Sensitive (when completed)

Australian Government
Department of Immigration and Border Protection
REQUEST FOR REMOVAL FROM AUSTRALIA
I am an unlawful non-citizen and I request that the Department of Immigration and Border
Protection (DIBP) remove me from Australia in accordance with s198(1) of the
Migration Act 1958 (the Act), which states that an officer must remove as soon as reasonably
practicable an unlawful non-citizen who asks the Minister, in writing, to be so removed.
Removee name:
I understand that I do not have to request removal but that DIBP
must remove me as soon as reasonably practicable if I have no
right to remain in Australia.

Yes No

2.

I am aware that if I am removed from Australia, this may affect

future re-entry rights to Australia

Yes No

3.

I understand that I will incur a debt for the cost of my removal

from Australia.

Yes No

4.

If I have outstanding visa applications, requests or legal

proceedings, I understand that if I choose not to withdraw them,
consideration of my claims by the department or relevant review
bodies (including the courts) may be discontinued once I am
removed from Australia.

Yes

5.

If I have a legal representative, I have discussed my decision to

request removal from Australia with my legal representative.

Yes No N/A

1.

If No, I give permission for DIBP to notify my legal

representative of my decision to request removal.
6.

7.

N/A

Yes No

An interpreter has assisted me to understand and complete this

form.

Yes No

I have read / had explained to me information in this form and the

attachments and I wish to be removed as soon as reasonably
practical.

Yes No

Not
required

This document may contain personal identifiers and personal information as defined under the Migration Act
1958 or Australian Citizenship Act 2007, and can only be used for purposes under these Acts.

Sensitive (when completed)

Sensitive (when completed)

-2If you have questions about departing Australia, please speak with your case manager
or your legal representative/ migration agent.
Signature:
Name:
Date of Birth:
Citizenship:
Centre ID Number
(if applicable):
Date:
DIBP Officer
signature:

Interpreter
signature
(if applicable):

Name:

Name:

Position:

TIS Number:

If this Request for Removal form is being signed by an unaccompanied minor, the
Independent Observer witness must sign below:
Independent observer
signature:
Name:
ATTACHMENT(S) PROVIDED TO REMOVEE: (delete if not applicable)
IMA

IMA Common questions about removal (ADF2011/14872)

Voluntary return Fact sheets We are here to help you fact sheet (ADF2014/37313)
Reintegration assistance onshore Fact sheets (ADF2014/36761)
Information for maritime crew (ADF2010/14590)

Non-IMA
Options for leaving Australia from detention (ADF2014/3188)

Sensitive (when completed)