Fill and Sign the Authorization for Release of Protected Health Information Phi

Form Application for a Work and Holiday visa The Department of Immigration and Border Protection (the department) acknowledges that Aboriginal and Torres Strait Islander peoples are the traditional custodians of the Australian land. Life in Australia – Australian values The Australian Government encourages people to gain an understanding of Australia, its people and their way of life, before applying for a visa to live in Australia. As part of this application every person aged 18 years or over must declare that they will respect Australian values, as outlined below and obey the laws of Australia. Australian values include respect for the freedom and dignity of the individual, freedom of religion, commitment to the rule of law, Parliamentary democracy, equality of men and women and a spirit of egalitarianism that embraces mutual respect, tolerance, fair play and compassion for those in need and pursuit of the public good. Australian society also values equality of opportunity for individuals, regardless of their race, religion or ethnic background. It is also important to understand that English is the national language. Further information is contained in the Life in Australia booklet, however, you are not required to read the booklet. The booklet is available in a wide range of languages. If you would like a copy of the booklet it can be obtained from www.immi.gov.au About this form Important – Please read this information carefully before you complete your application. Once you have completed your application we strongly advise that you keep a copy for your records. Note: Any reference in this form to ‘country’ refers to ‘foreign country’ which is defined in paragraph 22(1)(f) of the Acts Interpretation Act 1901 as any country (whether or not an independent sovereign state) outside Australia and the external territories. Who should use this application? Applicants applying for a Work and Holiday (subclass 462) visa. Each applicant must apply individually and cannot include family members in their application. 1208 Integrity of application The department is committed to maintaining the integrity of the visa and citizenship programs. Please be aware that if you provide us with fraudulent documents or claims, this may result in processing delays and possibly your application being refused. Visa overview The Work and Holiday visa program encourages cultural exchange and closer ties between arrangement countries by allowing young people to have an extended holiday supplemented by short-term employment. A Work and 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 visa is valid; • work in Australia for up to 6 months with each employer; and • study for up to 4 months. Arrangement countries Australia currently has reciprocal Work and Holiday arrangements with: • Argentina; • Bangladesh; • Chile; • Indonesia; • Malaysia; • Thailand; • Turkey; • the USA; and • Uruguay. Note: There is an annual limit to the number of visas that may be issued to applicants from: • Argentina; • Bangladesh; • Chile; • Indonesia; • Malaysia; • Thailand; • Turkey; and • Uruguay. Online applications If the limit has been reached, applicants will be notified and the processing of their application may be delayed. Applicants from the United States of America (USA) may apply on the department’s website. Payment must be made by credit card for online applications. Further information is available from the department’s website www.immi.gov.au/visitors/ Australia continues to negotiate Work and Holiday arrangements with additional countries. To see whether any arrangements have been established with additional countries, check the department’s website www.immi.gov.au/visitors/ If you wish to apply online do not use this application. © COMMONWEALTH OF AUSTRALIA, 2014 1208 (Design date 03/14a) - Page 1 Eligibility requirements Bangladesh To be granted a visa, there are a number of eligibility requirements that applicants must meet. All applicants must: • be aged between 18 years and 30 years inclusive (at the time you apply); • hold a passport from an eligible country, preferably valid for at least 6 months; • have functional English; • meet education requirements (see tables on pages 2 and 3); • not be accompanied by dependent children; • be outside Australia when you apply and when the visa is granted; • not have entered Australia on a Work and Holiday (subclass 462) or Working Holiday (subclass 417) visa; • have sufficient funds (generally AUD5,000); • have funds for a return or onward ticket to depart Australia (or an actual ticket); • have health insurance (recommended) covering your stay in Australia. This can be obtained in your home country or in Australia. More information is available from www.immi.gov.au/visitors; • meet Australia’s health requirement – depending on the country you are from and your intentions in Australia (such as entering a hospital, health care area, childcare centre or classroom), you may need to undertake a medical examination. More information is available from www.immi.gov.au/allforms/health-requirements/; and • meet Australia’s character requirement. More information is available from www.immi.gov.au/allforms/character-requirements/ Tertiary qualifications include a: • Doctoral degree; • Masters degree; • Graduate diploma; • Graduate certificate; • Bachelor degree; • Associate degree; • Advanced diploma; • Diploma level qualifications. Note: Tertiary qualifications do not include: • Certificate IV; • Certificate III; • Certificate II; • Certificate I; • Senior Secondary Certificate of Education. Chile Hold tertiary qualifications, or have successfully completed at least 2 years of undergraduate university study. Hold tertiary qualifications or have satisfactorily completed or have been approved to undertake a third year of undergraduate university study. Tertiary qualifications include a: • Doctoral degree; • Masters degree; • Graduate diploma; • Graduate certificate; • Bachelor degree; • Associate degree; • Advanced diploma; • Diploma; • Certificate IV; • Certificate III level qualifications. Applicants from Argentina, Bangladesh, Chile, Indonesia, Malaysia, Thailand, Turkey and Uruguay must also: • provide a letter of approval from your government agreeing to your stay in Australia under the Work and Holiday visa arrangement (the letter of support does not guarantee a place in the Work and Holiday program); and • provide proof of English proficiency. Argentina Hold tertiary qualifications, or have successfully completed at least 2 years of undergraduate university study. Note: Tertiary qualifications do not include: • Certificate II; • Certificate I; • Senior Secondary Certificate of Education. Indonesia Hold tertiary qualifications, or have successfully completed at least 2 years of undergraduate university study. Tertiary qualifications include a: • Doctoral degree; • Masters degree; • Graduate diploma; • Graduate certificate; • Bachelor degree; • Associate degree; • Advanced diploma; • Diploma level qualifications. Tertiary qualifications include a: • Doctoral degree; • Masters degree; • Graduate diploma; • Graduate certificate; • Bachelor degree; • Associate degree; • Advanced diploma; • Diploma level qualifications. Note: Tertiary qualifications do not include: • Certificate IV; • Certificate III; • Certificate II; • Certificate I; • Senior Secondary Certificate of Education. Note: Tertiary qualifications do not include: • Certificate IV; • Certificate III; • Certificate II; • Certificate I; • Senior Secondary Certificate of Education. 1208 (Design date 03/14a) - Page 2 © COMMONWEALTH OF AUSTRALIA, 2014 Malaysia Hold tertiary qualifications, or have successfully completed at least 2 years of undergraduate university study. Uruguay Tertiary qualifications include a: • Doctoral degree; • Masters degree; • Graduate diploma; • Graduate certificate; • Bachelor degree; • Associate degree. Thailand Note: Tertiary qualifications do not include: • Advanced diploma; Tertiary qualifications include a: • Doctoral degree; • Masters degree; • Graduate diploma; • Graduate certificate; • Bachelor degree; • Associate degree; • Advanced diploma; • Diploma level qualifications. • • • • • • Note: Tertiary qualifications do not include: • Certificate IV; • Certificate III; • Certificate II; • Certificate I; • Senior Secondary Certificate of Education. Diploma level qualifications; Certificate IV; Certificate III; Certificate II; Certificate I; Senior Secondary Certificate of Education. Hold tertiary qualifications. How much does the visa cost? Tertiary qualifications include a: • Doctoral degree; • Masters degree; • Graduate diploma; • Graduate certificate; • Bachelor degree; • Associate degree; • Advanced diploma; • Diploma level qualifications. Refer to Part G – Payment details of this form to calculate the correct charge and make payment. Refer to www.immi.gov.au/fees-charges for a complete and current list of applicable fees and charges. Fees and charges may be subject to change at any time and this may increase the cost of a visa application. Note: Tertiary qualifications do not include: • Certificate IV; • Certificate III; • Certificate II; • Certificate I; • Senior Secondary Certificate of Education. Turkey United States of America Hold tertiary qualifications, or have successfully completed at least 2 years of undergraduate university study. Generally, Visa Application Charges are reviewed on 1 July each year, and the exchange rates used to calculate the amount payable in a foreign country are updated on 1 January and 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 is withdrawn or refused. Hold tertiary qualifications, or have successfully completed at least 2 years of undergraduate university study. Method of payment Tertiary qualifications include a: • Doctoral degree; • Masters degree; • Graduate diploma; • Graduate certificate; • Bachelor degree; • Associate degree; • Advanced diploma; • Diploma level qualifications. Before making a payment outside Australia, please check with the Australian Government office or Visa Application Centre 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. Note: Tertiary qualifications do not include: • Certificate IV; • Certificate III; • Certificate II; • Certificate I; • Senior Secondary Certificate of Education. Please use a pen, and write neatly in English using BLOCK LETTERS. Hold a Senior Secondary Certificate of Education or equivalent. Step 2 Outside Australia How to apply Step 1 Complete this application. You must provide the address where you intend to live while your application is being processed. Failure to give a residential address in your application will result in your application being invalid. A post office box address will not be accepted as your residential address. Refer to Part G – Payment details of this form to calculate the correct charge and make payment. Ensure that payment or evidence of payment is included with this application. © COMMONWEALTH OF AUSTRALIA, 2014 1208 (Design date 03/14a) - Page 3 Contact the Australian Government office or Visa Application Centre in the country which issued your passport to confirm application arrangements (eg. whether there are any additional local requirements). More information is available from www.immi.gov.au/contacts/overseas/ Your Work and Holiday visa application is linked to the passport number provided in your application. If you are granted a visa, but do not provide the department with the details of any new passport you use to travel to Australia, you will experience significant delays at the airport and could be denied permission to board your plane. Step 4 Immigration assistance Lodge your completed application with the correct Visa Application Charge, and required attachments (see Application checklist on page 6 of this application) as outlined below. A person gives immigration assistance to you if he or she uses, or claims to use, his or her knowledge or experience in migration procedure to assist you with your visa application, request for ministerial intervention, cancellation review application, sponsorship or nomination. Step 3 Applicants from the USA can lodge their application by post, fax or hand delivering this application to any Australian Immigration office overseas. Applicants from Argentina, Chile, Indonesia, Thailand and Turkey can lodge their application by post, fax or hand delivering this application to the Australian Immigration office in their country of passport. Applicants from Uruguay can lodge their application by post, fax or hand delivering this application to the Australian Immigration office in Argentina. Do not send cash or your passport with your application. Applicants from Bangladesh or Malaysia need to provide their biometrics (fingerprints scan and facial photograph) at a Visa Application Centre when lodging an application. More information is available from www.immi.gov.au/contacts/overseas/ If you lodge your application with the Australian Immigration Office in Dkaha, Bangladesh or Kuala Lumpur, Malaysia you will be required to attend a Visa Application Centre in person to provide your biometrics. In Australia a person may only lawfully give immigration assistance if he or she is a registered migration agent or is exempt from being registered. Only registered migration agents may receive a fee or reward for providing immigration assistance. If an unregistered person in Australia, who is not exempt from registration, gives you immigration assistance they are committing a criminal offence and may be prosecuted. Migration agents in Australia Migration agents in Australia must be registered with the Office of the Migration Agents Registration Authority (Office of the MARA) unless they are exempt from registration. Migration agents outside Australia Migration agents who operate outside Australia do not have to be registered. The department may give some overseas agents an ID number. This number does not mean that they are registered. Note: Some Australian registered migration agents operate overseas. What happens next? Your application will be assessed. You may be asked to provide additional information to enable a decision to be made. You will be advised in writing whether your application has been approved. If your application is refused, you will be given reasons for the decision. You should not make any irreversible travel arrangements until you receive written advice of the department’s decision on your application. Note: If you are granted an Electronic Travel Authority (ETA) or Maritime Crew visa (MCV) as well as a Work and Holiday visa, you will activate the Work and Holiday visa on arrival in Australia, rather than the ETA or MCV. This will activate the 12 month stay period of the Work and Holiday visa, which will not be able to be postponed or deferred. If you want to travel on the ETA or MCV, you must have your Work and Holiday visa cancelled before travelling to Australia. You will be able to apply for a Work and Holiday visa in the future, provided you meet the eligibility requirements. 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 your application; • 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 assume that your migration agent will be your authorised recipient, unless you indicate otherwise. Your migration agent will be the person with whom the department will discuss your application and from whom it will seek further information when required. Important – change of personal/passport details You are not required to use a migration agent. However, if you use a migration agent, the department encourages you to use a registered migration agent. Registered agents are bound by the Migration Agents Code of Conduct, which requires them to act professionally in their clients’ lawful best interests. If you wish to change any details after you lodge your application, including your passport details, or if you wish to withdraw the application, please contact the department: Information on migration agents, including a list of registered migration agents, is available on the Office of the MARA website www.mara.gov.au • Applicants from Argentina, Bangladesh, Chile, Indonesia, Malaysia, Thailand, Turkey and Uruguay – contact the Australian Immigration office overseas or Visa Application Centre where you lodged your application. More information is available from www.immi.gov.au/contacts/overseas/ You can also access information about migration agents on the department’s website www.immi.gov.au • Applicants from the USA – Email eVisa.WANDH.Helpdesk@immi.gov.au 1208 (Design date 03/14a) - Page 4 © COMMONWEALTH OF AUSTRALIA, 2014 Exempt persons Consent to communicate electronically The following people do not have to be a registered migration agent in order to provide immigration assistance, but they must not 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 immigration assistance (eg. a Legal Aid provider); • a member of a diplomatic mission, consular post or international organisation. The department may use a range of means to communicate with you. However, electronic means such as fax or email will only be used if you indicate your agreement to receiving communication in this way. Appointing a migration agent/exempt person To appoint a migration agent/exempt person you should complete Part F – Options for receiving written communications. Your migration agent/exempt person should complete form 956 Advice by a migration agent/exempt person of providing immigration assistance. Form 956 is available from the department’s website www.immi.gov.au/allforms/ Options for receiving written communications If you do not appoint a migration agent/exempt person you may still authorise another person, in writing, to receive written communications on your behalf. This person is called the authorised recipient. To process your application the department may need to communicate with you about sensitive information, for example, health, police checks, financial viability and personal relationships. Electronic communications, unless adequately encrypted, are not secure and may be viewed by others or interfered with. If you agree to the department communicating with you by electronic means, the details you provide will only be used by the department for the purpose for which you have provided them, unless there is a legal obligation or necessity to use them for another purpose, or you have consented to use for another purpose. They will not be added to any mailing list. The Australian Government accepts no responsibility for the security or integrity of any information sent to the department over the internet or by other electronic means. If you authorise another person to receive documents on your behalf and they wish to be contacted electronically, their signature is required on form 956 or 956A to indicate their consent to this form of communication. Note: Electronic communication is the fastest means of communication available and the department prefers to communicate electronically because this results in faster processing. Authorised recipient information All written communication about your application will be sent to your authorised recipient, unless you indicate that you wish to have health and/or character information sent directly to you. The department will communicate with the most recently appointed authorised recipient as you may only appoint one authorised recipient at any time for a particular application. You will be taken to have received any documents sent to that person as if they had been sent to you. To appoint an authorised recipient you should complete: Important information about privacy Your personal information is protected by law, including the Privacy 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 1442i Privacy notice. Form 1442i is available from the department’s website www.immi.gov.au/allforms/ or offices of the department. You should ensure that you read and understand form 1442i before completing this form. • Part F – Options for receiving written communications; and • form 956A Appointment or withdrawal of an authorised recipient. Note: Migration agents/exempt persons do not need to complete form 956A. Form 956A is available from the department’s website www.immi.gov.au/allforms/ © COMMONWEALTH OF AUSTRALIA, 2014 1208 (Design date 03/14a) - Page 5 Application checklist This checklist is provided for your assistance and lists the required and optional documents to include with your application. It is not a requirement of your application. A list of offices of the department in Australia is available from www.immi.gov.au/contacts/ Further information about the Working Holiday visa is available from www.immi.gov.au/visitors/ Note: Processing of your application will be delayed if you do not provide all the required information and documents at the time of lodgement. Note: Certified copies are copies authorised, or stamped as being true copies or originals, by a person or agency recognised by the law of the country in which you currently reside. Note: If your documents are in a language other than English, translations into English must be provided. TICK ✓ when completed. A certified copy of the pages of your passport containing your photo and personal details (Note: Your passport preferably should be valid for at least 6 months). The Visa Application Charge (for the current Work and Holiday Visa Application Charge, refer to the department’s website www.immi.gov.au/fees-charges) If you are authorising another person to act and receive communications on your behalf, complete Part F – Options for receiving written communications on page 11 and form 956 Appointment of a migration agent or exempt agent or other authorised recipient. If you are from: • Argentina; • Bangladesh; • Chile; • Indonesia; • Malaysia; • Thailand; • Turkey; or • Uruguay an original letter of approval from your government. If you are from: • Argentina; • Bangladesh; • Chile; • Indonesia; • Malaysia; • Thailand; • Turkey; or • Uruguay Home page www.immi.gov.au General Telephone 131 881 during business hours enquiry line in Australia to speak to an operator (recorded information available outside these hours). If you are outside Australia, please contact your nearest Australian mission. proof of English proficiency. Please keep these information pages for your reference 1208 (Design date 03/14a) - Page 6 © COMMONWEALTH OF AUSTRALIA, 2014 Form Application for a Work and Holiday visa Please use a pen, and write neatly in English using BLOCK LETTERS. Tick where applicable 7 ✓ 1208 Details from your passport Passport number Country of passport Note: Any reference in this form to ‘country’ refers to ‘foreign country’ which is defined in paragraph 22(1)(f) of the Acts Interpretation Act 1901 as any country (whether or not an independent sovereign state) outside Australia and the external territories. DAY MONTH YEAR Date of issue Date of expiry Issuing authority/ Place of issue as shown in your passport Part A – Your details 1 Your full name, exactly as it appears on the passport on which you will be travelling to Australia Family name If you hold more than one passport please provide details of those passports Given names Your full name as it appears in the passport Family name 2 Have you been known by any other names? (including name at birth, previous married names, aliases) Given names Passport number No Yes Country of passport Give details DAY MONTH YEAR Date of issue Date of expiry 3 Sex 4 Date of birth Male DAY 5 Issuing authority/ Place of issue as shown in your passport Female MONTH YEAR Note: Visa applicants must hold a valid passport to be granted a visa. It is recommended that the passport be valid for at least 6 months. Place of birth If you change your passport after you have been granted the visa you must notify the nearest Australian mission, Visa Application Centre or office of the department. Town/city Country 6 If you do not provide the department with the details of any new or additional passport you use to travel to Australia, you will experience significant delays at the airport and could be denied permission to board your plane. Relationship status Married Separated Engaged Divorced De facto Widowed Never married or been in a de facto relationship 8 Do you hold any citizenship other than that shown as your country of passport above? No 9 Yes Give details Details of identity card or identity number issued to you by your government (if applicable) eg. National identity card. 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. Identity number Country of issue © COMMONWEALTH OF AUSTRALIA, 2014 1208 (Design date 03/14a) - Page 7 10 Usual occupation 17 Do you agree to the department communicating with you by fax, email, or other electronic means? (Providing an email address will allow for more efficient processing of your application) 11 What type of employment do you intend to seek during your stay? No Yes Give details COUNTRY CODE Fax number 12 Qualifications ( AREA CODE ) ( NUMBER ) Email address Please ensure you have access to this email while your application is being processed DAY MONTH YEAR 18 Date of proposed travel to Australia 13 If you are from Argentina, Bangladesh, Chile, Indonesia, Malaysia, Thailand, Turkey or Uruguay, please provide evidence of how you obtained your English language proficiency Completed a diploma or degree and the tuition was in English Note: You must enter Australia within 12 months from the date the visa is granted. 19 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). Passed an International English Language Testing System (IELTS) test and achieved at least 4.5 points No Yes 20 Do you have a return or onward ticket or the funds for a fare to depart Other Australia? Note: You may be asked to provide evidence. Give details No Yes 21 Do you have any dependent children that will accompany you to Australia? Note: You cannot be accompanied by dependent children on this visa. 14 Current residential address No (If applying in Australia, please give your current address in Australia) Note: A post office box address is not acceptable as a residential address. Failure to give a residential address will result in your application being invalid. Yes Part B – Previous applications 22 Have you previously been to Australia, applied for a visa, held or currently hold a visa for travel to Australia (including a Working Holiday (417) or Work and Holiday (462) visa)? POSTCODE No Yes 15 Address for correspondence (This may be required by the department to communicate with you about your application. If the same as your residential address, write ‘AS ABOVE’) Give details including type of visa(s), place(s) of application and date(s) of entry to Australia (if applicable) POSTCODE 16 Your telephone numbers COUNTRY CODE AREA CODE NUMBER Office hours ( ) ( ) After hours ( ) ( ) Mobile/cell 23 Have you previously had an Australian visa cancelled, been detained in Australia, removed or deported from Australia, or refused entry into Australia? No Yes 1208 (Design date 03/14a) - Page 8 © COMMONWEALTH OF AUSTRALIA, 2014 Give details 24 Please provide the contact details of a relative, friend or a person you 27 Do you intend to work as, or study to be, a doctor, dentist, nurse or know in Australia paramedic during your stay in Australia? Relationship to you No Yes Give details Family name Given names Address 28 Do you intend to work, or be a trainee, at a child care centre (including preschools and creches) while in Australia? POSTCODE No Telephone numbers Yes Office hours (AREA CODE ) After hours (AREA CODE ) Give details Mobile/cell Part C – Health 29 Do you intend to be in a classroom situation for more than 3 months 25 In the last 5 years, have you visited, or lived, outside your country of (eg. as either a student, teacher, lecturer, or observer)? passport for more than 3 consecutive months? No No Yes Yes Give details Give details 1. Country(s) DAY MONTH YEAR Date from DAY MONTH YEAR DAY MONTH YEAR • 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? DAY MONTH YEAR No to 2. Country(s) 30 Have you: DAY MONTH YEAR Date from to 3. Country(s) DAY MONTH Date from YEAR to Yes Give details 26 Do you intend to enter a hospital or a health care facility (including nursing homes) while in Australia? No Yes Give details © COMMONWEALTH OF AUSTRALIA, 2014 1208 (Design date 03/14a) - Page 9 31 During your proposed visit to Australia, do you expect to incur medical costs, or require treatment or medical follow up for: • blood disorder; • cancer; • heart disease; • hepatitis B or C and/or liver disease; • HIV infection, including AIDS; • kidney disease, including dialysis; • mental illness; • pregnancy; • respiratory disease that has required hospital admission or oxygen therapy; • other? 35 Have you ever: No Yes Give details 32 Do you require assistance with mobility or care due to a medical condition? No Yes Give details 33 Do you hold health insurance to cover your stay in Australia? Note: See page 2 of this form for further information about health insurance. No Yes 34 Have you undertaken a health examination for an Australian visa in the last 12 months? No Yes Give details (including HAP ID if available) Part D – Character • been convicted of a crime or offence in any country (including any conviction which is now removed from official records)? • been charged with any offence that is currently awaiting legal action? • been acquitted of any criminal offence or other offence on the grounds of mental illness, insanity or unsoundness of mind? • been removed or deported from any country (including Australia)? • left any country to avoid being removed or deported? • been refused a visa for Australia or another country? • been excluded from or asked to leave any country (including Australia)? • committed, or been involved in the commission of war crimes or crimes against humanity or human rights? • been involved in any activities that would represent a risk to Australian national security? • had any outstanding debts to the Australian Government or any public authority in Australia? • been involved in any activity, or been convicted of any offence, relating to the illegal movement of people to any country (including Australia)? • served in a military force or state sponsored/private militia, undergone any military/paramilitary training, or been trained in weapons/explosives use (however described) other than in the course of compulsory military service? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes If you answered ‘Yes’ to any of the above questions you must give all relevant details in the space provided below. If the matter relates to a criminal conviction, please give the nature of the offence, full details of sentence, dates of any period of imprisonment or other detention and a personal account of the events leading up to and including the offence(s) If insufficient space attach a separate sheet 1208 (Design date 03/14a) - Page 10 No © COMMONWEALTH OF AUSTRALIA, 2014 Part E – Assistance with this form Part G – Payment details 41 Do you have the application charge to include with your application? 36 Did you receive assistance in completing this form? No Go to Part F Yes Please give details of the person who assisted you Title: Mrs Mr Miss Ms (To check the Visa Application Charge, refer to the department's website www.immi.gov.au/fees-charges or check with the nearest office of the department.) No Other Family name This application will be returned to you as a valid application will not have been made Yes Given names Address POSTCODE Telephone number or daytime contact COUNTRY CODE Office hours ( AREA CODE ) ( NUMBER ) Mobile/cell 37 Is the person an agent registered with the Office of the Migration Agents Registration Authority (Office of the MARA)? No Yes Go to Part F 38 Is the person/agent in Australia? Go to Part F No Yes 39 Did you pay the person/agent and/or give a gift for this assistance? No Yes Part F – Options for receiving written communications 40 All written communications about this application should be sent to: (Tick one box only) Myself OR Authorised recipient You should complete form 956A Appointment or withdrawal of an authorised recipient OR Migration agent OR Exempt person Your migration agent/exempt person should complete form 956 Advice by a migration agent/exempt person of providing immigration assistance © COMMONWEALTH OF AUSTRALIA, 2014 1208 (Design date 03/14a) - Page 11 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. Visa subclass you are applying for Base Application Charge Write the amount shown on the reference table for your visa subclass AUD (1) + Non-internet Application Charge (if applicable) AUD Additional Applicant Charge aged 18 years or over at the time your application is lodged Write the amount shown on the reference table for your visa subclass (2) + Number of additional applicants aged 18 years or over AUD X (multiplied by) = AUD Additional Applicant Charge under 18 years of age at the time your application is lodged Write the amount shown on the reference table for your visa subclass (3) + Number of additional applicants under 18 years of age X (multiplied by) AUD = AUD Subsequent Temporary Application Charge (if applicable) Write the amount shown on the reference table for your visa subclass (4) + Number of applicants X (multiplied by) AUD = AUD (5) = Total Total (1) + (2) + (3) + (4) + (5) AUD 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. 43 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. Bank cheque Money order Debit card Cannot be used for applications lodged by mail Credit card Give details below Payment by (tick one box) Australian Dollars MasterCard Diners Club American Express JCB COUNTRY CODE Telephone number ( AREA CODE ) ( NUMBER ) Address AUD Visa POSTCODE Credit card number : : : : : : : : MONTH YEAR : : Expiry date Cardholder’s name : : : : : : : : : : As the cardholder I acknowledge and accept that a credit card surcharge may apply to the transaction. Signature of cardholder ✍ Credit card information will be used for charge paying purposes only. 1208 (Design date 03/14a) - Page 12 © COMMONWEALTH OF AUSTRALIA, 2014 Part H – Declaration and consent WARNING: Giving false or misleading information is a serious offence 44 Please sign the declaration below I declare that: • the information on this form is correct; • I have read the notes at the front of this application, and am aware that I am required to abide by the conditions that are placed on my visa; • after applying, I will notify the Department of Immigration and Border Protection of any change in my circumstances including my address details; • I will respect Australian values as listed on this form, during my stay in Australia and will obey the laws of Australia; • I have read the information contained in form 1442i Privacy notice; and • 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. For offshore applicants who are required to provide their fingerprints and facial image: • I understand that my fingerprints and facial image and my biographical information held by the Department of Immigration and Border Protection 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 of Immigration and Border Protection for any of the purposes outlined above; and – the Department of Immigration and Border Protection using the information obtained for the purposes of the Migration Act 1958 or the Australian Citizenship Act 2007. Signature of applicant ✍ DAY MONTH YEAR Date Please check all questions are answered. If your form is incomplete, there may be delays in processing your application. We strongly advise that you keep a copy of your application and all attachments for your records. © COMMONWEALTH OF AUSTRALIA, 2014 1208 (Design date 03/14a) - Page 13