Personal Contact Details
Family Name
First Name
Middle Name
Date of Birth
Sex Select One Male Female
Marital Status Select One Never Married Widowed Divorced Seperated Engaged Married De Facto Relationship
If Engaged - Proposed Date of Marriage
If Married - Date of Marriage
If De Facto Relationship - Date Relationship Commenced
Occupation
Mailing Address 1
Mailing Address 2
City
State
Postal Code
Telephone
Fax
Email
Passport / Visa Details
Date of Anticipated/Desired Arrival in Australia
Country of Residence
Country of Citizenship
Passport Number
Current Australian Visa Status Select One Current Never Held Previously Held Visa - Now
Current Australian Visa Number
Current Australian Visa Type
Current Australian Visa Expiry Date
Prior Visa Information
Visa Type
Date of Expiry
Date Departed Australia
Have you ever had a visa refused or cancelled? Select One Yes No
If so, please provide details
Sponsorship Details
Full Name of person who is sponsoring you
Is your sponsor a citizen or a permanant resident?
What is your sponsors date of birth?
What is your relationship to the sponsor?
What is your sponsors occupation?
Is your sponsor currently employed?
Has your sponsor ever sponsored any other person to Australia?
If so please provide details
Please provide here any further information that you may wish to have considered
Language Details
English Language Ability Select One Excellent Good Average Poor Nil
Do you speak a Second language Select One Yes No
What Other Languages do you speak?
IELTS Test Completed Select One Yes No
Date of Test
Results of IELTS Test Select One At Least 6 in all Categories At Least 5 in all Categories At Least 4 in all Categories Less than 4 in some Categories
Family Details
Spouse Family Name
Spouse First Name
Spouse Date of Birth
Spouse Sex Select One Male Female
Spouse Citizenship
Spouse Passport Number
Spouse Current Australian Visa Status Select One Current Never Held Previously Held Visa - Now
Spouse Current Australian Visa Type
Spouse Current Australian Visa Number
Spouse Current Australian Visa Expiry Date
Prior Visa Information
Visa Type
Date of Expiry
Date Departed Australia
Spouse Education and Training
Dependant Details
Dependants Select One Yes No
Dependant 1 Name
Dependant 1 Sex Select One Male Female
Dependant 1 Date of Birth
Dependant 1 Education Level
Dependant 1 Employment History
Dependant 2 Name
Dependant 2 Sex Select One Male Female
Dependant 2 Date of Birth
Dependant 2 Education Level
Dependant 2 Employment History
Dependant 3 Name
Dependant 3 Sex Select One Male Female
Dependant 3 Date of Birth
Dependant 3 Education Level
Dependant 3 Employment History
Dependant 4 Name
Dependant 4 Sex Select One Male Female
Dependant 4 Date of Birth
Dependant 4 Education Level
Dependant 4 Employment History
Dependant 5 Name
Dependant 5 Sex Select One Male Female
Dependant 5 Date of Birth
Dependant 5 Education Level
Dependant 5 Employment History
Relatives Details
Relatives in Australia Select One Yes No
Relatives Residency Status Select One Permanant Residency Temporary Resident Citizen New Zealand Residency
Relative Relationship Select One Father Step Father Mother Step Mother Brother Step Brother Half Brother Sister Step Sister Half Sister Uncle Aunt Cousin Nephew Neice Grand Father Grand Mother
Relatives Address
Relatives Address1
Relatives City
Relatives State Select One NSW QLD WA NT VIC SA ACT TASMANIA
Relatives Post Code
Relatives Employment History in the last 2 years only
Relatives Education and Training
Health and Fitness
Primary Applicant Health Status Select One Excellent Good Average Poor Nil
Secondary Applicant Health Status Select One Excellent Good Average Poor Nil
Dependants Health Status Select One Excellent Good Average Poor Nil
If any of the above have a pre-existing condition or the health status is not excellent, give full details.
Other Details
Do you or any other person to be included in your application have a criminal record? Select One Yes No
Provide Details
Have you or any other person to be included in your application ever been a member of the armed forces? Select One Yes No
Provide Details
Please provide details of any other aims or requirements that you may have.
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