Working Australia

1150 (Design date 07/14) - Page 1© COMMONWEALTH OF AUSTRALIA, 2014

The Department of Immigration and Border Protection (thedepartment) acknowledges that Aboriginal and Torres StraitIslander peoples are the traditional custodians of the Australianland.

Life in Australia – Australian valuesThe Australian Government encourages people to gain anunderstanding of Australia, its people and their way of life,before applying for a visa to live in Australia. As part of thisapplication every person aged 18 years or over must declarethat they will respect Australian values, as outlined below andobey the laws of Australia.

Australian values include respect for the freedom anddignity of the individual, freedom of religion,commitment to the rule of law, Parliamentarydemocracy, equality of men and women and a spirit ofegalitarianism that embraces mutual respect, tolerance,fair play and compassion for those in need and pursuitof the public good.

Australian society also values equality of opportunityfor individuals, regardless of their race, religion orethnic background.

It is also important to understand that English is the nationallanguage.

Further information is contained in the Life in Australiabooklet, however, you are not required to read the booklet.The booklet is available in a wide range of languages. If youwould like a copy of the booklet it can be obtained from thedepartment’s website www.immi.gov.au

About this formImportant – Please read this information carefully before youcomplete your application. Once you have completed yourapplication we strongly advise that you keep a copy for yourrecords.

Note: Any reference in this form to ‘country’ refers to ‘foreigncountry’ which is defined in paragraph 22(1)(f) of the ActsInterpretation Act 1901 as any country (whether or not anindependent sovereign state) outside Australia and the externalTerritories.

Who should use this application?Applicants for a first or second Working Holiday (subclass 417)visa.

Each applicant must apply individually and cannot include familymembers in their application.

Online applicationsApplicants from the arrangement countries listed below under‘Arrangement Countries and Regions’ may apply on thedepartment’s website. Payment must be made by credit cardfor online applications. Further information is available fromthe department’s website www.immi.gov.au/visit/

If you wish to apply online do not use this application.

Integrity of applicationThe department is committed to maintaining the integrity of thevisa and citizenship programmes. In relation to this application,if you or any member of your family unit:

• provide, or have provided in a previous application, fraudulentdocuments or false or misleading information (knowingly ornot); and/or

• fail to satisfy, or have failed to satisfy in a previous application,the Minister of your or their identity;

this visa application may be refused and you, and any membersof your family unit, may become unable to be granted a visa forspecified periods of time, as set out in migration legislation.

If documents are found to be fraudulent or information to beincorrect after the grant of a visa, the visa may subsequently becancelled.

Visa overviewThe Working Holiday programme encourages cultural exchangeand closer ties between arrangement countries by allowing youngadults to have an extended holiday during which they may engagein short term work or study.

A Working Holiday visa allows the visa holder to:

• enter Australia within 12 months of the date of visa grant;

• stay in Australia for up to 12 months;

• leave and re-enter Australia any number of times while the visais valid;

• work in Australia for up to 6 months with each employer; and

• study for up to 4 months.

Arrangement countries and regionsAustralia currently has reciprocal Working Holiday arrangementswith:

• Belgium;

• Canada;

• Republic of Cyprus;

• Denmark;

• Estonia;

• Finland;

• France;

• Germany;

• Hong Kong Special Administrative Region (HKSAR) of thePeople’s Republic of China;

• Republic of Ireland;

• Italy;

• Japan;

• Republic of Korea;

• Malta;

• Netherlands;

• Norway;

• Sweden;

• Taiwan; and

• United Kingdom.

Information on whether any arrangements have been establishedwith additional countries, is available from www.immi.gov.au/visit/

Form

1150Application for a Working Holiday visa

1150 (Design date 07/14) - Page 2

Eligibility requirementsTo be granted a Working Holiday visa, there are a number ofeligibility requirements that applicants must meet.

All applicants must:

• be aged between 18 years and 30 years inclusive (at the timeyou apply);

• hold a passport from an eligible country, preferably valid forat least 6 months;

• not be accompanied by dependent children;

• be outside Australia when you apply and when the visa isgranted (except applicants for a second Working Holiday visa,who can apply while in Australia – see ‘Second WorkingHoliday visa’ below);

• not have previously entered Australia on a Work and Holiday(subclass 462) visa;

• not have previously entered Australia on a Working Holidayvisa (except applicants for a second Working Holiday visa –see ‘Second Working Holiday visa’ below);

• have sufficient funds (generally AUD5,000);

• have funds for a return or onward ticket to depart Australia(or an actual ticket);

• meet Australia’s health requirement – depending on thecountry you are from and your intentions in Australia (suchas entering a hospital, health care area, childcare centre orclassroom), you may need to undertake a health examination.More information is available fromwww.immi.gov.au/allforms/health-requirements/; and

• meet Australia’s character requirement. More information isavailable fromwww.immi.gov.au/allforms/character-requirements/.

Note: We recommend that you have health insurance to coveryour stay in Australia. This can be obtained in your homecountry or in Australia. More information is available fromwww.immi.gov.au/visit/.

Second Working Holiday visaThe second Working Holiday visa is available to people whohave undertaken work for a minimum of 3 months (88 days intotal) in a specified field or industry* in a designated area ofregional Australia** on a first Working Holiday visa.

Specified work is any type of work in the list below:

• plant and animal cultivation:

– the harvesting and/or packing of fruit and vegetable crops;

– pruning and trimming vines and trees;Note: This must be the primary employment task anddirectly associated with the cultivation and commercialsale of plant produce, such as fruit and nut crops(commercial horticultural activity). General gardenmaintenance is not eligible.

– general maintenance crop work;

– cultivating or propagating plants, fungi or their productsor parts;

– immediate processing of plant products;

– maintaining animals for the purpose of selling them ortheir bodily produce, including natural increase;Note: Maintaining animals for tourism or recreationalpurposes is not eligible.

– immediate processing of animal products includingshearing, butchery in an abattoir, packing and tanning;Note: Secondary processing of animal products, such assmallgoods processing and retail butchery is not eligible.

– manufacturing dairy produce from raw material.

• fishing and pearling:

– conducting operations relating directly to taking orcatching fish and other aquatic species;

– conducting operations relating directly to taking orculturing pearls or pearl shell.

• tree farming and felling:

– planting or tending trees in a plantation or forest that areintended to be felled;

– felling trees in a plantation or forest;

– transporting trees or parts of trees that were felled in aplantation or forest to the place where they are first to bemilled or processed or from which they are to betransported to the place where they are to be milled orprocessed.

• mining:

– coal mining;

– oil and gas extraction;

– metal ore mining;

– construction material mining;

– non-metallic mineral mining and quarrying;

– exploration;

– mining support services.

• construction:

– residential building construction;

– non-residential building construction;

– heavy and civil engineering construction;

– land development and site preparation services;

– building structure services;

– building installation services;

– building completion services;

– other construction services.

Specified work:

• must be an activity listed above.

• must be the primary role / function / activity performedduring your employment.

• work undertaken in the mining and construction sectorsmust appear in the Australian and New Zealand StandardIndustrial Classification (ANZSIC) division for these sectorsto meet the specified work requirement.

For information regarding ANZSIC Mining Division and ANZSICConstruction Division see the department’s websitewww.immi.gov.au/visas/pages/417.aspx

In addition to the eligibility requirements for a first WorkingHoliday visa (see ‘Eligibility requirements’ above), applicantsfor a second Working Holiday must also have:

• entered Australia on no more than one Working Holiday visapreviously; and

• done specified work in regional Australia for a minimum of3 months (88 days in total) while holding a Working Holidayvisa.

You can apply while you hold a first Working Holiday visa, or ata later date.

© COMMONWEALTH OF AUSTRALIA, 2014

* For further information please see ‘Specified work’www.immi.gov.au/visas/pages/417.aspx

** ‘Regional Australia’ is restricted to areas within thepostcodes listed in the table on page 3.

1150 (Design date 07/14) - Page 3

Applications can be made either in Australia or outside Australia.If you apply in Australia, you should lodge your applicationbefore your current visa ceases, and must be in Australia for thevisa to be granted. If you apply outside Australia, you must beoutside Australia for the visa to be granted.

If you apply for a second Working Holiday visa, you will need toprovide evidence that you have worked for a minimum of3 months doing specified work in regional Australia (seepostcode table for areas defined as regional Australia).

Acceptable evidence includes:

• a completed form 1263 Working Holiday visa: Employmentverification, signed by your employer(s), which you canobtain from the nearest office of the department or fromwww.immi.gov.au/allforms/; and/or

• an original or certified copies of payslips, group certificates,payment summaries, tax returns, employer references and/oran original Australian bank statement covering the period ofdeclared specified work.

Note: Providing form 1263 and additional evidence will allowyour application to be assessed more quickly.

Eligible regional Australia postcodes

How much does the visa cost?Refer to Part G – Payment details of this form to calculate thecorrect charge and make payment.

Refer to www.immi.gov.au/fees-charges for a complete andcurrent list of applicable fees and charges.

Fees and charges may be subject to change at any time andthis may increase the cost of a visa application.

Generally, Visa Application Charges are reviewed on 1 Julyeach year, and the exchange rates used to calculate theamount payable in a foreign country are updated on 1 Januaryand 1 July each year.

If you do not pay the full Visa Application Charge amount,your visa application will not be valid.

Charges are generally not refundable, even if the application iswithdrawn or refused.

Method of paymentIn Australia

To make a payment, please pay by credit card, debit card, bankcheque or money order made payable to the Department ofImmigration and Border Protection. Debit card and credit cardare the preferred methods of payment.

Outside Australia

Before making a payment outside Australia, please check withthe Australian Government office where you intend to lodgeyour application as to what methods of payment and currenciesthey can accept and to whom the payment should be madepayable.

How to apply

Step 1

Complete this application form.

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

You must provide the address where you intend to live whileyour application is being dealt with. Failure to give a residentialaddress in your application will result in your application beinginvalid. A post office box address will not be accepted as yourresidential address.

Step 2

Refer to Part G – Payment details of this form to calculate thecorrect charge and make payment. Ensure that payment orevidence of payment is included with this application.

Step 3

Lodge your completed application with the correct VisaApplication Charge, and required attachments (see Applicationchecklist on page 6 of this form) as outlined below.

All applicants for a first Working Holiday visa can lodge theirapplication by posting, faxing or hand delivering this form toany Australian Immigration office overseas. Seewww.immi.gov.au/help/pages/help-and-support.aspx.

Applications for a second Working Holiday visa cannot be madein person. More information about Working Holiday visas andlodgement addresses is available from the department’s websitewww.immi.gov.au/visas/pages/417.aspx. Please read theinformation under ‘How to apply’ for the correct lodgementaddress for this application.

© COMMONWEALTH OF AUSTRALIA, 2014

2311 to 23122328 to 24112420 to 24902536 to 25512575 to 25942618 to 27392787 to 2898

Northern Territory Entire Territory

4124 to 4125413342114270 to 427242754280428542874307 to 4499451045124515 to 45194522 to 4899

South Australia Entire State

Tasmania Entire State

31393211 to 33343340 to 34243430 to 36493658 to 37493753, 3756, 3758, 3762, 37643778 to 37813783, 3797, 37993810 to 39093921 to 39253945 to 397439793981 to 3996

6041 to 60446083 to 60846121 to 61266200 to 6799

Information about harvest work opportunities in regionalAustralia is available from the Harvest Trail websitewww.jobsearch.gov.au/harvesttrail

Note: Some vacancies on the Harvest Trail website may not bein the above eligible postcodes.

Regional areas Postcodes

New South Wales(most areas except the greaterSydney area, Newcastle, theCentral Coast and Wollongong)

Queensland(most areas except the greaterBrisbane area and the Gold Coast)

Victoria(most areas except thegreater Melbourne area)

Western Australia(most areas except Perth andsurrounding areas)

1150 (Design date 07/14) - Page 4 © COMMONWEALTH OF AUSTRALIA, 2014

Migration agents outside Australia

Migration agents who operate outside Australia do not have tobe registered. The department may give some overseas agentsan ID number. This number does not mean that they areregistered.

Note: Some Australian registered migration agents operateoverseas.

Migration agent information

A migration agent is someone who can:

• advise you on the visa that may best suit you;

• tell you the documents you need to submit with yourapplication;

• help you fill in the application and submit it; and

• communicate with the department on your behalf.

If you appoint a migration agent, the department will assumethat your migration agent will be your authorised recipient,unless you indicate otherwise.

Your migration agent will be the person with whom thedepartment will discuss your application and from whom it willseek further information when required.

You are not required to use a migration agent. However, if youuse a migration agent, the department encourages you to usea registered migration agent. Registered agents are bound bythe Migration Agents Code of Conduct, which requires them toact professionally in their clients’ lawful best interests.

Information on migration agents, including a list of registeredmigration agents, is available on the Office of the MARA websitewww.mara.gov.au

You can also access information about migration agents on thedepartment’s website www.immi.gov.au

Exempt persons

The following people do not have to be a registered migrationagent in order to provide immigration assistance, but they mustnot charge a fee for their service:

• a close family member (spouse, de facto partner, child,parent, brother or sister);

• a member of parliament or their staff;

• an official whose duties include providing immigrationassistance (eg. a Legal Aid provider);

• a member of a diplomatic mission, consular post orinternational organisation.

Appointing a migration agent/exempt person

To appoint a migration agent/exempt person you shouldcomplete Part F – Options for receiving writtencommunications.

Your migration agent/exempt person should complete form 956Advice by a migration agent/exempt person of providingimmigration assistance.

Form 956 is available from the department’s websitewww.immi.gov.au/allforms/

Options for receiving written communicationsIf you do not appoint a migration agent/exempt person youmay still authorise another person, in writing, to receive writtencommunications on your behalf. This person is called theauthorised recipient.

What happens next?Your application will be assessed. You may be asked to provideadditional information to enable a decision to be made. You willbe advised in writing whether your application has beenapproved. If your application is refused, you will be given reasonsfor the decision.

You should not make any irreversible travel arrangementsuntil you receive written advice of the department’sdecision on your application.

Activating your Working Holiday visaIf you applied for your Working Holiday visa outside Australia,your 12 month stay period starts when you enter Australia. Your12 month stay period will start if you pass through immigrationclearance in Australia (the counter where you present yourpassenger card and passport), even if you are in transit or holdan Electronic Travel Authority or Maritime Crew visa.

If you are intending to transit or travel to Australia, and you donot want to start your Working Holiday visa, you should delayapplying for this visa until you wish to commence your workingholiday.

Important – change of personal/passport detailsIf you wish to change any details after you lodge your application,including your passport details, or if you wish to withdraw theapplication, please contact the department as follows:

• First Working Holiday visa applicants – Contact theAustralian Government office where you lodged yourapplication. Contact details for offices of the department areavailable on the department’s websitewww.immi.gov.au/help/pages/help-and-support.aspxor if you lodged your application online [email protected]

• Second Working Holiday visa applicants – [email protected]

Your Working Holiday visa application is linked to the passportnumber provided in your application. If you are granted aWorking Holiday visa, but do not provide the departmentwith the details of any new passport you use to travel toAustralia, you will experience significant delays at theairport and could be denied permission to board yourplane.

Immigration assistanceA person gives immigration assistance to you if he or she uses,or claims to use, his or her knowledge or experience in migrationprocedure to assist you with your visa application, request forministerial intervention, cancellation review application,sponsorship or nomination.

In Australia a person may only lawfully give immigrationassistance if he or she is a registered migration agent or is exemptfrom being registered. Only registered migration agents mayreceive a fee or reward for providing immigration assistance.

If an unregistered person in Australia, who is not exempt fromregistration, gives you immigration assistance they arecommitting a criminal offence and may be prosecuted.

Migration agents in Australia

Migration agents in Australia must be registered with the Officeof the Migration Agents Registration Authority (Office of theMARA) unless they are exempt from registration.


Telephone 131 881 during business hoursin Australia to speak to an operator (recordedinformation available outside these hours).If you are outside Australia, please contactyour nearest Australian mission.

Generalenquiry line

Home page www.immi.gov.au

Application checklistThis checklist is provided for your assistance and lists therequired documents to include with your application. It is nota requirement of your application and does not apply to onlineapplications.

Note: Processing of your application will be delayed if you donot provide all the required information and documents at thetime of lodgement.

Note: Certified copies are copies authorised, or stamped asbeing true copies or originals, by a person or agency recognisedby the law of the country in which you currently resideeg. police or notary.

Note: If your documents are in a language other than English,translations into English must be provided.

A certified copy of the pages of your passportcontaining your photo and personal details(Note: Your passport should preferably be validfor at least 6 months).

The Visa Application Charge (for the currentWorking Holiday Visa Application Charge, referto the department’s websitewww.immi.gov.au/fees-charges)

�TICK when completed.

If you are applying for a second WorkingHoliday visa:

Evidence of your specified work in regionalAustralia, which may include a completed andsigned form 1263 Working Holiday visa:Employment verification, and/or original orcertified copies of payslips, groupcertificates, payment summaries, tax returns,employer references and an original Australianbank statement covering the period of declaredspecified work.

A list of offices of the department in Australia is available fromwww.immi.gov.au/help/pages/help-and-support.aspx

Further information about the Working Holiday visa is availablefrom www.immi.gov.au/visit/

If you are authorising another person to actand receive communications on your behalf,complete Part F – Options for receiving writtencommunications on page 10 and form 956Appointment of a migration agent or exemptagent or other authorised recipient.

Authorised recipient information

All written communication about your application will be sent toyour authorised recipient, unless you indicate that you wish tohave health and/or character information sent directly to you.

The department will communicate with the most recentlyappointed authorised recipient as you may only appoint oneauthorised recipient at any time for a particular application.

You will be taken to have received any documents sent to thatperson as if they had been sent to you.

To appoint an authorised recipient you should complete:

• Part F – Options for receiving written communications; and

• form 956A Appointment or withdrawal of an authorisedrecipient.

Note: Migration agents/exempt persons do not need tocomplete form 956A.

Form 956A is available from the department’s websitewww.immi.gov.au/allforms/

Consent to communicate electronicallyThe department may use a range of means to communicatewith you. However, electronic means such as fax or email willonly be used if you indicate your agreement to receivingcommunication in this way.

To process your application the department may need tocommunicate with you about sensitive information, for example,health, police checks, financial viability and personalrelationships. Electronic communications, unless adequatelyencrypted, are not secure and may be viewed by others orinterfered with.

If you agree to the department communicating with you byelectronic means, the details you provide will only be used bythe department for the purpose for which you have providedthem, unless there is a legal obligation or necessity to use themfor another purpose, or you have consented to use for anotherpurpose. They will not be added to any mailing list.

The Australian Government accepts no responsibility for thesecurity or integrity of any information sent to the departmentover the internet or by other electronic means.

If you authorise another person to receive documents on yourbehalf and they wish to be contacted electronically, theirsignature is required on form 956 or 956A to indicate theirconsent to this form of communication.

Note: Electronic communication is the fastest means ofcommunication available and the department prefers tocommunicate electronically because this results in fasterprocessing.

Important information about privacyYour personal information is protected by law, including thePrivacy Act 1988. Important information about the collection,use and disclosure (to other agencies and third parties,including overseas entities) of your personal information,including sensitive information, is contained in form 1442iPrivacy notice. Form 1442i is available from the department’swebsite www.immi.gov.au/allforms/ or offices of thedepartment. You should ensure that you read and understandform 1442i before completing this form.

Please keep these information pages for your reference

This page is intentionally blank


1

Yes

No

Part A – Your details

Your full name exactly as it appears on the passport on which you willbe travelling to Australia

2

Family name

Given names

Have you been known by any other names?(including name at birth, previous married names, aliases)

Give details

Sex3 Male Female

Date of birth4

Place of birth5

Town/city

Country

Form

1150Application for a Working Holiday visa

Details from your passport

DAY MONTH YEAR

Passport number

Country ofpassport

Date of issue

Issuing authority/Place of issue asshown in yourpassport

DAY MONTH YEAR

Date of expiry

Note: Any reference in this form to ‘country’ refers to ‘foreign country’ whichis defined in paragraph 22(1)(f) of the Acts Interpretation Act 1901 as anycountry (whether or not an independent sovereign state) outside Australia andthe external territories.

Note: Visa applicants must hold a valid passport to be granted a visa. Itis recommended that the passport be valid for at least 6 months.

If you change your passport after you have been granted the visa youmust notify the nearest Australian mission or office of the department.

If you do not provide the department with the details of any newor additional passport you use to travel to Australia, you willexperience significant delays at the airport and could be deniedpermission to board your plane.

Do you hold any citizenship other than that shown asyour country of passport above?

YesNo Give details

7

9

If you hold more than one passport please provide details ofthose passports

Passport number

Country ofpassport

Date of issue

Date of expiry

DAY MONTH YEAR

Details of identity card or identity number issued to you by yourgovernment (if applicable) eg. National identity card.Note: If you are the holder of multiple identity numbers because you area citizen of more than one country, you need to enter the identity numberon the card from the country that you live in.

Identity number

Country of issue

Issuing authority/Place of issue asshown in yourpassport

Your full name as it appears in the passport

Family name

Given names

8

Relationship status6Married Never married or

been in a de factorelationship

Separated

De facto

Engaged

Widowed

Divorced

Tick where applicable �

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


Part B – Previous applications

11 What type of employment do you intend to seek during your stay?

If you are applying for a second Working Holiday visa, have youundertaken 3 months of specified work in regional Australia on aWorking Holiday (subclass 417) visa? (See postcode table on page 3for areas defined as regional Australia)

23

Please attach evidence of 3 months of specified work inregional Australia.

Yes

No You are not eligible to apply for a second Working Holidayvisa.

Note: Acceptable evidence of 3 months of specified work in regionalAustralia may be any of the following (providing evidence will allow yourapplication to be assessed more quickly):

• completed form 1263 Working Holiday visa: Employment verification;and/or

• certified copies of payslips, tax returns, group certificates, employerreferences and an original Australian bank statement covering theperiod of declared specified work.

Qualifications12

Usual occupation10

Have you previously been to Australia, applied for a visa, held or currentlyhold a visa for travel to Australia (including a Working Holiday visa)?

21

Yes

No

Current residential address(If applying in Australia, please give your current address in Australia)Note: A post office box address is not acceptable as a residentialaddress. Failure to give a residential address will result in your applicationbeing invalid.

13

POSTCODE

Address for correspondence(This may be required by the department to communicate with youabout your application. If the same as your residential address, write‘AS ABOVE’)

14

POSTCODE

16 Do you agree to the department communicating with you by fax,email, or other electronic means? (Providing an email address will allowfor more efficient processing of your application)

Give details

Email address

Fax number ( )

COUNTRY CODE AREA CODE

( )

NUMBER

Your telephone numbers15

Office hours

After hours

( )


( )

NUMBER

( ) ( )

If you are outside Australia, date ofproposed travel to Australia

17 DAY MONTH YEAR

Yes

No

Mobile/cell

Do you have sufficient funds for the initial period of your stay in Australia?Note: You may be asked to provide evidence (eg. bank statement).

18

No

Please ensure you have access to this email while your applicationis being processed

Give full details including type of visa(s), place(s) ofapplication and date(s) of entry to Australia (if applicable)

Have you previously had an Australian visa cancelled, been detainedin Australia, removed or deported from Australia, or refused entryinto Australia?

22

Yes

No

Give full details

Yes

Do you have a return or onward ticket or the funds for a fare to departAustralia?WARNING: You may be asked to provide evidence.

19

No

Do you have any dependent children that will accompany you to Australia?20No

Yes

Yes

Note: You cannot be accompanied by dependent children on this visa.


Part C – Health

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

24

Yes

No

Give details

Country(s)

DateDAY MONTH YEAR DAY MONTH YEAR

tofrom

1.

2.

3.


tofrom


tofrom

Country(s)

Country(s)

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

25

Yes

No

Give details

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

26

Yes

No

Give details

Do you intend to work, or be a trainee, at a child care centre (includingpreschools and creches) while in Australia?

27

Yes

No

Give details

Do you intend to be in a classroom situation for more than 3 months(eg. as either a student, teacher, lecturer, or observer)?

28

Yes

No

Give details

Have you:

• ever had, or currently have, tuberculosis?

• been in close contact with a family member that has activetuberculosis?

• ever had a chest x-ray which showed an abnormality?

29

Yes

No

Give details

Do you require assistance with mobility or care due to a medicalcondition?

31

Yes

No

Give details

30 During your proposed visit to Australia, do you expect to incur medicalcosts, 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 requiredhospital admission or oxygen therapy;

• other?

Yes

No

Give details

32 Have you undertaken a health examination for an Australian visa in thelast 12 months?

Yes

No

Give details (including HAP ID if available)

34 Have you ever:

If you answered ‘Yes’ to any of the above questions you must give allrelevant details in the space provided below.

If the matter relates to a criminal conviction, please give the nature ofthe offence, full details of sentence, dates of any period of imprisonmentor other detention and a personal account of the events leading up toand including the offence(s).


Part D – Character

• been convicted of a crime or offence in anycountry (including any conviction which isnow removed from official records)?

• been charged with any offence that iscurrently awaiting legal action?

• been acquitted of any criminal offence orother offence on the grounds of mentalillness, insanity or unsoundness of mind?

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

• left any country to avoid being removedor deported?

• been refused a visa for Australia or anothercountry?

• been excluded from or asked to leave anycountry (including Australia)?

• committed, or been involved in thecommission of war crimes or crimes againsthumanity or human rights abuses?

• been involved in any activities that wouldrepresent a risk to Australian national security?

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

• been involved in any activity, or been convictedof any offence, relating to the illegal movementof people to any country (including Australia)?

• served in a military force or statesponsored/private militia, undergone anymilitary/paramilitary training, or been trainedin weapons/explosives use (howeverdescribed) other than in the course ofcompulsory national military service?

Do you hold health insurance to cover your stay in Australia?Note: See page 2 of this form for further information about healthinsurance.

33

Yes

No

Part F – Options for receiving writtencommunications

Part E – Assistance with this form

Is the person an agent registered with the Office of the Migration AgentsRegistration Authority (Office of the MARA)?

36

Yes

No

Go to Part F

Did you receive assistance in completing this form?35

Yes

No

Please give details of the person who assisted you

Did you pay the person/agent and/or give a gift for this assistance?38

Yes

No

Go to Part F

Mr Mrs Miss MsTitle: Other

Family name

Given names

Address

Telephone number or daytime contact

Office hours

Mobile/cell

Email address

( )


( )

NUMBER

Is the person/agent in Australia?37

Yes

No Go to Part F

POSTCODE

39

Myself

Migration agent

Authorisedrecipient

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

Exempt person

You should complete form 956A Appointmentor withdrawal of an authorised recipient

OR

Your migration agent/exempt person shouldcomplete form 956 Advice by a migrationagent/exempt person of providingimmigration assistance

OR

OR

YesNo

YesNo

YesNo

YesNo

YesNo

YesNo

YesNo

YesNo

YesNo

YesNo

YesNo

YesNo

Do you have the application charge to include with your application?(To check the application charge, refer to the department's websitewww.immi.gov.au/fees-charges or check with the nearest office ofthe department.)

40

Yes

No This application will be returned to you as a valid applicationwill not have been made

Part G – Payment details


42

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.

41

Visa subclass you are applying for

Base Application Charge

Write the amount shown on the reference table for your visa subclass AUD (1)

+

AUD (2)Non-internet Application Charge (if applicable)

+

AUD (3)

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

AUD

Write the amount shown on thereference table for your visa subclass

X (multiplied by) =

Number of additional applicantsaged 18 years or over

+

AUD (4)

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


X (multiplied by) =

Number of additional applicantsunder 18 years of age

+

AUD (5)

Subsequent Temporary Application Charge (if applicable)


X (multiplied by) =

Number of applicants

=

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

Total

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 bepaid before we can grant some visas.

AUD

AUD

Payment by (tick one box)

MasterCard

Visa

Diners Club

JCB

Australian Dollars

AUD

Expiry date

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

Signature ofcardholder

Address

Telephonenumber

Cardholder’s name

Credit card number

Bank cheque

Money order

Credit card Give details below

American Express

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

Debit card

:MONTH YEAR

:

( )


( )

NUMBER

POSTCODE

Cannot be used for applications lodged by mail

�

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.htmIf 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 methodsof payment and currencies they can accept and to whom the payment should be made payable.

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

WARNING: Giving false or misleading information or documents is aserious offence.

I declare that:

• the information on this form is complete, correct and up-to-date;

• I have read the notes at the front of this application, and am awarethat I am required to abide by the conditions that are placed on myvisa;

• after applying, I will notify the department of any change in mycircumstances, including my address details;

• I will respect Australian values as listed on this form, during my stayin Australia and will obey the laws of Australia;

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

• I understand the department may collect, use and disclose mypersonal information (including biometric information and othersensitive information) as outlined in form 1442i Privacy notice;

• I understand that if any fraudulent documents or false or misleadinginformation has been provided with this application, or if I fail to satisfythe Minister of my identity, my application may be refused and I, andany other member of my family unit, may become unable to be granteda visa for specified periods of time; and

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

For offshore applicants who are required to provide their fingerprints andfacial image:

• I understand that my fingerprints and facial image and my biographicalinformation held by the department may be given to Australian lawenforcement agencies to help identify me, to help determine myeligibility for grant of the visa I have applied for, and for lawenforcement purposes.

• I consent to:

– Australian law enforcement agencies disclosing my biometric,biographical and criminal record information to the department forany of the purposes outlined above; and

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

43

Date

Signature ofapplicant

DAY MONTH YEAR

Part H – Declaration and consent


Please check all questions are answered. If your form isincomplete, there may be delays in processing your application.

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

�

Documents

Working Australia