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147
Please use a pen, and write neatly in English using BLOCK LETTERS.
Tick where applicable
DAY
MONTH
YEAR
Does the visa subclass you are applying for require you to be
sponsored by an organisation or individual in Australia?
No
Yes
No
Yes
No
Yes
Name of agreement
primary person
OR
secondary person applying
separately and wishing to join a
person who already holds a visa
Go to Question 7
OR
retiree
7
No
Yes
No
Yes
Give details
Family name
Given names
If you have been known by other names, attach a page giving the names
9 Sex
Male
Female
DAY
MONTH
are a citizen of more than one country, you need to enter the
10 Date of birth
identity number on the card from the country that you live in.
Place of birth
Identity
number
Country of issue
Town/city
Country
12 Relationship status
Married
Separated
Engaged
Divorced
De facto
Widowed
Never married or
been in a de facto
relationship
POSTCODE
POSTCODE
14 Do
you
hold
citizenship? No
any
other
15
COUNTRY CODE
AREA CODE
NUMBER
Office hours
After hours
number
No
Yes
No
Yes
Passport
Country of passport
DAY
Give details
COUNTRY CODE
Fax number
AREA CODE
)
NUMBER
)
E-mail address
MONTH
YEAR
Date of issue
Date of expiry
Issuing authority/
Place of issue as
shown in your
passport
Sex
Male
Female
DAY
MONTH
Date of birth
Subclass of visa held
Passport number
YEAR
24
Hours of work
Wage/salary in Australian dollars
AUD Other benefits to be paid
Name
of
employer Address
POSTCODE
Telephone
number
(AREA CODE
26
If you will be undertaking an activity, give details of the
individual or organisation you will undertake the activity
for in Australia Name of individual or organisation
POSTCODE
Telephone
number
(AREA CODE
27
South Australia
Tasmania
Northern Territory
Victoria
Queensland
Western Australia
29
28
Are you able to fully support yourself (and your
partner if applicable) in Australia?
No
Yes
DAY
From
MONTH
YEAR
DAY
MONTH
to
YEAR
No
Go to Part L
Yes
Title:
Mr
Mrs
Miss
Ms
Other
Family name
Given names
Address
Bank cheque
Money order
Debit card
POSTCODE
Office hours
Credit card
AREA CODE
)
MasterCard
Diners Club
American Express
JCB
Mobile/cell
AUD
Visa
No
: : :
MONTH
Yes
Australian Dollars
NUMBER
Go to Part L
: :
: :
: :
: :
YEAR
Expiry date
33 Is the person/agent in
Cardholders name
Australia? No Go to Part L
Yes
COUNTRY CODE
Telephone
number
AREA CODE
(
NUMBER
)
Address
Yes
POSTCODE
OR
Authorised
recipient
OR
Migration agent
OR
Agent exempt
from registration
Signature of
cardholder
Credit card information will be used for charge paying purposes only.
Approved
Rejected
Subclass
Class
Entry
Single
Multiple
Conditions
DAY
MONTH
YEAR
Date of entry
validity
Length of stay
Signature of
authorised
officer
DAY
Date
MONTH
YEAR