

ÉksarRTRTg´ nigB&t(manbEnæmEpñk M Application checklist – (bBa¢IEqkemIlBaküsuM’ enATMB&r 17 mancuH B&t(manGMBIÉksarRTRTg´. RbsinebIelakGñkdak´BaküsMurbsélakGñkenAbreTs elakGñkk*KYrEqkemIlvuibsayrbs´kariyal&yTidðakarGURsþalIEdlenACitelakGñk CageKpgEdr enARtg´ www.border.gov.au/about/contact/offices-locations

karZanap<t´p<géZVIeLIgedayjatisnþanEdlmansiTÆiRksYgGacesñIsMuelakGñkopþl´karRTRTgćMeBaHBaküsMurbsélakGñk edaymanGñk Zanap<t´p<gÉdlmansiTÆi nigR:k´kk´ZanaEdlCaEpñkéndMeNIrkarvaytémøBaküsMu.

karbnþeBlsñakénArbsélakGñkkñúgRbeTsGURsþalIRbsinebIelakGñkdak´BaküsMuTidðakarzµI ßsMukarbnþeBlkñúgkalkMBugsñakénAkñúg RbeTsGURsþalI elakGñkRtUvdak´BaküsMuTidðakarzµI munnwgTidðakarbc©úb|nñrbsélak GñkputkMNt´. eBllÁbMputedIm|Idak´BaküsMuTidðakarGñkmkelgzµI KWRbEhlCa2 GaTitümuneBlTidðakarbc©úb|nñrbsélakGñkputkMNt´. sUmcgcaMzakarpþl´Tidðakar zµInwgbJÄb´TidðakarNamYyEdlelakGñkkan´kabénAeBlbc©úb|nñ nigPaBmansiTÆi TTYl:nEdlP¢ab´mkCamYyTidðakarenaH. óTahrN¾ RbsinebIbc©úb|nñenHelak GñkmansiTÆieZVIkargar ßmansiTÆisikSatampøÚvkar PaBmansiTÆiTaMgenaHnwgElgman teTAeT[t enAeBlTidðakarGñkmkelgRtUv:npþló.


elakGñkBMuRtUvsñakénAkñúgRbeTsGURsþalI eRkayeBlTidðakarrbsélakGñkputkMNt´ eLIy.


elakGñkBMuRtUvcMNayeBleRcInCag12ExkñúgRbeTsGURsþalI kñúgGMLúgeBl18Ex NamYyeLIy.

ézødak´BaküsMuTidðakar eyageTAEpñk L - B&t(manlMGitGMBIkarbg´ézødak´BaküsuMenH edIm|IKNnatémø BitR:kd ehIyeZVIkarbg´ézø.eyageTAviubsay www.border.gov.au/trav/visa/fees sRmab´bBa¢IeBjelj nigbc©úb|nñénézøQñÜl nigkarKitézøTaMgLayEdlGacGnuvtþ.ézøQñÜl nigkarKitézøGacERbRbYlkñúgeBlNamYy ehIykarenHGacbeg,Inézødak´ BaküsuMTidðakar.CaTUeTA karKitézødak´BaküsuMTidðakarRtUv:nBinitüeLIgvijenAézáTI1 Exkk,daer[gral´ qñaM ehIyGRtabþÚrR:kÉdleRbIedIm|IKNnacMnYnR:kÉdlRtUvbgénAtamRbeTseRkA RtUv:ner[bcMTan´bc©úb|nñPaBenAézáTI1 Exmkra nigézáTI1 Exkk,daer[gral´qñaM. RbsinebIelakGñkBuMbg´ézødak´BaküsuMTidðakarRKbćMnYneT BaküsuMTidðakarrbsélakGñk nwgBuMmansuBlPaBeT.CaTUeTA karKitézønwgBuMsgmkvijeLIy eTaHbICaBaküsuMRtUv:ndkecj ßRtUv:n bdiesZkþI.

viZIbg´R:k´karbg´R:k´ ßPsþútagénkarbg´R:k´ RtUvP¢ab´mkCamYyBaküsMurbsélakGñk.sUmEqkemIlB&t(manGMBI viZIdak´BaküsMu edIm|IodwgGMBIreb[b nigTIkEnøgEdl elakGñkRtUvdak´BaküsMu munnwgelakGñkeRCIserIsviZIbg´R:k´rbsélakGñk.kMNtćMNaM; minTTYlykmUlb|Tanb&RtpÞal´xøÜn nigmUlb|Tanb&RtGñkeZVIdMeNIr eLIy.

enAeRkARbeTsGURsþalImunnwgbg´ézøenAeRkARbeTsGURsþalI sUmEqkemIlCamYykariyal&yTidðakarGURsþalI EdlelakGñkbMrugnwgdak´BaküsMu edIm|IodwgzaetIviZIbg´ézømYyNa nigrUbiyvtæúmYy NaEdleKGacTTYlyk ehIyzaetIKYrbgéTAonrNa.B&t(manGMBITIkEnøgEdlRtUvdak´BaküsMuenAeRkARbeTsGURsþalI manpþlĆUnenAtamviub sayrbs´RksYg www.border.gov.au/about/contact/offices-locations

enAkñúgRbeTsGURsþalIedIm|Ibg´ézødak´BaküsMu sUmeRbIb&NÑ«NTan (credit card), mUlb|Tanb&RtZnaKar (bank cheque), ßGaNtþiéRbsNIy¾ (money order) ehIybgéTA Department of Immigration and Border Protection‘RksYgGenþaRbevsn¾ nigkarBarRBMEdn’. b&NÑ«NTan KWCaviZIbg´R:kÉdleKniymcUlcitþ.

http://www.border.gov.au/trav/visa-1/600-

http://www.border.gov.au/about/contact/offices-locations


tRmUvkarEpñksuxPaBGñkdak´BaküsMuTaMgGs´RtUvbMeBjtamtRmUvkarEpñksuxPaBénRbeTsGURsþalI. elak GñkGactRmUvoTTYlkarztemIledImRTUgedaykaMrsµIGikS nigkarBinitüemIlEpñkeBTü edIm|IbMeBjtamlk¡N;vinicä&y sRmab´karpþlńUvTidðakarRbePTzñak´rg 600. sUmeZVItamkarENnaMpþlóedaybuK<likcatÉcgTidðakar Tak´TinnwgkarBinitüemIl EpñkeBTü ßkarztemIledImRTUgedaykaMrsµIGikS EdlGactRmUvoman.B&t(manbEnæmTak´Tinnwg tRmUvkarEpñksuxPaBsRmab´karcUlmkkñúgRbeTsGURsþalI manpþlĆUnenAtamviubsayrbs´RksYg www.border.gov.au/trav/visa/heal/meeting-the-health-requirement/health-examinations

tRmUvkarZanaräb´rgelIsuxPaBkarBüa:lEpñkeBTüenAkñúgRbeTsGURsþalIGacGs´témøyägeRcIn. enHRtUv:nENnaM zaelakGñkRtUver[bcMomankarZanaräb´rgelIsuxPaB sRmab´ry;eBlénkarsñakénA kñúgRbeTsGURsþalIrbsélakGñk. elakGñknwgmin:nRKbdNþbénAeRkameRKag karN¾suxPaBCatirbs´RbeTsGURsþalIeLIy luHRtaEtelakGñk:nRKbdNþbénA eRkamkic©RBmeRB[gemIlEzTaMsuxPaBKñaeTAvijeTAmk.

RbsinebIelakGñkEsVgrkTidðakarGñkmkelgsRmab´karsñakénAyUr - EpñkeTscrN¾ ßmanGayu75qñaM ßeRcInCagelakGñkGacRtUv:nesñIsMuopþl´PsþútagCamYyBaküsMurbsélakGñk zaelakGñkman karZanaräb´rgEpñksuxPaB edIm|IRKbdNþb´karsñakénArbsélakGñkkñúgRbeTsGURsþa lI. B&t(maneRcIneT[tGMBIkarZanaräb´rgEpñksuxPaB manpþlénAtamviubsayrbs´ RksYg www.border.gov.au/trav/visi/visi

karcak´zñaMbg,areraKRbsinebIenHCaeKalbMNgrbsélakGñk edIm|IcuHeQµaHkUnrbsélakGñkcUler[nenA salaer[nkñúgRbeTsGURsþalI ßkEnøgemIlEzkumar‘kEnøgemIlekµg ßmetþyüsala’ enAkñúgry;eBlénkarGeJ¢IjmkelgRbeTsGURsþalIrbsélakGñk elakGñkRtUv:n elIkTwkcitþyägmaMmYn oyksJ¦ab&RténsæankarN¾cak´zñaMbg,areraKrbs´kUnelak GñkmkCabĆamYy. eKGacsYrrksJ¦ab&Rtcak´zñaMbg,areraK enAeBlelakGñkcuHeQµaH kUncUler[n.karcak´zñaMbg,areraKRtUv:nENnaMedIm|ITb´TlńwgCmáWsVitédeCIg ettaNus kRJ¢wl RsLaETn sÁÚc‘kRJ¢wlGaLWm¨g´’ xan´søak´ kÁkman´ hIub(Hib) nigCmáWrlakezøIm CMBUkb)I.kMNtćMNaM; karcak´zñaMTb´TlńwgCmáWsÁÚc‘kRJ¢wlGaLWm¨g´’ k*RtUv:nENnaMpgEdr sRmab´RsþIEdlmanv&yGacbeg,ItkUn:n.

B&t(manGMBIlixitqøgEdnGñkdak´BaküsuMTidðakarPaKeRcIn nwgtRmUvokan´lixitqøgEdnEdlmansuBlPaB mun nwgeKRtUv:nRbKlóTidðakar. enHRtUv:nENnaMya¨gmaMmYnzalixitqøgEdnRtUvman suBlPaBya¨gticNas´6Ex. RbsinebIelakGñkpøas´bþÚrlixitqøgEdnrbsélakGñk bnÞab´BIelakGñkRtUv:neKRbKl´ oTidðakar elakGñkRtUvpþl´dMNwgeTAkariyal&yTidðakarGURsþalI ßkariyal&yrbs´ RksYgEdlenACitelakGñkCageK.RbsinebIelakGñkBMupþlóeyIgnUvB&t(manlMGiténlixitqøgEdnzµI ßlixitqøgEdnbEnæm NamYyEdlelakGñkeRbIsRmabéZVIdMeNIrmkRbeTsGURsþalIeTenaH elakGñkGacCYb RbTHnwgkaryWtyUrCaxøaMgenARBlanynþehaH ehIyGacRtUveKbdiesZBMuGnuJ¦ato eLIgynþehaHrbsélakGñk.

GasydðanrsénAelakGñkRtUvpþl´GasydðanénTIkEnøgEdlelakGñkmanbMNgrsénA kñúgGMLúgeBl EdleKkMBugKitBicarNaBaküsMurbsélakGñk. karxkxanBuM:npþlńUvGasydðan rsénArbsélakGñk nwgbNþaloBaküsMuenHKµansuBlPaB. GasydðanenAtam RbGb´sMbuRtéRbsNIy¾nwgBMuTTYlykCaGasydðanrsénAeLIy.

karpøas´bþÚrGasydðanRbsinebIelakGñkpøas´bþÚrGasydðanrsénArbsélakGñkeRcInCag14ézá kñúgGMLúg eBlEdleKkMBugcatÉcgBaküsMurbsélakGñk elakGñkRtUvR:b´RksYgGMBIGasy dðanzµI nigry;eBlyUrbu¨NÑaEdlelakGñknwgsñakénATIenaH. RksYgnwgbJ©Únkar R:Rs&yTak´TgGMBIBaküsMurbsélakGñk eTAÉGasydðansRmab´Tak´TgcugeRkay bMputEdlelakGñk:npþló.

CMnYyEpñkGenþaRbevsn¾buK<lNamñak´RtUv:ncat´TukzapþlĆMnYyEpñkGenþaRbevsn¾CUnelakGñk RbsinebIeKeRbI ßGHGagza:neRbIcMeNH ßbTBiesaZn¾rbs´xøÜnkñúgdMeNIrkarGenþaRbevsn¾ edIm|ICYy elakGñkkñúgkardak´BaküsMuTidðakarrbsélakGñk esñIsMuomankareZVIGnþraKmn¾BIRksYg dak´BaküsMuoBinitüemIleLIgvijGMBIkarlubecal karZana ßkarEtgtaMg.enAkñúgRbeTsGURsþalI buK<lmñak´GacpþlĆMnYyEpñkGenþaRbevsn¾edayRsbc|ab´ Rb sinebIeKCaPñak´garGenþaRbevsn¾Edl:ncuHeQµaHRsbc|ab´ ß:nelIkElgBIkarcuH eQµaHRsbc|ab´. manEtPñak´garGenþaRbevsn¾Edl:ncuHeQµaHRsbc|ab´büeNÑaHEdl GacTTYlykézøQñÜl ßrgVan´sRmabĆMnYyEpñkGenþaRbevsn¾.RbsinebIbuK<lNamñakÉdlmin:ncuHeQµaHRsbc|abénAkñúgRbeTsGURsþalI nigmin:n TTYlkarelIkElgBIkarcuHeQµaHRsbc|ab´ ehIyeK:npþlĆUnelakGñknUvCMnYyEpñk GenþaRbevsn¾ enaHeKkMBugRbRBwtþbTelµIs ehIyGacCab´maneTas.GñkZanap<t´p<gćMeBaHGñkdak´BaküsMuTidðakarGñkmkelg - EpñkRKYsarEdlRtUv:nZa nap<t´p<g´ RtUv:nelIkElgBItRmUvkarocuHbJ¢ICaPñak´garGenþaRbevsn¾edIm|ICYykar dak´BaküsMuTak´TinnwgTidðakarGñkmkelg - EpñkRKYsarEdlRtUv:nZanap<t´p<g´´.

Pñak´garGenþaRbevsn¾enAkñúgRbeTsGURsþalIPñak´garGenþaRbevsn¾enAkñúgRbeTsGURsþalI RtUvEt:ncuHeQµaHRsbc|abĆamYykariya l&yGaC\aZrcuHeQµaHPñak´garGenþaRbevsn¾ (Office of the MARA) elIkElgEt eK:nelIkElgBIkarcuHeQµaH.

Pñak´garGenþaRbevsn¾enAeRkARbeTsGURsþalIPñak´garGenþaRbevsn¾EdleZVIkarenAeRkARbeTsGURsþalI BMucaM:cćuHeQµaHRsbc|abéLIy. RksYgGacpþlélxGtþsJ¦aN dl´Pñak´garxøHEdlenAÉbreTs. elxenHBMumann&y zaeK:ncuHeQµaHRsbc|abéLIy.kMNt´sm<al´; Pñak´garGenþaRbevsn¾GURsþalIEdl:ncuHeQµaHRsbc|ab´xøHeZVIkarenA breTs.

B&t(manGMBIPñak´garGenþaRbevsn¾Pñak´garGenþaRbevsn¾KWCabuK<lNamñakÉdlGac;• pþlÓvaTCUnelakGñk GMBITidðakarEdlGacsmRsbbMputsRmabélakGñk• CMrabelakGñkGMBIÉksarnanaEdlelakGñkRtUvkardakéTACamYyBaküsMurbsélakGñk• CYyelakGñkkñúgkarbMeBjBaküsMu ehIydak´BaküsMuenaH ehIy• Tak´TgCamYyRksYgkñúgnamelakGñk.RbsinebIelakGñkEtgtaMgPñak´garGenþaRbevsn¾ RksYgnwgsnñidðanzaPñak´garGenþaRbevsn¾ rbsélakGñknwgeZVICaGñkTTYlEdlmankarGnuJ¦atrbsélakGñk elIkElgEtelak GñkcgÁúlbgØajepSgBIenH. Pñak´garGenþaRbevsn¾rbsélakGñk KWCabuK<lEdlRksYgnwgBiPakSaGMBIBaküsMurbs´ elakGñk nigCabuK<lEdlRksYgnwgTak´TgedIm|IEsVgrkB&t(manbEnæmeBlNaRtUvkar.elakGñkmin:ntRmUvoeRbIPñak´garGenþaRbevsn¾eLIy. k*büEnþebIelakGñkeRbIPñak´gar GenþaRbevsn¾ RksYgsUmelIkTwkcitþelakGñkoeRbIPñak´garGenþaRbevsn¾Edl:ncuH eQµaHRsbc|ab´. Pñak´garEdl:ncuHeQµaHRsbc|ab´ :nCabénAeRkamc|abćriya RbRBwtþrbs´Pñak´garGenþaRbevsn¾ EdltRmUvoeKbMeBjmuxkartamEbbviC¢aCIv;kúñgkar pþl´RbeyaCn¾Rsbc|ab´d¾lÁbMputsRmab´GtiziCnrbs´xøÜn.B&t(mansþIGMBIPñak´garGenþaRbevsn¾ manrYmTaMgbJ¢IraynamPñak´garGenþaRbevsn¾Edl :ncuHeQµaHRsbc|ab´ manpþlĆUnenAtamvuibsayrbs´kariyal&y MARA enARtg´ www.mara.gov.au

elakGñkk¾GacTTYl:nB&t(manGMBIPñak´garGenþaRbevsn¾pgEdr enAtamvuibsayrbs´ RksYg www.border.gov.au

http://www.border.gov.au/trav/visa/heal/meeting-the-health-requirement/health-examinations

http://www.border.gov.au/trav/visa/heal/meeting-the-health-requirement/health-examinations


karGnuJ¦atyl´RBmedIm|ITak´TgtamEbbeGLikRtUnicRksYgGaceRbIviZImYycMnYnedIm|ITak´TgCamYyelakGñk. eTaHbICayägNakþI manEt viZITak´TgtamEbbeGLikRtUnicdUcCatamry;TUrsar ßGIuem¨lbüeNÑaHEdlnwgRtUveRbI RbsinebIelakGñkbJ¢ak´R:b´GMBIkaryl´RBmrbsélakGñk edIm|ITTYlykkarTak´Tg tamviZIenH.edIm|IcatÉcgBaküsMurbsélakGñk RksYgGacnwgRtUvkarTak´TgCamYyelakGñkGMBI B&t(mansmáat´pÞal´xøÜn óTahrN¾ EpñksuxPaB karEqkemIlÉksarCamYybÜlIs cMnYnR:k´kasEdlGacsMerckar:n nigTMnak´TMngpÞal´xøÜn. luHRtaEtmanviZIkar BarRKb´RKan´ ebIBMuenaHeT karTak´TgtamEbbeGLikRtUnicBuMmansnþisuxeLIy ehIy GacRtUvGñkepSgeT[tlYcBinitüemIl ßrMxaneT[tpg. RbsinebIelakGñkyl´RBmoRksYgTak´TgCamYyelakGñktamEbbeGLikRtUnic enaH B&t(manlMGitEdlelakGñk:npþló nwgRtUv:nRksYgeRbIsRmabÉteKalbMNgdUc EdlelakGñk:npþlóbüeNÑaH elIkElgEtmankatBVkic©xagpøÚvc|ab´ ßkarcaM:c´ EdlRtUveRbIsRmabéKalbMNgepSgeT[t ßelakGñk:nGnuJ¦atyl´RBmoykeRbI sRmabéKalbMNgepSgeT[t. B&t(manTaMgenHnwgminRtUv:nykeTAdak´bEnæmenAkñúg bJ¢Iep\IecjNamYyeLIy.rdðaPi:lGURsþalIminTTYlxusRtUvcMeBaHsnþisux ßesckþIsucriténB&t(manNamYy Edlep\IeTAoRksYgtamry;GuIneZINit ßtamEbbeGLikRtUnicNaepSgeT[teLIy.RbsinebIelakGñkGnuJ¦atoGñkdéTmñakéT[t TTYlykÉksarnanakñúgnamrbsélak Gñk ehIyGñkenaHmanbMNgoeKTak´TgCamYyxøÜntamEbbeGLikRtUnic GñkenaHRtUv cuHhtæelxaelIBaküsMuelx 956 ß 956A edIm|IbJ¢ak´R:b´GMBIkarGnuJ¦atyl´RBm rbséK cMeBaHkarTak´TgtamsNðanEbbenH.kMNt´sMKal´; karTak´TgtamEbbeGLikRtUnic KWCaviZITak´Tgd*el]nbMputEdlGac man ehIyRksYgmancMNUlcitþkñúgkarTak´TgtamEbbeGLikRtUnic BIeRBaHviZIenHeZVIo karcatÉcgRbRBwtþeTA:nel]n.

B&t(mansMxan´GMBIer]gÉkCnB&t(manpÞal´xøÜnrbsélakGñkRtUv:nc|ab´karBar manrYmTaMgc|abér]gÉkCn qñaM1988 (Privacy Act 1988). B&t(mansMxan´GMBIkarRbmUlyk kareRbIR:s´ nigkar beBa©jodwg‘eTAdl´Pñak´gar nigPaKITIbIÉeT[tmanrYmTaMgGg<PaBenAÉbreTs’énB&t( manpÞal´xøÜnrbsélakGñk manrYmTaMgB&t(mansmáat´pÞal´xøÜn KWmancuHenAkñúghV&m 1442i B&t(manGMBIer]gÉkCn. hV&m 1442i manpþlénAtamvuibsayrbs´RksYg www.border.gov.au/allforms/ ßenAtamkariyal&yrbsRksYg. elakGñkKYr R:kdo:nc|as´zaelakGñkGan ehIyyl´dwgGMBIhV&m 1442i munnwgbMeBjhV&m enH.

edayeRBaHza GactRmUvomankardak´hV&mZanasRmab´Tidðakarzñak´rgrbsélakGñk dUecñaHlTÆplénkardak´BaküsuMrbsélakGñk GacRtUv:neKR:bódwgdl´buK<l/ Gg<karEdl:ndak´hV&mZana Tak´Tinnwgkardak´BaküsuMrbsélakGñk.

CnEdl:nTTYlkarelIkElgCnTaMgLaydUcteTAenHBMucaM:cĆaPñak´garEdlcuHeQµaHRsbc|ab´ edIm|IpþlĆMnYyEpñk GenþaRbevsn¾ k*büEnþeKBMuRtUvKitézøQñÜlcMeBaHkic©bMerIrbs´xøÜneLIy;• smaCikRKYsarEdlCitsñiTÆ‘bþI ßRbBnÆ édKUrsénACamYyKñaedayminTan´:ner[b karRsbc|ab´ kUn ÓBuk / mþay bgbÁÚnRbus ßRsI’

• smaCikrdðsPa ßbuK<likrbs´sPa• m®nþIpøÚvkarEdlkic©karrbséK manrYmTaMgkarpþlĆMnYyEpñkGenþaRbevsn¾pgEdr ‘óTahrN¾ sæab&nCMnYyxagpøÚvc|ab´’

• smaCikénGñkkarTUt muxdMENgkugs)ul ßGg<karGnþrCati.

karEtgtaMgPñak´garGenþaRbevsn¾ / CnEdl:nTTYlkarelIkElgedIm|IEtgtaMgPñak´garGenþaRbevsn¾¾ / CnEdl:nTTYlkarelIkElg elakGñkRtUv bMeBj Epñk K – Options for receiving written communications ‘CeRmIs edIm|ITTYlykkarTak´TgCalaylk¡N¾GkSr’.Pñak´garGenþaRbevsn¾¾ / CnEdl:nTTYlkarelIkElgrbsélakGñkKYrbMeBjBaküsMu elx 956 Advice by a migration agent/exempt person of providing immigration assistance ‘BaküsuM 956 OvaTpþlédayPñak´garGenþaRbevsn¾¾ / CnEdl:nTTYlkarelIkElgBIkarpþlĆMnYyEpñkGenþaRbevsn¾’.BaküsMuelx 956 GacTTYl:nBIviubsayrbs´RksYg www.border.gov.au/allforms/

CeRmIsedIm|ITTYlykkarTak´TgCalaylk¡N¾GkSrRbsinebIelakGñkBMu:nEtgtaMgPñak´garGenþaRbevsn¾¾ / CnEdl:nTTYlkarelIkElg eT elakGñkk¾enAEtGacGnuJ¦atCalaylk¡N¾GkSr obuK<ldéTeT[tTTYlykkar Tak´TgCalaylk¡N¾GkSrkñúgnamelakGñkEdr. buK<lenHRtUv:neKehAzaGñkTTYl EdlmankarGnuJ¦at.

B&t(manGMBIGñkTTYlEdlmankarGnuJ¦atRKb´TaMgkarTak´TgCalaylk¡N¾GkSrGMBIkardak´BaküsMurbsélakGñk nwgRtUvep\IeTAGñk TTYlEdlmankarGnuJ¦atrbsélakGñk elIkElgEtelakGñkbgØajR:b´zaelakGñk manbMNgcg´:nB&t(mansþIGMBIsuxPaB nig /ßcritmaryaTep\IeTAoelakGñkpÞal´.RksYgnwgeZVIkarTak´TgCamYyGñkTTYlEdlmankarGnuJ¦at EdleTIb:nEtgtaMgenA eBlcugeRkaybMput edayeRBaHzaelakGñkGacEtgtaMgGñkTTYlEdlmankarGnuJ¦at :nEt1nak´büeNÑaHkñúgeBlNamYy sRmab´kardak´BaküsMuCak´lakŃamYy.elakGñknwgRtUveKcat´Tukza:nTTYlÉksarNamYyEdleKep\IeTAoCnenaH k*dUcCa :nep\IeTAoelakGñkEdr.edIm|IEtgtaMgGñkTTYlEdlmankarGnuJ¦at elakGñkRtUvbMeBj;• Epñk K – Options for receiving written communications ‘CeRmIsedIm|I TTYlykkarTak´TgCalaylk¡N¾GkSr’ nig

• BaküsMuelx 956A Appointment or withdrawal of an authorised recipient ‘karEtgtaMg ßdkecjGñkTTYlEdlmankarGnuJ¦at’

kMNt´sMKal´; Pñak´garGenþaRbevsn¾¾ / Pñak´garEdl:nTTYlkarelIkElgBMucaM:c´ bMeBjBaküsMuelx 956A eLIy.BaküsMuelx 956A GacTTYl:nBIviubsayrbs´RksYg www.border.gov.au/allforms/

www.border.gov.ausUmelxTUrs&BÞ 131 881 kñúgema¨geZVIkarkñúgRbeTs GURsþalI edIm|IniyayeTAkan´GñkRbtibtþiTUrs&BÞ ‘B&t(manztTukmanpþlĆUnenAeRkAema¨geZVIkar’. RbsinebIelakGñkenAeRkARbeTsGURsþalI sUmTak´Tg CamYyebskkmµGURsþalIEdlenACitelakGñkCageK.

eKhTMB&rExSTUrs&BÞ saksYr

B&t(manTUeTA

sUmrkSaTukTMB&renHsRmabĆaÉksareyagrbsélakGñk


Form

1419 KHMKHMER

3Tick where applicable

Please use a pen, and write neatly in English using BLOCK LETTERS.

sUmKUssBa¦aenAkEnøgEdlGacGnuvtþ:n

sUmeRbIb)ic ehIysresrPasaGgéKøsCaGkSrZMo:nc|as´lÁ.

Up to 3 monthsrhUtdléTA3ExUp to 6 monthsrhUtdléTA6Ex

How long do you wish to stay in Australia?etIelakGñkmanbMNgcg´sñakénARbeTsGURsþalIry;eBlyUrbüNÑa/

3

Up to 12 monthsrhUtdléTA12Ex

Note: The stay period granted may be less than the period requested. You should check the terms of any visa granted.kMNtćMNaM; ry;eBlsñakénAEdl:npþló GacmanticCagry;eBlsñak´ enAEdl:nesñIsuM. elakGñkKYrEqkemIlGMLúgeBlénTidðakarEdl:npþló NamYy.

PHOTOGRAPH

Please attach a recent passport size photograph of yourself.

rUbztsUmP¢ab´mkCamYynUvrUb zteBlzµI>rbsélakGñk EdlmanTMhMsRmab´ lixitqøgEdn

Outside AustraliaeRkARbeTsGURsþalI

In AustraliakñúgRbeTsGURsþalI

Indicate if you are applying outside Australia or in Australia:sUmbgØajR:b´zaetIelakGñkkMBugdak´BaküsMuenAeRkA ßenAkñúgRbeTsGURsþalI;

1

Go to Question 2sUmeTAsMNYrTI 2Go to Question 5sUmeTAsMNYrTI 5

When do you wish to visit Australia?etIelakGñkmanbMNgcg´mkelgRbeTsGURsþalIenAeBlNa/

2 DAY

ézáMONTH

ExYEAR

qñaM

Gñkdak´BaküsMuenAeRkARbeTsGURsþalI

Give detailssUmpþl´B&t(manBisþar

NoeT

Yes:T/ cas@

Do you intend to enter Australia on more than one occasion?etIelakGñkmanbMNgcUlmkRbeTsGURsþalIelIsBImYydgß/

4

Go to Question 7sUmeTAsMNYrTI 7

Go to Question 7sUmeTAsMNYrTI 7

Specify the date you wish to extend your stay tosUmbJ¢akóc|as´GMBIézáExEdlelakGñk manbMNgbnþeBlsñakénArbsélakGñk

5

Gñkdak´BaküsMuenAkñúgRbeTsGURsþalI

Provide detailed reasons for requesting this further staysUmpþl´mUlehtuBisþarcMeBaHkaresñIsMusñakénAbnþeT[t

6

DateézáEx

toeTATlńwg

fromcab´BI

DAY

ézáMONTH

ExYEAR

qñaM

Application for a Visitor visa – Tourist stream

BaküsMuTidðakarGñkmkelg – EpñkeTscrN¾

3

Applicants outside Australia Applicants in Australia


10 Are you or have you been known by any other name? (including name at birth, previous married names, aliases)etIelakGñkman ßRtUv:neKs<al´zamaneQµaHepSgNamYyeT[tßeT/ ‘rab´bJ©ÚlTaMgeQµaHenAeBlekIt eQµaHBlmuner[bkareBlmun eQµaHehAeRkA’


NoeTYes:T/ cas@

Note: If this visa application is approved, your current visa may cease.kMNt´sMKal´; RbsinebIBaküsMuTidðakarenHRtUv:nyl´RBm Tidðakarbc©úb|nñrbsélakGñkGacQb´mansuBlPaB.

Yes:T/ cas@

Do you currently hold an Australian visa?etIbc©úb|nñenH elakGñkkan´TidðakarGURsþalIßeT/

11

12 Have you applied for a Parent (subclass 103) visa?etIelakGñk:ndak´BaküsMuTidðakarÓBuk/mþay ‘zñak´rg 103’ ßeT/

Please provide your queue datesUmpþl´ézáExCYrrgćaMrbsélakGñk:T/

cas@

Yes

List countriessUmrayeQµaHRbeTsTaMgenaH

Are you a citizen of any other country?etIelakGñkCaBlrdðénRbeTsepSgNamYyeT[tßeT/

14

13 Do you currently hold, or have you applied for, an APEC Business Travel Card (ABTC)?etIbc©úb|nñenHelakGñkkan´ ß:ndak´BaküsMub&NÑeZVIdMeNIrBaNiC¢kmµ APEC

(ABTC) ßeT/

Note: If this visa application is approved, the Australian visa associated with your ABTC will cease.kMNt´sMKal´; RbsinebIBaküsMuTidðakarenHRtUv:nyl´RBm TidðakarGURsþalIEdlCab´Tak´TgCamYyb&NÑ ABTC rbsélakGñk nwgQb´mansuBlPaB.

8 Place of birthTIkEnøgekIt

Rkug / TIRkugTown/city

State/provincerdð / extþ

CountryRbeTs

9 Relationship statussæankarN¾TMnak´TMng

Marrieder[bkarehIy

De factorsénACamYyKña edayminTan´:n er[bkarRsbc|ab´

EngagedP¢ab´BaküehIy

DivorcedlHElgKña

SeparatedrsénAEbkBIKña

Widowedemmäy

Never married or been in a de facto

relationship

minEdler[bkar ßZøab´:n rsénACamYyKñaedaymin Tan´:ner[bkarRsbc|ab´

Date of birthézáExqñaMkMeNIt

elxlixitqøgEdnPassport number

RbeTspþl´lixitqøgEdnCountry of passport

Nationality of passport holdersJ¢atirbs´Gñkkan´ lixitqøgEdn

Date of issueézáecjoDate of expiryézáputkMNt´

Place of issue/issuing authorityTIkEnøgecjo / GaC\aZrecjo

Part A – Your detailsEpñk A — B&t(manlMGitrbsélakGñk

Give the following details exactly as they appear in your passportMake sure your passport is valid for the period of stay you are applying for.sUmpþl´B&t(manlMGitdUcteTAenHoBitR:kd dUcbgØajenAkñúglixitqøgEdn rbsélakGñksUmo:nc|as´R:kdza lixitqøgEdnrbsélakGñkmansuBlPaBsRmab´ GMLúgeBlénkarsñakénAEdlelakGñkkMBugdak´BaküsMu.

7

namRtkUlFamily name

Given namesnamxøÜn

SexePT

MaleRbus

FemaleRsI

Yes

Yes

NoeT

NoeT

NoeT

NoeT

DAY

ézáMONTH

ExYEARqñaM

DAY

ézáMONTH

ExYEAR

qñaM

DAY

ézáMONTH

ExYEAR

qñaM

:T/ cas@

:T/ cas@


Do you have other current passports?etIelakGñkmanlixitqøgEdnbc©úb|nñdéTeT[tßeT/

15

Passport numberelxlixitqøgEdnCountry of passportRbeTsénlixitqøgEdn

Yes

NoeT

:T/ cas@


Type of documentRbePTénÉksar

Identity numberelxGtþsJ¦aN

Country of issueRbeTsEdlecjo

23 Do you agree to the Department communicating with you by email and/or fax?

This may include receiving notification of the outcome of this application.

Note: We can communicate about this application more quickly using email and/or fax.

etIelakGñkyl´RBmoRksYgR:Rs&yTak´TgCamYyelakGñktamGIuem¨l nig /ßtamTUrsarßeT/karenHGacrab´bJ©ÚlTaMgkarTTYldMNwgGMBIlTÆplénBaküsMuenHEdr.

kMNt´sMKal´; eyIgGacR:Rs&yTak´TgGMBIBaküsMuenH:nkanÉtqabédayeRbIGIuem¨l nig /ßTUrsar.

Fax numberelxTUrsar

Email addressGasydðanGIuem¨l

( ) ( )

COUNTRY CODE AREA CODE NUMBER

20

POSTCODEelxkUdéRbsNIy

Your current residential address Note: A street address is required as a post office box address cannot be accepted. GasydðanrsénAbc©úb|nñrbsélakGñk kMNt´sMKal´; tRmUvomanGasydðantamdgpøÚv edayeRBaHzaGasydðan RbGb´sMbuRtéRbsNIy¾BMuGacTTYlykeLIy.

21 Address for correspondence (If the same as your residential address, write ‘AS ABOVE’)GasydðansRmab´Tak´Tg ‘RbsinebIdUcKñanwgGasydðanrsénArbsélakGñk sUmsresr ‘AS ABOVE’’

Country

Country

RbeTs

RbeTs

22 Contact telephone numberselxTUrs&BÞsRmab´Tak´Tg

HomepÞH ( ) ( )

COUNTRY CODEelxkUdRbeTs

AREA CODEelxkUdtMbn´

NUMBERelx

Officekariyal&y ( ) ( )

Mobile/cellTUrs&BÞcl&t

Do you hold an identity card or identity number issued to you by your government (eg. National identity card) (if applicable)?

Note: If you are the holder of multiple identity numbers because you are a citizen of more than one country, you need to enter the identity number on the card from the country that you live in.etIelakGñkkan´GtþsJ¦aNb&NÑ ßelxGtþsJ¦aNEdlecjoelakGñk edayrdðaPi:lrbsélakGñkßeT ‘óTahrN¾ GtþsJ¦aNb&NÑCati’ ‘RbsinebIGacGnuvtþ:n’/kMNt´sMKal´; RbsinebIelakGñkCaGñkkanélxGtþsJ¦aNeRcIn edayeRBaH elakGñkCaBlrdðénRbeTseRcInCagmYy elakGñkRtUvkardak´bJ©Úlelx GtþsJ¦aNelIb&NÑénRbeTsEdlelakGñkrsénAkñúgenaH.

16

Family namenamRtkUlGiven namesnamxøÜn


NoeTYes


NoeTYes

elxkUdRbeTs elxkUdtMbn´ elx

:T/ cas@

:T/ cas@

19 What is the purpose of your stay in your current location and what is your visa status?

etIeKalbMNgénkarsñakénAkñúgTItaMgbc©úb|nñrbsélakGñkKWedIm|IGVI ehIyetIsæankarN¾TidðakarrbsélakGñkKWGVIeTA/

17 In what country are you currently located? etIelakGñkkMBugmanTItaMgenARbeTsNamYy/


18 What is your legal status in your current location? etIsæankarN¾pøÚvc|abŃamYyrbsélakGñk enAkñúgTItaMgbc©úb|nñrbsélakGñk/

CitizenBlrdð

VisitorGñkmkelg

Work visaTidðakareZVIkar

OtherdéTeT[t

Permanent residentBlrdðGciéRnþy¾

StudentsisS

No legal statusBuMmansæankarN¾Rsbc|ab´



Are you travelling to, or are you currently in, Australia with any family members?etIelakGñkkMBugeZVIdMeNIrmk ßelakGñk«LÚvenHenAkñúgRbeTsGURsþalICamYysmaCikRKYsarNamñak´ß/

24

Full name Relationship to you Name of sponsor (if applicable)

sUmpþl´B&t(manBisþarGMBIsmaCikRKYsarnImYy> sUmoR:kdzaBaküsMuTaMgGs´RtUv:ndak´kñúgeBldMNalKña.

Give details of each family member Make sure all the applications are lodged at the same time.

Part B – Family travelling to Australia with youEpñk B – RKYsareZVIdMeNIrmkRbeTsGURsþalICamYyelakGñk

Do you have a partner, any children, or fiancé who will NOT be travelling, or has NOT travelled, to Australia with you?etIelakGñkmanédKU kUn ßKUdNþwgEdlnwgBMueZVIdMeNIr ßBMuZøabéZVIdMeNIrmkRbeTsGURsþalICamYyelakGñkßeT/

25

Full nameDate of birth

Relationship to you Their address while you are in Australia DAY MONTH YEAR

/ /

/ /

/ /

/ /

Part C – Family NOT travelling to Australia with youEpñk C – RKYsarBMu:neZVIdMeNIrmkRbeTsGURsþalICamYyelakGñk

If insufficient space, give details at Part ORbsinebIBuMmankEnøgRKb´RKanéT sUmpþl´B&t(manlMGitenAEpñk O


:T/ cas@

Yes


NoeTYes:T/ cas@

NoeT

eQµaHeBj TMnak´TMngeTAnwgelakGñk eQµaHGñkZanap<t´p<g´ ‘RbsinebIGacGnuvtþ:n’

eQµaHeBj TMnak´TMngeTAnwgelakGñk GasydðanrbséKkñúgkalelakGñkkMBugsñakénAkñúgRbeTsGURsþalIézáExqñaMkMeNIt

ézá Ex qñaM


Do you have any relatives in Australia?27

Full nameDate of birth Relationship

to you Address Citizen or permanent resident of Australia

DAY MONTH YEAR

ézá Ex qñaM

/ /

/ /

/ /

/ /


to you Address Citizen or permanent resident of Australia

DAY MONTH YEAR

ézá Ex qñaM

/ /

/ /

/ /

/ /

If insufficient space, give details at Part O


RbsinebIBuMmankEnøgRKb´RKanéT sUmpþl´B&t(manlMGitenAEpñk O


Do you have any friends or contacts in Australia?28


NoeTYes

etIelakGñkmanjatisnþanNamñakénAkñúgRbeTsGURsþalIßeT/

etIelakGñkmanmitþPkþi ßTMnak´TMngNamñakénAkñúgRbeTsGURsþalIßeT/


NoeTYes

NoeT

Yes:T/ cas@

NoeT

Yes:T/ cas@

NoeT

Yes:T/ cas@

NoeT

Yes:T/ cas@

NoeT

Yes:T/ cas@

NoeT

Yes:T/ cas@

NoeT

Yes:T/ cas@

NoeT

Yes:T/ cas@

Is it likely you will be travelling from Australia to any other country (eg. New Zealand, Singapore, Papua New Guinea) and back to Australia?etIelakGñkTMngCaRtUveZVIdMeNIrBIRbeTsGURsþalI eTAkan´RbeTsdéTNamYyeT[t ‘RbeTsjÚveh)SLwn saMgkabÜ Papua New Guinea CaedIm.l.’ ehIyRtLbćUlmkRbeTsGURsþalIvijß/

26

Attach itinerary detailssUmP¢ab´mkCamYynUvB&t(manlMGitGMBIpøÚveZVIdMeNIr

Part D – Details of your visit to AustraliaEpñk D – B&t(manlMGitGMBIkarmkelgRbeTsGURsþalIrbsélakGñk

Yes

NoeT

eQµaHeBj TMnak´TMngeTA nwgelakGñk

GasydðanézáExqñaMkMeNIt

Blrdð ßGñkrsénA GciéRnþy¾énRbeTsGURsþalI

eQµaHeBj TMnak´TMngeTA nwgelakGñk

GasydðanézáExqñaMkMeNIt

Blrdð ßGñkrsénA GciéRnþy¾énRbeTsGURsþalI

:T/ cas@

:T/ cas@

:T/ cas@


30 Do you intend to do a course of study while in Australia?etIelakGñkmanbMNgbMeBjvK<sikSaNamYy kñúgkalkMBugsñakénAkñúgRbeTs GURsþalIß/

Name of the courseeQµaHvK<sikSa

Name of the institutioneQµaHsæab&nsikSa

How long will the course last?etIvK<sikSaenaHmanry;eBlyUr büNÑa/

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

Do not include time spent in Australia.kñúgry;eBl5qñaMcugeRkay etIelakGñkZøab´:neTAelg ßrsénAeRkARbeTs énlixitqøgEdnrbsélakGñkelIsBI3ExCab´KñaßeT/sUmkMurab´bJ©ÚleBlevlacMNaykñúgRbeTsGURsþalI

31

Country(s)

Country(s)

Country(s)

RbeTs

RbeTs

RbeTs

1.

2.

3.

Part E – Health detailsEpñk E – B&t(manlMGitGMBIsuxPaB


32 Do you intend to enter a hospital or health care facility (including nursing homes) while in Australia?etIelakGñkmanbMNgcUlmnÞIreBTü ßkEnøgEzTaMsuxPaB ‘rab´bJ©ÚlTaMgkEnøg emIlEzmnusScas´’ kñúgkalEdlelakGñkkMBugsñakénAkñúgRbeTsGURsþalIß/


NoeTYes


NoeTYes


NoeTYes

Why do you want to visit Australia? Include details of any dates that are of special significance to your visit.ehtuGVI:nCaelakGñkmanbMNgcg´GeBa¢IjmkelgRbeTsGURsþalI/sUmdak´bBa©ÚlnUvB&t(manCak´lak´énézáNamYy Edlmann&ysMxan´Biess sRmab´kareZVIdMeNIrmkelgrbsélakGñk.

29



DateézáTI

toeTA

fromcab´BIézáTI

DateézáTI

toeTA

fromcab´BIézáTI

DateézáTI

toeTA

fromcab´BIézáTI

DAY

DAY

DAY

ézá

ézá

ézá

MONTH

MONTH

MONTH

Ex

Ex

Ex

YEAR

YEAR

YEAR

qñaM

qñaM

qñaM

:T/ cas@

:T/ cas@

:T/ cas@


35

36 Do you require assistance with mobility or care due to a medical condition?etIelakGñkRtUvkarCMnYyedIm|Ipøas´bþÚrkEnøg ßemIlEzedaysarsæanPaBBüa:l eraKßeT/

37 Have you undertaken a health examination for an Australian visa in the last 12 months?etIelakGñkZøab´:nTTYlkarsnüaBinitüsuxPaBsRmab´TidðakarGURsþalIkñúgGMLúg eBl12ExcugeRkayßeT/

Note: If you are applying for a long stay Visitor visa or are 75 years or over, you will be asked to undergo a health assessment and may be asked to show that you have medical insurance to cover your intended stay in Australia. Please contact your nearest office of the Department for further advice before lodging your application. If additional medical consultations are required, a decision on your visa application will be delayed.kMNt´sMKal´; RbsinebIelakGñkdak´BaküsMuTidðakarGñkmkelgsRmab´kar sñakénAyUr ßmanGayu75qñaM ßeRcInCag elakGñknwgRtUv:nesñIsMuoTTYl karvaytémøsuxPaB ehIyGacRtUvsMuobgØajzaelakGñkmankarZanaräb´rg EpñkeBTüedIm|IRKbdNþb´bMNgsñakénArbsélakGñk kñúgRbeTsGURsþalI. sUmTak´Tgkariyal&yrbs´RksYgEdlenACitelakGñkCageK edIm|ITTYlOvaT bEnæmmunnwgdak´BaküsMurbsélakGñk. RbsinebItRmUvomankarBieRKaHeyabl´ EpñkeBTübEnæmeT[t enaHesckþIseRmccitþcMeBaHBaküsMuTidðakarrbsélakGñk nwgRtUvyWtyUr.

• kidney disease, including dialysis;• mental illness;• pregnancy;• respiratory disease that has

required hospital admission or oxygen therapy

• other?

• CmáWtRmgenam manrYmTaMgviZIeRcaH EjkQam (dialysis)

• CmáWxYrk|al• manépÞeBaH CmáWTak´TinkardkdegØImEd

lRtUvkarBüa :lenAmnÞIreBTü ßkarBüa:lCamYy

• xül´GuksIuEh)Sn• déTeT[t/

During your proposed visit to Australia, do you expect to incur medical costs, or require treatment or medical follow up for:

kñúgGMLúgeBlénkarmkelgRbeTsGURsþalIEdl:nesñIsMurbsélakGñk etIelak GñkrMBwgzanwgecjézøcMNayEpñkeBTü ßtRmUvomankarBüa:l ßkarbnþtam danEpñkeBTüsRmab´;

• blood disorder;• cancer;• heart disease;• hepatitis B or C and/or

liver disease;• HIV infection, including

AIDS;

• eraKQam• CmáWmharIk• CmáWebHdUg• eraKrlaezøImRbePT B ß C

nig/ßCmáWezøIm• eraKeGC¢-Gay-vI ( HIV) manrYmTaMgCmáWeGds¾


NoeTYes


NoeTYes

Give details (including HAP ID if available)sUmpþl´B&t(manBisþar ‘rYmmanGtþsJ¦aN HAP RbsinebIman’

NoeTYes

33 Do you intend to work as, or study to be, a doctor, dentist, nurse or paramedic during your stay in Australia?etIelakGñkmanbMNgeZVIkargarCa ßsikSaedIm|IeTACaevC¢bNÐit RKUeBTüeZµj Kilanub|dðak ßGñkCMnYyevC¢bNÐitkñúgkalelakGñkkMBugsñakénAkñúgRbeTs GURsþalIß/

34 Have you: • 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?

etIelakGñk;• ZøabÉdlman ßkñúgeBlbc©úb|nñenHmanCmáWrebgßeT/• ZøabÉdlTak´TgCitsñiTÆCamYysmaCikRKYsarNamñakÉdlmanCmáWrebgskmµ ßeT/

• ZøabÉdlmanztedImRTUgedaykaMrsµIGikS EdlbgØajoeXIjPaBxusBI RbRktIßeT/


NoeTYes


NoeTYes

:T/ cas@

:T/ cas@

:T/ cas@

:T/ cas@

:T/ cas@


Part F – Character details

38 Have you ever:etIelakGñkZøab´:n;

Epñk F –B&t(manlMGitGMBIcriyamaryaT

• been involved in people smuggling or people trafficking offences?

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

• Tak´TinkñúgbTelµIsrt´BnÆmnusSßeT/

• Cab´bMNulNamYycMeBaHrdðaPi:lGURsþalI ßGaC\aZrrdðkñúgRbeTsGURsþalIßeT/

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

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

• CabéTasBIbTóRkidð ßbTelµIsmYyenAkñúgRbeTs NamYy‘rYmmankarCabéTasNamYy Edl«LÚv enHRtUv:neKhUtecjBIkMNt´RtatampøÚvkar’ ßeT/

• eKedaHorYcBIbTelµIsNamYy edayeRBaHmUlehtu énkarmanGarmµN¾minlÁ ßkarq,ÜtvegVgßeT/

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

• TTYlkarhVwkhVWnkñúgkgT&B/kgeyaZaRbtiB&TÆ NamYy :nhVwkhVWnkñúgkareRbIR:s´sBVavuZ/ eRK]gpÞúH ßkñúgósSahkmµplitplCatiKImI/ CIvsaRsþßeT/

eT :T/ cas@

No Yes

eT :T/ cas@

No Yes

eT :T/ cas@

NoYes

eT :T/ cas@

NoYes

eT :T/ cas@

NoYes

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

• ecaTRbkan´BIbTelµIsNamYy EdlkñúgeBl bc©úb|nñenHkMBugrgćaMkarbþwgeTAtulakarßeT/ eT :T/

cas@No Yes

• been the subject of an arrest warrant or Interpol notice?

• Cab´bTenAkñúgdIkacab´xøÜn ßdIkabÜlisGnþrCati ßeT/ eT :T/

cas@No Yes

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

• eKrkeXIjmaneTasBIbTelµIspøÚvePTTak´Tinkumar ‘rYmman eTaHbIBuMmankMNt´RtaGMBIkardakéTaskþI’ ßeT/

eT :T/ cas@

No Yes

• been named on a sex offender register?• eKdakéQµaHenAkñúgbBa¢IGñkRbRBwtþbTelµIsxag

pøÚvePTßeT/ eT :T/ cas@

No Yes

• been found by a court not fit to plead?• tulakarkat´kþIza BuMmansmtæPaBsmrmüedIm|I

eqøIytbbTecaTßeT/ eT :T/ cas@

No 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?

• Tak´TinpÞal´ ßRbeyalkñúg ßcUlrYmCamYyskmµPaB TaMgLayEdlCasBa¦anaMmknUveRKaHzñak´dl´snþisux énRbeTsCatiGURsþalI ßRbeTsÉeT[tNamYyßeT/

eT :T/ cas@

No 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?

• Cab´bTecaTRbkan´ ßkarecaTRbkanĆapøÚvkar cMeBaH; karRbl&yBUCsasn¾ bTóRkidðsRg<am ßbTóRkidðRbqaMgnwgmnusSCati karRbRBwtþGMeBI TaruNkmµ TasPaB ßbTóRkidðÉeT[tNamYy EdlRtUv:ncat´TukzaCakgVlćMeBaHGnþrCati d¾Zán´ZárßeT/

eT :T/ cas@

No Yes

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

• cUlrYmCamYybuK<lNamñak´ ßRkum ßGg<karNamYy EdlZøab´Tak´TinkñúgGMeBIóRkidðßeT/ eT :T/

cas@No

Yes

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

• RtUv:neKykecj nireTsecj ßbeNþj ecjBIRbeTsNamYy‘rYmmanRbeTsGURsþalI’ßeT/ eT :T/

cas@No

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?

• cUlrYmCamYyGg<karNamYyEdlTak´TinkñúgGMeBI eXareXA ‘rYmmansRg<am karbHe:r karvay RbyuTÆedIm|IesrIPaB GMeBIePrvkmµ :tukmµCMTas´’ eTaHzaenAbreTs ßkñúgRbeTsGURsþalIßeT/

eT :T/ cas@

NoYes

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

• bMerIkñúgkgkmøaMgeyaZa kgkmøaMgbÜlis Pñak´garkgCIvBl ßPñak´garQøbóbtæmÖKaMRT edayrdð/ÉkCn‘rYmmanbÜlissmáat´’ßeT/

eT :T/ cas@

NoYes

• overstayed a visa in any country (including Australia)?

• sñakénAhYskMNtéBlTidðakarkñúgRbeTsNamYy ‘rYmTaMgRbeTsGURsþalI’ßeT/ eT :T/

cas@No

Yes


Epñk G – sæankarN¾kargarPart G – Employment status

What is your employment status?etIelakGñksæitenAkñúgsæankarN¾kargarmYyNa/

39

Telephone numberelxTUrs&BÞ

Employed/self-employed

eZVIkar / rksIuedayxøÜnÉg


Employer/business nameeQµaHnieyaCk / GaCIvkmµ

elxkUdéRbsNIyPOSTCODE

GasydðanAddress

Position you holdmuxgarEdlelakGñkRKb´RKg

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

GaCIvkmµenHyUrbüNÑaehIy/

:ncUlnivtþRetired

qñaMénkarcUlnivtþYear of retirement

sisSStudent

sUmpþl´B&t(manBisþarGive details

Your current coursemuxviC¢asikSabc©úb|nñrbsélakGñk

eQµaHsæab&nGb´rMName of educational institution

How long have you been studying at this institution?etIelakGñksikSaenAsæab&nenH yUrbüNÑaehIy/

déTeT[tOther

sUmpþl´B&t(manBisþarGive details

Unemployed«tmankargareZVI

Explain why you are unemployed and give details of your last employment (if applicable)sUmBnül´GMBImUlehtuEdlelakGñk«tmankargareZVI nigpþl´B&t(manlMGitGMBIkargarcugeRkayrbsélakGñk ‘RbsinebIGacGnuvtþ:n’

( ) ( )



NUMBERelx

If you answered ‘Yes’ to any of the questions at Question 38, give ALL relevant details below.

RbsinebIelakGñkeqøIy ‘:T/cas@ ’eTAnwgsMNYrTaMgenHNamYycMeBaHsMNYr 38 sUmpþl´B&t(manlMGitBak´B&nÆTaMgGsénAxageRkamenH.



Part H – Funding for stayEpñk H – karpþl´R:k´sRmab´karsñakénAAll visitors to Australia must be able to demonstrate they have adequate funds to cover all costs associated with their visit. Providing evidence of funds will help expedite the processing of a visitor visa application. Examples may include personal bank statements showing a financial history, pay slips, audited accounts, taxation records or details of funds that visitors will be taking with them or funds that are available to them. Relevant factors may also include the number of persons your are supporting, the type of activities planned and the length of stay sought.

GñkmkelgRbeTsGURsþalITaMgGs´RtUvEtGacbgØajoeXIjza eKmanR:k´RKb´RKanédIm|IRKbdNþbélIézøcMNayTaMgGs´Tak´TinnwgkarmkelgrbséK. karpþl´PsþútagGMBIR:k´ Edlman nwgCYydl´karcatÉcgBaküsMuTidðakarGñkmkelgeZVI:nqab´rh&s. óTahrN¾ PsþútagTaMgenHGacrab´bJ©ÚlTaMgr:ykarN¾smtulüKNnIpÞal´xøÜn edaybgØaj GMBIRbvtþihirJ¦vtæú b&NÑebIkR:k´ KNnIEdl:nRtYtBinitürYcehIy kMNt´RtaBnÆdar ßB&t(manlMGitGMBIR:kÉdlGñkmkelgnwgykmkCamYyeK ßR:kÉdlmansRmabéK. ktþaBak´B&nÆTaMgLay k*Gacrab´bJ©ÚlTaMgcMnYnmnusSEdlelakGñkkMBugp<t´p<g´ RbePTénskmµPaBEdl:neRKagTuk nigry;eBlsñakénAEdl:nesñIsMu.

40 Give details of how you will maintain yourself financially while you are in AustraliasUmpþl´B&t(manlMGitGMBIreb[bEdlelakGñknwgp<t´p<gÉpñkhirJ¦vtæúsRmabélakGñk kñúgkalelakGñkkMBugsñakénAkñúgRbeTsGURsþalI

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

Note: This includes support from an organisation.

etIGñkZanap<t´p<g´rbsélakGñk ßnrNamñakéT[t pþl´karp<t´p<g´sRmabélakGñkmkelgRbeTsGURsþalIß/kMNt´sMKal´; karenHmanrYmTaMgkarp<t´p<g´BIGg<karpgEdr.

41


to you Their address while you are in Australia

Type of support provided

DAY MONTH YEAR

Financial Accommodation Other

/ /

/ /

/ /

/ /


Attach details. The person or people you have listed will need to provide evidence of their ability to provide this support.


sUmP¢ab´B&t(manlMGitmkCamYy. buK<l ßmnusSEdlelakGñk:nrayeQµaH nwgRtUvkarpþl´PsþútagénsmtæPaBrbséKedIm|Ipþl´karp<t´p<génH.


NoeT

eQµaHeBj TMnak´TMng eTAnwgelakGñk

GasydðanrbséK kñúgkalelakGñkkMBugsñakénA kñúgRbeTsGURsþalI

ézáExqñaMkMeNIt RbePTénkarp<t´p<g´ EdlpþlĆUn

déTeT[tsñak´GaRs&yhirJ¦vtæúézá Ex qñaM

:T/ cas@

Yes


42

RbsinebIelakGñkeqøIy ‘:T/cas@ ’ cMeBaHsMNYrTaMgenHNamYyenAxagelI sUmpþl´B&t(manlMGit

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

Have you ever:

etIelakGñkZøab´;• been in Australia and not complied with visa

conditions or departed Australia outside your authorised period of stay?

• Edl:nmkdl´RbeTsGURsþalI ehIymin:neKarB taml&k¡x&NÐTidðakar ß:ncakecjBIRbeTs GURsþalIxusBIkMNt´ry;eBlGnuBa¦atosñakénA rbsélakGñkßeT/

• had an application for entry to or further stay in Australia refused, or had a visa for Australia cancelled?

• RtUv:neKbdiesZcMeBaHBaküsuMocUlmk ßbnþeBl sñakénAkñúgRbeTsGURsþalIbEnæmeT[t ßRtUv:neK lubecalTidðakarcUlmkRbeTsGURsþalIßeT/

Part I – Previous applicationsEpñk I – kardak´BaküsuMBIeBlmun>

Please give details of the person who assisted yousUmsresrcuHnUvB&t(manlMGiténCnEdl:nCYyelakGñk

NoeTYes:T/ cas@

43 Did you receive assistance in completing this form?etIelakGñk:nTTYlCMnYykñúgkarbMeBjBaküsuMenHßeT/

Epñk J – CMnYykñúgkarbMeBjBaküsuMenHPart J – Assistance with this form

Go to Part KsUmeTAEpñk K

Family namenamRtkUl

Given namesnamxøÜn

Title:fan;

Mrelak

MrsGñkRsI

MisskBa¦a

MsGñknag

OtherdéTeT[t


AddressGasydðan

Telephone number or daytime contactelxTUrs&BÞ ßelxTUrs&BÞTak´TgenAeBlézá

kñúgema¨geZVIkarOffice hours

TUrs&BÞcl&tMobile/cell

44 Is the person an agent registered with the Office of the Migration Agents Registration Authority (Office of the MARA)?etIbuK<lenaHCaPñak´garEdl:ncuHbJ¢IRsbc|ab´ CamYykariyal&yénGaC\aZr EpñkcuHbJ¢IPñak´garGenþaRbevsn¾ ‘kariyal&y MARA’ ß/

45 Is the person/agent in Australia?etIbuK<l/Pñak´garenaHenAkñúgRbeTsGURsþalIß/

46etIelakGñk:nbg´R:kóbuK<l/Pñak´garenaH nig/ßpþl´GMeNaysRmab´kar pþlĆMnYyenHßeT/

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

Part K – Options for receiving written communicationsEpñk K – CeRmIsedIm|ITTYlykkarTak´TgCa laylk¡N¾GkSr

47

RKb´karTak´TgCalaylk¡N¾GkSrGMBIkardak´BaküsuMenH KYrep\IeTA; ‘sUmsKUsykEtRbGb´mYybüeNÑaH’

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

x\MúpÞal´Myself

elakGñkKYrbMeBjBaküsuMelx 956A Appointment or withdrawal of an authorised recipient ‘karEtgtaMg ßkardk ecjGñkTTYlEdlmankarGnuBa¦at’.

You should complete form 956A Appointment or withdrawal of an authorised recipient

GñkTTYlEdlman karGnuBa¦at

Authorised recipient

Migration agentPñak´gar

GenþaRbevsn¾

Exempt personCnEdl:nTTYl

karelIkElg

Your migration agent/exempt person should complete form 956 Advice by a migration agent/exempt person of providing immigration assistance

Pñak´garGenþaRbevsn¾ / CnEdl:nTTYlkarelIk ElgrbsélakGñkKYrbMeBjBaküsuMelx 956 Advice by a migration agent/exempt person of providing immigration assistance ‘OvaTpþlédayPñak´garGenþaRbevsn¾¾ / CnEdl:nTTYlkarelIkElgBIkarpþlĆMnYyEpñk GenþaRbevsn¾’.

ßOR

ORß

ORß

NoeT


Yes:T/ cas@

( ) ( )



NUMBERelx

NoeT :T/

cas@

Yes

NoeT :T/

cas@

Yes

Yes:T/ cas@

NoeT

Yes:T/ cas@

NoeT



48 IMPORTANT: You must refer to the Department’s website at www.border.gov.au/trav/visa/fees to complete this part of your application. The website shows reference tables with the Visa Application Charges applicable to each visa subclass.

sarsMxan´; elakGñkRtUveyageTAviubsayrbs´RksYgenARtg´ www.border.gov.au/trav/visa/fees edIm|IbMeBjEpñkenHénBaküsuMrbsélakGñk. viubsaybgØajR:b´BItaragelxeyag CamYynwgkarKitézødak´BaküsuMTidðakarTaMgLayEdlGacGnuvtþcMeBaHTidðakarnImYy>.

AUD

AUD

AUD

AUD

AUD

AUD

AUD

AUD

AUD

Visa subclass you are applying forTidðakarzñak´rgEdlelakGñkkMBugdak´BaküsuM

elakGñkRtUvbg´témøeBjelj ebIBuMdUecñaHeTBaküsuMTidðakarrbsélakGñknwgBuMmansuBlPaBeT.kMNt´sMKal´; elakGñkk*RtUvbg´témøbNþakélIkTIBIrénBaküsuMTidðakarrbsélakGñkpgEdr munnwgeyIgGacecjTidðakarxøHCUnelakGñk.

You must pay the total amount or your visa application will not be valid.Note: A second instalment of the Visa Application Charge must also be paid before we can grant some visas.

Non-internet Application Charge (if applicable)karKitézødak´BaküsuMBuMeZVItamGIuneZINit ‘RbsinebIGacGnuvtþ:n’

(1)

(2)

(3)

(4)

(5)

+

+

+

=

+

Additional Applicant Charge aged 18 years or over at the time your application is lodgedkarKitézøGñkdak´BaküsuMbEnæmGayu18qñaM ßeRcInCagenH enAcMeBlEdlelakGñkdak´BaküsuM

Additional Applicant Charge under 18 years of age at the time your application is lodgedkarKitézøGñkdak´BaküsuMbEnæmGayueRkam18qñaM enAcMeBlEdlelakGñkdak´BaküsuM

Subsequent Temporary Application Charge (if applicable)karKitézødak´BaküsuMbeNþaHGasnñbnÞabéRkaymkeT[t‘RbsinebIGacGnuvtþ:n’

Total (1) + (2) + (3) + (4) + (5) srub (1) + (2) + (3) + (4) + (5)

Totalsrub

=

=

=

sUmsresrcuHcMnYnR:kÉdlbgØajenAelItarag elxeyag sRmab´Tidðakarzñak´rgrbsélakGñk

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





cMnYnGñkdak´BaküsuMbEnæm Gayu18qñaM ßeRcInCagenH

Number of additional applicants aged 18 years or over

cMnYnGñkdak´BaküsuMbEnæm GayueRkam18qñaM ßeRcInCagenH

Number of additional applicants under 18 years of age

cMnYnGñkdak´BaküsuM Number of applicants

Part L – Payment detailsEpñk L – B&t(manlMGitGMBIkarbg´ézø

Base Application Charge Write the amount shown on the reference table for your visa subclasskarKitézødak´BaküsuMCamUldðansUmsresrcuHcMnYnR:kÉdlbgØajenAelItaragelxeyag sRmab´Tidðakarzñak´rgrbsélakGñk

(multiplied by)‘KuNnwgcMnYn’X




49 How will you pay your application charge?

Note: A surcharge may apply to payments made by credit card. Further information is available from www.border.gov.au/trav/visa/fees/how-to-pay-for-an-application

If applying in Australia, credit card is the preferred method of payment. If paying by bank cheque or money order please make payable to the Department of Immigration and Border Protection.

If applying outside Australia, please check with the Australian Government office where you intend to lodge your application as to what methods of payment and currencies they can accept and to whom the payment should be made payable.

etIelakGñknwgbg´ézødak´BaküsuMrbsélakGñkedayEbbNa/kMNt´sMKal´; karKitézøbEnæmGacGnuvtþcMeBaHkarbg´ézøedayeRbIb&NÑ«NTan. B&t(manbEnæmGacTTYlyk:nBIviubsay www.border.gov.au/trav/visa/fees/how-to-pay-for-an-application

RbsinebIdak´BaküenAkñúgRbeTsGURsþalI b&NÑ«NTan KWCaviZIbg´R:kÉdleK niymcUlcitþ. RbsinebIelakGñkbg´tammUlb|Tanb&RtZnaKar ßGaNtþiéRb sNIy¾‘mUlb|Tanb&RtTijtambüsþ¥sMbuRt’ sUmbgéTA Department of Immigration and Border Protection ‘RksYgGenþaRbevsn¾ nigkarBarRBMEdn’.

RbsinebIdak´BaküenAeRkARbeTsGURsþalI sUmEqkemIlCamYykariyal&yrdða Pi:lGURsþalIEdlelakGñkbMrugnwgdak´BaküsMu edIm|IodwgzaetIviZIbg´ézømYy Na nigrUbiyvtæúmYyNaEdleKGacTTYlyk ehIyzaetIKYrbg´ézøeTAonrNa.

Give details belowsUmpþlB&t(manBisþarxageRkamenH

mUlb|Tanb&Rt ZnaKar

Bank cheque

GaNtþi éRbsNIy¾

Money order

b&NÑ«NTanCredit card

MasterCard

American Express

Visa

Diners Club

JCB

bgéday ‘KUsykRbGb´mYy’Payment by (tick one box)

CaTwkR:k´GURsþalIAustralian Dollars

AUD

Credit card numberelxb&NÑ«NTan

:

: : : :

ExMONTH

:

: : :: :: :: :: :: : :

qñaMYEAR

ézáputkMNtÉxpiry date

eQµaHGñkkan´b&NÑCardholder’s name

AddressGasydðan


Signature of cardholderhtæelxa Gñkkan´b&NÑ

Credit card information will be used for charge paying purposes only.B&t(manGMBIelxb&NÑ«NTan nwgRtUvykeRbIsRmabÉteKalbMNgénkarbg´ézø kardak´BaküsuMbüeNÑaH.

Telephone numberelxTUrs&BÞ

Part M – Application checklistEpñk M – bJ¢IEqkemIlBaküsMu

50 With your completed and signed application form 1419, you must include:CamYyBaküsMuénh&Vm 1419 rbsélakGñkEdl:nbMeBj nigcuHhtæelxarYc elakGñkRtUvdak´bJ©Úl;

• a certified copy of the identity page (showing photo and personal details) of a valid passport and other pages which provide evidence of travel to any other countries

• esckþIcmøgmYyc|ab´én TMB&rGtþsBa¦aNEdl:nbBa¢ak´GHGag CapøÚvkar ‘manbgØajrUbzt nigB&t(manlMGitpÞal´xøÜn’ énlixit qøgEdnEdlmansuBlPaB ehIynigTMB&rÉeT[tEdlpþl´ PsþútagénkareZVIdMeNIreTAkan´RbeTsÉeT[t.

• a recent passport photograph (not more than 6 months old) of yourself

• rUbzteBlzµI>rbsélakGñksRmab´lixitqøgEdn ‘minRtUvyUrCag6ExeLIy’

• the Visa Application Charge (if applicable)• ézødak´BaküsMuTidðakar ‘RbsinebIGacGnuvtþ:n’

• a completed form 1257 Undertaking declaration, for applicants under 18 years of age, staying in Australia with someone other than a parent, legal guardian or relative (if applicable)

• h&Vm 1257 Undertaking declaration ‘esckþIRbkas cMeBaHkic©snüaTTYleZVI’ Edl:nbMeBjrYc sRmab´Gñkdak´ BaküsMuGayueRkam18qñaM EdlsñakénAkñúgRbeTsGURsþalICamYy nrNamñakéT[tepSgBIÓBukmþay GaNaBüa:lRsbc|ab´ ßjatisnþan ‘RbsinebIGacGnuvtþ:n’

( ) ( )



NUMBERelx

mäsésÞIrkat

GaemrikkaMgGiceRb¨s

vIhSa

b&NÑdajenIrxøwb

eh¢s)Ib)I

As the cardholder I acknowledge and accept that a credit card surcharge may apply to the transaction.kñúgfan;CaGñkkan´b&NÑ x\MúsUmTTYls<al´ ehIyRBmTTYlykkarKitézøbEnæm cMMeBaHkarbg´ézøedayeRbIb&NÑ«NTanEdlGacGnuvtþcMeBaHkic©karCMnYjenH.

-

http://www.border.gov.au/trav/visa/fees/how-to-pay-for-an-application





• evidence of access to funds to support your stay• PsþútagénkarGacTTYl:nR:kédIm|Ip<t´p<g´karsñakénArbs´ elakGñk

• evidence of your medical/travel insurance (if requested)

• PsþútagénkarZanaräb´rgEpñkeBTü /kareZVIdMeNIrrbsélakGñk ‘RbsinebIesñIsuM’

• medical examination or tests (if requested)• karBinitüemIlEpñkeBTü ßkareZVIetsþTaMgLay ‘RbsinebIesñIsuM’

• a letter from your employer confirming your leave• sMbuRtBInieyaCkrbsélakGñk EdlbJ¢ak´GMBIkarQb´ sRmakrbsélakGñk

• evidence of enrolment at school, college or university• PsþútagénkarcuHeQµaHcUler[nenAsalaer[n mhaviTüal&y ßsaklviTüal&y

If visiting a close family member in Australia (who is a citizen or permanent resident of Australia):

• a letter of invitation to visit

RbsinebICakarmkelgsmaCikRKYsarCitsñiTÆkñúgRbeTsGURsþalI ‘EdlmansJ¢atiGURsþalI ßCaGñkrsénAGciéRnþy¾kñúgRbeTs GURsþalI’ : • sMbuRtEdleKGeJ¢IjelakGñkmkelg

• other information to show that you have an incentive and authority to return to your country of residence, such as property or other significant assets in your home country

• B&t(mandéTeT[tedIm|IbgØajzaelakGñkmaneRK]gelIkTwkcitþ nigmansiTÆiedIm|IRtLbéTARbeTsEdlelakGñkrsénAvij dUcCaGclnRTBü ßRTBüsm|tþisMxan´déTeT[tkñúgRbeTs kMeNItrbsélakGñk

Under the Migration Act 1958, decision-makers are not obliged to seek additional information from the applicant before making a decision on a visa application. It is therefore in the your best interest to submit the following documentation, if applicable, with your application:

eRkamc|ab´GenþaRbevsn¾ qñaM1958 GñkeZVIesckþIseRmccitþBMutRmUvoEsVgrk B&t(manbEnæmeT[tBIGñkdak´BaküsMu muneZIVkarseRmccitþcMeBaHBaküsMuTidðakar eLIy. edayehtuenHKWCaplRbeyaCn¾sMxan´bMputrbsélakGñkEdlRtUvdak´ ÉksardUcteTAenH RbsinebIGacGnuvtþ:n CamYyBaküsMurbsélakGñk;

Important: Do not provide original documents unless requested. You should provide ‘certified copies’ of original documentation. Documents not in English should be accompanied by accredited English translations.

sMxan´; sUmkMupþl´Éksarc|abédIm elIkElgEt:nesñIsMu. elakGñkKYr pþlńUv ‘esckþIcmøgEdl:nbJ¢ak´GHGagCapøÚvkar’ énÉksarc|abédIm. ÉksarEdlBMuEmnCaPasaGgéKøs KYrP¢ab´mkCamYynUvkarbkERbPasa GgéKøsEdlrdðTTYls<al´.

Additional documents

ÉksarbEnæm

When you have lodged your application, you should attach your receipt to this sheet.

enAeBlelakGñkdak´BaküsMurbsélakGñkehIy elakGñkKYrP¢ab´ bg,an´édrbsélakGñkmkCamYyBaküsMuenH.

• a completed form 1229 Consent to grant an Australian visa to a child under the age of 18 years, for applicants under 18 years of age, travelling alone or without one or both of their parents or legal guardians (if applicable)

• h&Vm 1229 Consent to grant an Australian visa to a child under the age of 18 years ‘karyl´RBmpþl´ TidðakarGURsþalIcMeBaHekµgeRkamGayu18qñaM’ Edl:nbMeBj rYcsRmab´Gñkdak´BaküsMueRkamGayu18qñaM EdleZVIdMeNIrEtÉg ßedayKµanÓBukmþaymñak´ ßTaMgBIrnak´ ßGaNaBüa:lRsb c|ab´rbséK ‘RbsinebIGacGnuvtþ:n’

If you authorise another person to receive all written communications about your application with the Department:

• completed Part K – Options for receiving written communications; and

• form 956 Advice by a migration agent/exempt person of providing immigration assistance; or

• form 956A Appointment or withdrawal of an authorised recipient

RbsinebIelakGñkGnuJ¦atobuK<lNamñak´ TTYlykkarTak´Tg Calaylk¡N¾GkSrGMBIBaküsMurbsélakGñkBIRksYg;• Epñk K – Options for receiving written communications

‘Edl:nbMeBjrYc – CMerIssRmab´TTYlykkarTak´Tg Calaylk¡N¾GkSr’ nig

• h&Vm 956 Advice by a migration agent/exempt person of providing immigration assistance‘OvaT pþlédayPñak´garGenþaRbevsn¾¾/CnEdl:nTTYlkarelIkElg BIkarpþlĆMnYyEpñkGenþaRbevsn¾’ ß

• h&Vm 956A Appointment or withdrawal of an authorised recipient‘karEtgtaMg ßkardkecj GñkTTYlEdlmankarGnuJ¦at’


Part N – SignaturesEpñk N – htæelxa

x\Múyl´RBmcMeBaH;• karRbmUlyksñampþitRmaméd nigrUbmuxrbs´x\Mú.

x\MúsUmRbkasza;• x\Múyl´dwgzasñampþitRmaméd nigrUbmuxrbs´x\Mú ehIynigB&t(manGMBIRbvtþirbs´x\Mú Edlkan´kabédayRksYg GacpþléTAoPñak´garRbtibtþitampøÚvc|ab´GURsþalI edIm|ICYysMKal´GMBIrUbx\Mú edIm|ICYykMNtélIsiTÆirbs´x\MúsRmab´karpþlńUvTidða karEdlx\Mú:ndak´BaküsuM nigsRmabéKalbMNgRbtibtþic|ab´TaMgLay.

x\Múyl´RBmcMeBaH;• Pñak´garRbtibtþitampøÚvc|ab´GURsþalIbeBa©jnUvB&t(manGMBICIvmaRt CIvRbvtþi ehIynigkMNt´Rtaez,aleTasrbs´x\MúeTAoRksYg sRmabéKalbMNgNamYy dUc:nbBa¢ak´xagelIenH. nig

• RksYgedIm|IeRbIR:s´B&t(manEdlTTYl:nsRmabéKalbMNgénc|ab´Genþa Rbevsn¾ qñaM1958 (Migration Act 1958) ßc|abćUlsBa¢atiGURsþalI qñaM2007 (Australian Citizenship Act 2007).

Signature of applicanthtæelxaén Gñkdak´BaküsuM

Dateézá

DAY

ézáMONTH

ExYEAR

qñaM

-

51

I consent to:

• the collection of my fingerprints and facial image.

I declare that:

• I understand that my fingerprints and facial image and my biographical information held by the Department may be given to Australian law enforcement agencies to help identify me, to help determine my eligibility for grant of the visa I have applied for, and for law enforcement purposes.

I consent to:

• Australian law enforcement agencies disclosing my biometric, biographical and criminal record information to the Department for any of the purposes outlined above; and

• the Department using the information obtained for the purposes of the Migration Act 1958 or the Australian Citizenship Act 2007.

BIOMETRICS DECLARATION AND CONSENT

This declaration and consent is for offshore visa applicants.

If I am requested or required to provide my fingerprints and facial image:

esckþIRbkas nigkaryl´RBmpþl´B&t(manGMBICIvmaRtesckþIRbkas nigkaryl´RBmenHKWsRmab´Gñkdak´BaküsuMTidðakarBIeRkARbeTs.RbsinebIx\MúRtUv:nesñIsuM ßtRmUvopþl´sñampþitRmaméd nigrUbmuxrbs´x\Mú;


52

• the information given is complete, correct and up-to-date;

• I understand that the visa I am applying for does not permit me to work in Australia;

• I understand that the visa I am applying for does not permit me to study for longer than 3 months in Australia;

• my intention to visit Australia is genuine and I will abide by the conditions and period of stay of the visa;

• I have access to adequate funds to meet all costs associated with the visit to and from Australia;

• I have never had tuberculosis or any serious condition likely to endanger or be a cost to Australia (otherwise, I attach details);

• I understand that if a no further stay 8503 condition is imposed on this visa, it will limit my ability to remain in Australia beyond the authorised period of the visa;

• in any part of this form which has been completed with the assistance of another person, that the information as set down is true and correct and has been included with my full knowledge, consent and understanding;

• if granted a visa, I will advise the Australian Visa Office should my circumstances change;

• I understand that if I do not abide by the conditions imposed on my visa, my visa may be cancelled or I may be subject to other penalties. If applicable, my sponsor may also be penalised;

• I have truthfully declared all relevant details requested of me in this application;

• I have read the information contained in form 1442i Privacy notice;

• I understand the Department may collect, use and disclose my personal information (including biometric information and other sensitive information) as outlined in form 1442i Privacy notice;

• I understand that if any fraudulent documents or false or misleading information has been provided with this application, or if I fail to satisfy the Minister of my identity, my application may be refused and I, and any other member of my family unit, may become unable to be granted a visa for specified periods of time;

• if documents are found to be fraudulent or information to be incorrect after the grant of a visa, the visa may subsequently be cancelled.

• B&t(manEdl:npþlóKWeBjelj RtwmRtUv ehIyTan´bc©úb|nñPaB.• x\Múyl´zaTidðakarEdlx\MúkMBugdak´BaküsuM minGnuBa¦atox\MúeZVIkarenAkñúgRbeTs GURsþalIeLIy.

• x\Múyl´zaTidðakarEdlx\MúkMBugdak´BaküsuM minGnuBa¦atox\MúsikSaelIsBI3Ex enAkñúgRbeTsGURsþalIeLIy.

• eKalbMNgénkareTAelgRbeTsGURsþalIrbs´x\MúKWBitRtg´ ehIyx\MúnwgeKarB eTAtaml&k¡x&NÐ nigry;eBlsñakénAdUcmancuHenAkñúgTidðakar.

• x\MúmanlTÆPaBTTYlR:k´RKb´RKan´ edIm|IbMeBjézøcMNayTak´Tinnwgkarmk elg nigkarcakecjBIRbeTsGURsþalI.\

• x\MúBMuZøab´manCmáWrebg ßsæanPaBZán´ZárNamYyEdlTMngCanaMomaneRKaHzñak´ ßGs´ézøcMNaycMeBaHRbeTsGURsþalIeLIy ‘ebIBMuenaHeT x\MúsUmP¢ab´mkCamYy nUvB&t(manlMGit’.

• x\Múyl´dwgzaRbsinebIl&k¡x&NÐ 8503 minosñakénAteTAeT[t RtUv:ndak´ elITidðakarenH karenHnwgkMritsmtæPaBrbs´x\MúedIm|IsñakénAkñúgRbeTsGURsþalI elIsBIGMLúgeBlGnuJ¦aténTidðakar.

• kñúgEpñkNamYyénh&VmenH Edl:nbMeBjedaymanCMnYyBIbuK<lmñakéT[t zaB&t(mandUcEdl:nsresrenHKWBit nigRtwmRtUv ehIy:ndak´bJ©Úl edaymankarecHdwgeBjelj yl´RBm nigyl´dwgrbs´x\Mú.

• RbsinebITidðakarRtUv:npþló x\MúnwgR:bókariyal&yTidðakarGURsþalI:n dwg RbsinebImankarpøas´bþÚrkñúgkal;eTs;rbs´x\Mú.

• x\Múyl´dwgza RbsinebIx\MúBMueKarBtaml&k¡x&NÐEdl:ncuHelITidðakarrbs´x\MúeT Tidðakarrbs´x\MúGacRtUveKlubecal ßx\MúGacTTYlkarpakBin&ydéTeT[t. RbsinebIGacGnuvtþ:n GñkZanap<t´p<g´rbs´x\Múk*RbEhlCaRtUvCab´Bin&yEdr.

• x\Mú:nRbkasedayeT[gRtg´ GMBIB&t(manlMGitBak´B&nÆTaMgGsÉdl:nesñIsMu GMBIx\MúenAkñúgBaküsMuenH.

• x\Mú:nGanB&t(manEdlcuHenAkñúghV&m 1442i B&t(manGMBIer]gÉkCn.• x\Múyl´dwgzaRksYgGacRbmUlyk eRbIR:s´ nigbeBa©jodwgnUvB&t(manpÞal´ xøÜnrbs´x\Mú ‘manrYmTaMgB&t(manGMBICIvmaRt nigB&t(mansmáat´pÞal´xøÜnÉeT[t’ dUc:nKUsbBa¢akénAkñúghV&m 1442i B&t(manGMBIer]gÉkCn.

• x\Múyl´dwgza RbsinebIÉksarNamYyEdlEkøgbnøM ßB&t(manNamYyEdlxus ßnaMoyl´xus :npþlóCamYynwgBaküsuMenH ßx\MúBuM:nbMeBjtambMNg rbs´rdðmRnþInUvGtþsBa¦aNrbs´x\Mú enaHBaküsuMrbs´x\MúGacRtUveKbdiesd ehIyx\Mú nigsmaCikÉeT[tNamñak´énRkumRKYsarrbs´x\Mú GacnwgBuM:neKecjonUv TidðakarNamYysRmab´GMLúgeBlCak´lakŃamYyeLIy.

• R bsinebIÉksarTaMgLayRtUv:neKrkeXIjzaEkøgbnøM ßB&t(manBuMRtwmRtUv eRkayBI:npþlónUvTidðakarNamYyrYcehIy TidðakarenaHGacRtUveKlubecal enAeBleRkaymk.

karRBman; karpþlńUvB&t(man ßÉksarxus ßnaMoyl´xus KWCakarRbRBwtþ bTelµIsmYyd¾Zán´Zár.

WARNING: Giving false or misleading information or documents is a serious offence.

Having read the ‘Conditions for a Visitor visa to Australia’ on page 1 of this form, I declare that:

eday:nGan ¨l&k¡x&N\ÐTidðakarGñkmkelgRbeTsGURsþalI ¨ enATMB&r 1

énh&VmenH x\MúsUmRbkasza;

Signature of applicanthtæelxaén Gñkdak´BaküsuM

Dateézá

DAY

ézáMONTH

ExYEAR

qñaM

We strongly advise that you keep a copy of your application and all attachments for your records.eyIgsUmCUnOvaTyägmaMmYnza elakGñkRtUvrkSaTukesckþIcmøgénBaküsuM rbsélakGñkmYyc|ab´ nigkardak´P¢ab´TaMgLaysRmabĆakMNt´Rtarbs´ elakGñk.

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DECLARATION esckþIRbkas


Question numberelxsMNYr

Additional informationB&t(manbEnæm

53

Part O – Additional information

If insufficient space, attach additional details.RbsinebIBMumankEnøgRKb´RKanéT sUmP¢ab´mkCamYynUvB&t(manlMGitbEnæm.

Epñk O – B&t(manbEnæm