Form Visitor visa – Tourist stream 1419 CHS · Note: If this visa application is approved, the Australian visa associated with your ABTC will cease. Ö Ã U (' ¤ $ i ¥ ¼ È ö

1419 CHS (Design date 07/14) - Page 5© COMMONWEALTH OF AUSTRALIA, 2014

Form

1419 CHSCHINESE SIMPLIFIED

Application for a Visitor visa – Tourist stream

Tick where applicable

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

Up to 3 months

Up to 6 months

How long do you wish to stay in Australia?3

Up to 12 months

Note: The stay period granted may be less than the period requested. You should check the terms of any visa granted.

PHOTOGRAPH

Please attach a recent passport size photograph of yourself.

Outside Australia

In Australia

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

Go to Question 2 2

Go to Question 5 5

When do you wish to visit Australia?2 DAY MONTH YEAR

Applicants outside Australia

Give details

No

Yes

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

Go to Question 7 7

Go to Question 7 7

Specify the date you wish to extend your stay to

5

Applicants in Australia

Provide detailed reasons for requesting this further stay6

Date

to

from

DAY MONTH YEAR

1419 CHS (Design date 07/14) - Page 6 © COMMONWEALTH OF AUSTRALIA, 2014

10 Are you or have you been known by any other name? (including name at birth, previous married names, aliases)

Give details

No

Yes

Note: If this visa application is approved, your current visa may cease.Yes

Do you currently hold an Australian visa?11

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

Please provide your queue dateYes

List countries

Are you a citizen of any other country?14

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

Note: If this visa application is approved, the Australian visa associated with your ABTC will cease.

ABTC

8 Place of birth

Town/city

State/province

Country

9 Relationship status

Married

De facto

Engaged Divorced

Separated

Widowed

Never married or been in a de facto

relationship

Date of birth

Passport number

Country of passport

Nationality of passport holder

Date of issue

Date of expiry

Place of issue/issuing authority

Part A – Your detailsA 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.

7

Family name

Given names

Sex Male Female

Yes

Yes

No

No

No

No

DAY MONTH YEAR

DAY MONTH YEAR

DAY MONTH YEAR

Give details

Do you have other current passports?15

Passport number

Country of passport

Yes

No


Type of document

Identity number

Country of issue

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.

Fax number

Email address

( ) ( )

COUNTRY CODE AREA CODE NUMBER

20

POSTCODE

Your current residential address Note: A street address is required as a post office box address cannot be accepted.

21 Address for correspondence (If the same as your residential address, write ‘AS ABOVE’)

Country

Country

22 Contact telephone numbers

Home( ) ( )


Office( ) ( )

Mobile/cell

POSTCODE

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.

16

Family name

Given names

Give details

No

Yes

Give details

No

Yes19 What is the purpose of your stay in your current location and what isyour visa status?

17 In what country are you currently located?

Give details

18 What is your legal status in your current location?

Citizen

Visitor

Work visa

Other

Permanent resident

Student

No legal status


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

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

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

Part B – Family travelling to Australia with youB

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

If insufficient space, give details at Part OO


Yes

Give details

No

Yes

No


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

/ /

/ /

/ /

/ /


to you Address Citizen or permanent resident of Australia

DAY MONTH YEAR

/ /

/ /

/ /

/ /

If insufficient space, give details at Part O


O

O

Do you have any friends or contacts in Australia?28

No Yes

Give details

No

Yes

Give details

No

Yes

No Yes

No Yes

No Yes

No Yes

No Yes

No Yes

No Yes

Is it likely you will be travelling from Australia to any other country (eg. New Zealand, Singapore, Papua New Guinea) and back to Australia?26

Attach itinerary details

Part D – Details of your visit to AustraliaD

Yes

No


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

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?Do not include time spent in Australia.

31

Country(s)

Country(s)

Country(s)

1.

2.

3.

Part E – Health detailsE


32 Do you intend to enter a hospital or health care facility (including nursing homes) while in Australia?

Give details

No

Yes

Give details

No

Yes

Give details

No

Yes

Why do you want to visit Australia? Include details of any dates that are of special significance to your visit.

29


Date

Date

Date

to

to

to

from

from

from

DAY

DAY

DAY

MONTH

MONTH

MONTH

YEAR

YEAR

YEAR


35

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

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

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.

required hospital admission or oxygen therapy

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

Give details

No

Yes

Give details

No

Yes

Give details (including HAP ID if available) HAP ID

No

Yes

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

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?

Give details

No

Yes

Give details

No

Yes


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


Part F – Character details

38 Have you ever:

F

represent a risk to Australian national security?

Government or any public authority in Australia?

No Yes

No Yes

country (including any conviction which is now removed from official records)?

currently awaiting legal action?

other offence on the grounds of mental illness, insanity or unsoundness of mind?

country (including Australia)?

deported?

country (including Australia)?

No Yes

No Yes

No Yes

No Yes

No Yes

No Yes

commission of war crimes or crimes against humanity or human rights? No Yes

convicted of any offence, relating to the illegal movement of people to any country (including Australia)?

sponsored/private militia, undergone any military/paramilitary training, or been trained in weapons/explosives use (however described)?

No Yes

No Yes


Part G – Employment status

What is your employment status?39

Telephone number

Employed/self-employed Give details

Employer/business name

POSTCODE

Address

Position you hold

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

Retired Year of retirement

Student Give details

Your current course

Name of educational institution

How long have you been studying at this institution?

Other Give details

Unemployed

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

( ) ( )



Part H – Funding for stayH All 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.

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

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

Note: This includes support from an organisation.

41


to you Their address while you are in AustraliaType 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.

O

Give details

No

Yes


42

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

Have you ever:

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

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

Part I – Previous applicationsI

Please give details of the person who assisted you

No

Yes

43 Did you receive assistance in completing this form?

J Part J – Assistance with this form

Go to Part K K

Family name

Given names

Title: Mr Mrs Miss Ms Other

POSTCODE

Address

Telephone number or daytime contact

Office hours

Mobile/cell

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

Office of the MARA

45 Is the person/agent in Australia?

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

Part K – Options for receiving written communicationsK

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

Myself

956A

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

Authorised recipient

Migration agent

Exempt person

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

956

OR

OR

OR

No Yes

No Yes

No

Yes

No

Yes

Go to Part K K

No

Yes

( ) ( )


Go to Part K K


Part L – Payment detailsL

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.

www.immi.gov.au/fees-charges

AUD

AUD

AUD

AUD

AUD

AUD

AUD

AUD

AUD

Visa subclass you are applying for

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)

(1)

(2)

(3)

(4)

(5)

+

+

+

=

+

Additional Applicant Charge aged 18 years or over at the time your application is lodged18

Additional Applicant Charge under 18 years of age at the time your application is lodged18

Subsequent Temporary Application Charge (if applicable)

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

Total

=

=

=

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



18

Number of additional applicants aged 18 years or over

18

Number of additional applicants under 18 years of age

Number of applicants

Base Application Charge Write the amount shown on the reference table for your visa subclass

(multiplied by)

( )X

(multiplied by)

( )X

(multiplied by)

( )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.immi.gov.au/fees-charges/how-to-pay.htm

If applying in Australia, debit card or credit card are the preferred methods of payment. Debit cards cannot be used for applications lodged by mail. 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.

www.immi.gov.au/fees-charges/how-to-pay.htm debit card

money order the Department of Immigration and Border

Protection

Give details below

Bank cheque Money order

Debit card

Credit card

MasterCard

American Express

Visa

Diners Club

JCB

Payment by (tick one box) Australian Dollars

AUD

Credit card number

:

: : : :

MONTH

:

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

YEAR

Expiry date

Cardholder’s name

Address

POSTCODE

Signature of cardholder

Credit card information will be used for charge paying purposes only.

Telephone number

Cannot be used for applications lodged by mail

( ) ( )


As the cardholder I acknowledge and accept that a credit card surcharge may apply to the transaction.

✍

Part M – Application checklistM

50 With your completed and signed application form 1419, you must include:

1419

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

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

the Visa Application Charge (if applicable)

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)

1257


evidence of access to funds to support your stay

evidence of your medical/travel insurance (if requested)

medical examination or tests (if requested)

a letter from your employer confirming your leave

evidence of enrolment at school, college or university

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

a letter of invitation to visit

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

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:

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.

Additional documents

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

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)

1229

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; orform 956A Appointment or withdrawal of an authorised recipient

956

956A


51

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.

8503

1442i Privacy notice

1442i Privacy notice

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:

Part N – Declaration and consent


If insufficient space, attach additional details.

Question number Additional information52

Part O – Additional informationO

Signature of applicant

Date

DAY MONTH YEAR

We strongly advise that you keep a copy of your application and all attachments for your records.

✍

For offshore applicants who are required to provide their 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;

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

1958 2007

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