Form

Application for a Work and Holiday visa 1208

Department of Home Affairs

The Department of Home Affairs (the Department) Visit www.fairwork.gov.au for information for visa holders and
acknowledges that Aboriginal and Torres Strait Islander peoples international students. This includes information in numerous
are the traditional custodians of the Australian land. languages. There is also a range of helpful videos, in many
languages, about working in Australia at
Life in Australia – Australian values www.youtube.com/fairworkgovau
The Australian Government encourages people to gain an You can also contact the Fair Work Ombudsman by phone
understanding of Australia, its people and their way of life, within Australia on 13 13 94 (Translating and Interpreting
before applying for a visa to live in Australia. Service 13 14 50).
This includes understanding that the English language, as the The Fair Work Information Statement which is available in
national language, is an important unifying element of numerous languages also provides important information,
Australian society. Australian society is also united through the www.fairwork.gov.au/employee-entitlements/national-
following shared values: employment-standards/fair-work-information-statement
• respect for the freedom and dignity of the individual;
• freedom of religion (including the freedom not to follow About this form
a particular religion), freedom of speech, and freedom of Important – Please read this information carefully before you
association; complete your application. Once you have completed your
• commitment to the rule of law, which means that all people application we strongly advise that you keep a copy for your
are subject to the law and should obey it; records.
• parliamentary democracy whereby our laws are determined Note: Any reference in this form to ‘country’ refers to ‘foreign
by parliaments elected by the people, those laws being country’ which is defined in paragraph 22(1)(f ) of the Acts
paramount and overriding any other inconsistent religious or Interpretation Act 1901 as any country (whether or not an
secular ‘laws’; independent sovereign state) outside Australia and the external
• equality of opportunity for all people, regardless of their territories.
gender, sexual orientation, age, disability, race, or national or
ethnic origin; Who should use this application?
• a ‘fair go’ for all that embraces: Only applicants who have received a written notice from the
– mutual respect; Department authorising them to apply for this visa using this
– tolerance; paper application form should use this form.
– compassion for those in need; and Each applicant must apply individually on a separate form and
– equality of opportunity for all. cannot include family members in their application.
The Life in Australia booklet provides more information on the
values that Australians share and their way of life. This booklet is Visa overview
available in a wide range of languages and can be obtained from
www.homeaffairs.gov.au The Work and Holiday visa program encourages people to
people links between partner countries by allowing young people
You are encouraged to read the Life in Australia booklet before to have an extended holiday during which they may engage in
completing this application form. If you have difficulty, or are short-term work and study.
unable to read the booklet, you may have the content of it
explained to you, for example, by a friend or relative. This form A Work and Holiday visa allows the visa holder to:
contains a declaration, that you must sign, that confirms you • enter Australia within 12 months of the date of visa grant;
understand and will undertake to conduct yourself in accordance • stay in Australia for up to 12 months;
with the values of Australian society (as explained in the booklet) • leave and re-enter Australia any number of times while the
and will obey the laws of Australia. visa is valid;
This declaration must also be signed by each person aged • work in Australia for up to 6 months with each employer;
18 years or over, who is included in this form.
• study for up to 4 months; and
Australian working conditions • carry out specified work to become eligible to apply for a
second or third Work and Holiday visa.
Overseas workers – know your workplace rights
Note: Australia applies an annual limit to the number of visas
Pay rates and workplace conditions are set by Australian law. All issued to first Work and Holiday visa applicants from all partner
people working in Australia, including those from overseas, have countries, except the USA. More information is available from
rights and protections at work. These cannot be taken away by https://immi.homeaffairs.gov.au/what-we-do/whm-program/
contracts or agreements. status-of-country-caps
If you have questions about your pay and conditions while in If the limit has been reached, applicants will be notified and the
Australia, you can contact the Fair Work Ombudsman for free processing of their application will not proceed.
help.
Australia does not apply an annual limit to the number of visas
issued to second or third Work and Holiday visas from any
partner country.
© COMMONWEALTH OF AUSTRALIA, 2022 1208 (Design date 09/22) - Page 1
Eligibility requirements Integrity of application
Eligibility requirements for the Work and Holiday visa for first, The Department is committed to maintaining the integrity of
second and third visas can be found on the Department’s website the visa and citizenship programs. In relation to this application,
https://immi.homeaffairs.gov.au/visas/getting-a-visa/visa- if you or a member of your family unit:
listing/work-holiday-462 • provide, or have provided in a previous application,
Health insurance fraudulent documents or false or misleading information
(knowingly or not); and/or
We recommend that you have health insurance to cover your
stay in Australia. This can be obtained in your home country or • fail to satisfy, or have failed to satisfy in a previous application,
in Australia. More information is available from the Minister of your or their identity;
https://immi.homeaffairs.gov.au/help-support/meeting-our- this visa application may be refused and you, and any members
requirements/health/adequate-health-insurance of your family unit, may become unable to be granted a visa for
specified periods of time, as set out in migration legislation.
Specified work If documents are found to be fraudulent or information to be
If you apply for a second or third Work and Holiday visa, you incorrect after the grant of a visa, the visa may subsequently be
will need to provide evidence that you have worked for a cancelled.
minimum of 3 months (second visa application) or 6 months
(third visa application) doing specified work in Australia. For How to apply
further information on eligible regions, industries and types of
Step 1
work and what evidence is required, see
https://immi.homeaffairs.gov.au/what-we-do/whm-program/ Complete this application.
overview Please open this form using Adobe Acrobat Reader.
Either type (in English) in the fields provided or print this form
Where you need to be when applying for a visa and complete it (in English) using a pen and BLOCK
LETTERS.
You must be outside Australia when applying for your first visa
and when a decision is made on your application. You must provide the address where you intend to live while
your application is being processed. Failure to give a residential
If you apply in Australia for a second or third visa, you should
address in your application will result in your application being
lodge your application before your current visa ceases, and must
invalid. A post office box address will not be accepted as your
be in Australia for the visa to be granted.
residential address.
If you apply outside Australia, you must be outside Australia for
You should provide all documents as outlined on the Department’s
the visa to be granted.
website https://immi.homeaffairs.gov.au/visas/getting-a-visa/
visa-listing/work-holiday-462 with your application.
How much does the visa cost?
Refer to Part G – Payment details of this form to calculate the Step 2
correct charge. Refer to Part G – Payment details of this form to calculate the
Refer to https://immi.homeaffairs.gov.au/visas/visa-pricing- correct charge. Ensure that evidence of payment is included with
estimator for a complete and current list of applicable fees and this application.
charges.
Step 3
Fees and charges may be subject to change at any time and this
may increase the cost of a visa application. First, second or third Work and Holiday visa applicants who
have received a written notice from the Department authorising
Generally, Visa Application Charges are reviewed on 1 July each them to apply for this visa using this paper application form
year, and the exchange rates used to calculate the amount should follow the instructions provided.
payable in a foreign country are updated on 1 January and 1 July
each year. Some applicants need to provide their biometrics (fingerprints
scan and facial photograph) at a Visa Application Centre when
If you do not pay the full Visa Application Charge amount, your lodging an application. More information is available from
visa application will not be valid. www.homeaffairs.gov.au
Charges are generally not refundable, even if the application is
withdrawn or refused. What happens next?
Your application will be assessed. You will be advised in writing
Method of payment whether your application has been approved or refused. If your
Make your payment electronically through the ‘My Payments’ application is refused, you will be given reasons for the decision.
section of ImmiAccount. Sign into, or create, your ImmiAccount You should not make any irreversible travel arrangements
and select My Payments>Manage Payments>Pre-Pay Paper until you receive written advice of the Department’s decision
Service, at www.homeaffairs.gov.au/immiaccount on your application.
If you are outside Australia and cannot pay online in
ImmiAccount check the Department’s website for alternative
payment methods for your location
www.homeaffairs.gov.au/locations

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Activating your Work and Holiday visa Exempt persons
If you applied for your Work and Holiday visa outside of The following people do not have to be a registered migration
Australia, your 12 month stay period will start when you enter agent or legal practitioner in order to provide immigration
Australia. Your 12 month stay period will start if you pass assistance:
through immigration clearance in Australia (the counter where • a close family member (spouse, child, adopted child, parent,
you present your passenger card and passport), even if you are in brother or sister of a visa applicant);
transit or hold an Electronic Travel Authority, Maritime Crew • a sponsor or nominator for a visa applicant;
visa, Special Purpose visa or Transit visa.
• a member of parliament or their staff;
If you are intending to transit or travel to Australia, and you do
not want to start your Work and Holiday visa, you should delay • a member of a diplomatic mission, consular post or
applying for this visa until you wish to commence your working international organisation.
holiday. An exempt person must not charge a fee for their assistance. In
Australia, if they do charge a fee they are committing an offence
Important – change of personal/passport details and penalties of up to 10 years jail can apply.
If you wish to change any details after you lodge your Appointing a registered migration agent/legal practitioner/exempt
application, including your passport details, or if you wish to person
withdraw the application, please take one of the following steps: To appoint a registered migration agent/legal practitioner/exempt
• email [email protected] person you should complete Part F – Options for receiving written
• change your information via your ImmiAccount communications.
(online lodgement only) Your registered migration agent/legal practitioner/exempt person
• submit form 929 Change of address and/or passport details. should complete form 956 Appointment of a registered migration
Your Work and Holiday visa application is linked to the passport agent, legal practitioner or exempt person.
number provided in your application. If you are granted a visa, Form 956 is available from the Department’s website
but do not provide the Department with the details of any www.homeaffairs.gov.au/allforms/
new passport you use to travel to Australia, you will
experience significant delays at the airport and could be Options for receiving written communications
denied permission to board your plane. If you do not appoint a migration agent/legal practitioner/
exempt person you may still authorise another person, in
What is immigration assistance? writing, to receive written communications on your behalf. This
A person gives immigration assistance if he or she uses, or person is called the authorised recipient.
purports to use, his or her knowledge or experience in migration
procedure to assist a person with matters related under the Authorised recipient information
Migration Act 1958. All written communication about your application will be sent
The most common times assistance is provided is during visa to your authorised recipient, unless you indicate that you wish to
application processes, visa cancellation processes or sponsorship have health and/or character information sent directly to you.
processes (including monitoring or sanctions). The Department will communicate with the most recently
Note: Immigration assistance does not include simply filling in appointed authorised recipient as you may only appoint one
an application form, translating or interpreting or passing on authorised recipient at any time for a particular application.
information about an application without comment or You will be taken to have received any documents sent to that
explanation. person as if they had been sent to you.
To appoint an authorised recipient you should complete:
Registered migration agents
• Part F – Options for receiving written communications; and
A registered migration agent is a person who is registered with
the Office of the Migration Agents Registration Authority • form 956A Appointment or withdrawal of an authorised
(OMARA) to provide immigration assistance. recipient.
If operating in Australia, migration agents must be registered Note: Migration agents/legal practitioners/exempt persons do
with the OMARA. not need to complete form 956A.
Information on registered migration agents, including how to Form 956A is available from the Department’s website
find one, is available on the OMARA website www.mara.gov.au www.homeaffairs.gov.au/allforms/

Legal practitioners
A legal practitioner is a lawyer who holds an Australian legal
practising certificate (whether restricted or unrestricted) granted
under a law of an Australian state or territory.
Legal practitioners can provide immigration assistance in
connection with legal practice.
Information on legal practitioners, including how to find one, is
available on the Law Council of Australia website.
Information on legal practitioners can also be sought from the
relevant state or territory legal professional bodies.

© COMMONWEALTH OF AUSTRALIA, 2022 1208 (Design date 09/22) - Page 3

Consent to communicate electronically Application checklist
The Department may use a range of means to communicate The checklist below is provided for your assistance and lists the
with you. However, electronic means such as email will only be required and optional documents to include with your
used if you indicate your agreement to receiving communication application. It is not a requirement of your application.
in this way. Note: Processing of your application will be delayed if you do
To process your application the Department may need to not provide all the required information and documents at the
communicate with you about sensitive information, for example, time of lodgement.
health, police checks, financial viability and personal Note: Certified copies of documents are required with paper
relationships. Electronic communications, unless adequately applications, for information see
encrypted, are not secure and may be viewed by others or https://immi.homeaffairs.gov.au/help-support/applying-
interfered with. online-or-on-paper/on-paper/certified-copy
If you agree to the Department communicating with you by Note: If your documents are in a language other than English,
electronic means, the details you provide will only be used by the translations into English must be provided.
Department for the purpose for which you have provided them,
unless there is a legal obligation or necessity to use them for TICK 3 when completed
another purpose, or you have consented to use for another
purpose. They will not be added to any mailing list. A copy of the pages of your passport containing your
The Australian Government accepts no responsibility for the photo and personal details (Note: Your passport
security or integrity of any information sent to the Department preferably should be valid for at least 6 months).
over the internet or by other electronic means. The Visa Application Charge (for the current Work
If you authorise another person to receive documents on your and Holiday Visa Application Charge, refer to the
behalf and they wish to be contacted electronically, their Department’s website
signature is required on form 956 or 956A to indicate their https://immi.homeaffairs.gov.au/visas/visa-
consent to this form of communication. pricing-estimator)
Note: Electronic communication is the fastest means of If you are authorising another person to act and
communication available and the Department prefers to receive communications on your behalf, complete
communicate electronically because this results in faster Part F – Options for receiving written communications
processing. on page 11 and form 956 Appointment of a registered
migration agent, legal practitioner or exempt person.
Important information about privacy
The Privacy Act 1988 contains 13 Australian Privacy Principles First Work and Holiday visa applicants
which regulate the way that the Department collects and handles
personal information. Information about how the Department Provide proof of English proficiency, see
collects, uses and discloses personal information for its key https://immi.homeaffairs.gov.au/visas/getting-a-
functions can be found in form 1442i Privacy notice. More visa/visa-listing/work-holiday-462/first-work-
information about the Department’s general information holiday-462#HowTo
handling practices (including form 1442i) can be found in the Provide an original letter of support from your
Department’s Privacy policy at government (if required), see
https://www.homeaffairs.gov.au/access-and-accountability/ https://immi.homeaffairs.gov.au/visas/getting-a-
our-commitments/privacy visa/visa-listing/work-holiday-462/first-work-
holiday-462#HowTo

Second and third Work and Holiday visa applicants

Evidence of your specified work in Australia, which
may include certified copies of payslips, group
certificates, payment summaries, tax returns and an
original Australian bank statement covering the
period of declared specified work.
A list of offices of the Department in Australia is available from
www.homeaffairs.gov.au
Further information about the Work and Holiday visa is
available from https://immi.homeaffairs.gov.au/visas/getting-
a-visa/visa-listing/work-holiday-462

Home page www.homeaffairs.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.

Please keep these information pages for your reference

1208 (Design date 09/22) - Page 4 © COMMONWEALTH OF AUSTRALIA, 2022
 Form

Application for a Work and Holiday visa 1208

Department of Home Affairs

Please open this form using Adobe Acrobat Reader. 7 Details from your passport
Either type (in English) in the fields provided or print this form
Passport number pp4188187
and complete it (in English) using a pen and BLOCK LETTERS.
Tick where applicable 3 Country of passport HAITTI
Nationality as I am HAITIEN
Note: Any reference in this form to ‘country’ refers to ‘foreign country’ shown in passport
which is defined in paragraph 22(1)(f) of the Acts Interpretation Act 1901 Day Month Year
as any country (whether or not an independent sovereign state) outside Date of issue
Australia and the external territories.
Date of expiry

Part A – Your details Issuing authority/place of issue as shown in your passport

1 Your full name, exactly as it appears on the passport on which you will
If you hold more than one passport please provide details of those
be travelling to Australia
passports
Family name
Your full name as it appears in the passport
SAINT FLEUR
Family name SAINT FLEUR
Given names
Given names HEROLD
HEROLD
Passport number pp4188187
2 Have you been known by any other names?
Country of passport HAITI
(including name at birth, previous married names, aliases)
Day Month Year
No ✔
Date of issue
Yes Give details
I want to travel to Australia to work Date of expiry
Issuing authority/place of issue as shown in your passport

Indeterminate /
3 Sex Male ✔ Female Intersex / Unspecified 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.
Day Month Year
If your passport details change after you have been granted the visa, you
4 Date of birth 08/05/1978 must notify the nearest Australian mission, Visa Application Centre or
office of the Department, or notify the Department at
5 Place of birth https://immi.homeaffairs.gov.au/change-in-situation/passport-
details
Town/city HAITi
If you do not provide the Department with the details of any new
or additional passport you use to travel to Australia, you will
Country I' m HAITIEN
experience significant delays at the airport and could be denied
permission to board your plane.
6 Relationship status
Married ✔ Separated Never married or 8 Do you hold any citizenship other than that shown as your country of
been in a de facto passport above?
Engaged Divorced
relationship No ✔
De facto Widowed
Yes Give details

© COMMONWEALTH OF AUSTRALIA, 2022 1208 (Design date 09/22) - Page 5

9 Details of identity card or identity number issued to you by your 13 Provide evidence of how you obtained your English language proficiency
government (if applicable) eg. National identity card. (eg. IELTS 4.5 or equivalent)
Note: If you are the holder of multiple identity numbers because you are Note: This is not required for second or third Work and Holiday visa
a citizen of more than one country, you need to enter the identity applications.
number on the card from the country that you live in. Completed a diploma
Identity number or degree and the
tuition was in English
Country of issue Undertaken an Give details of your English test
English language Cambridge English: Advanced (CAE)
proficiency test within test (also known as Certificate in
10 Usual occupation
the last 12 months Advanced English)
yes (Note: CAE results must be from a test
taken on or after 1 January 2015)
11 What type of employment do you intend to seek during your stay? International English Language
Testing System (IELTS)
I am a seamstress work in a factory
Occupational English Test (OET)
Pearson Test of English Academic
(PTE Academic)
12 Qualifications Test of English as a Foreign Language
internet-Based Test (TOEFL iBT)
Date of test
Day Month Year

Test location
(country where test was taken)

Test reference number – Depending on

the test you have taken, this may also be
known as a Reference Number, Test
Report Form Number, Registration ID or
Registration Number.

Other Give details – for example, applying

as a USA passport holder, have
completed an English ‘Bagrut exam’
in the level of 3 study units.

14 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 residential
address. Failure to give a residential address will result in your
application being invalid.

Postcode

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’)

Postcode

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16 Your telephone numbers Part B – Previous applications
Country code Area code Number

Office hours ( +55 ) ( 49 ) 9986-2202

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
After hours 49 3555 6751
(subclass 417) or Work and Holiday (subclass 462) visa)?
Mobile/cell No ✔
Yes Give details including type of visa(s), place(s) of application
and date(s) of entry to Australia (if applicable)
17 Do you agree to the Department communicating with you by email, or
other electronic means? (Providing an email address will allow for more
efficient processing of your application)
No
Yes Give details
Email address
Please ensure you have access to this email while your application is
being processed

18 If you are outside Australia, date of proposed travel to Australia

Day Month Year

23 Have you previously had an Australian visa cancelled, been detained

in Australia, removed or deported from Australia, or refused entry into
19 Do you have sufficient funds for the initial period of your stay in Australia? Australia?
Note: You may be asked to provide evidence (eg. bank statement). No
No Yes Give details
Yes

20 Do you have a return or onward ticket or the funds for a fare to depart
Australia?
Note: You may be asked to provide evidence.
No
24 Which visa are you applying for?
Yes
First Work and Holiday visa ✔ Go to Question 29
21 Do you have any dependent children that will accompany you to Australia? Second Work and Holiday visa Go to Question 25
Note: You cannot be accompanied by dependent children on this visa. Third Work and Holiday visa Go to Question 26
No
Yes 25 If you are applying for a second Work and Holiday visa, have you
undertaken 3 months of specified work in Australia on a first Work and
Holiday (subclass 462) visa?
See https://immi.homeaffairs.gov.au/what-we-do/whm-
program/specified-work-conditions/specified-work-462
Not applicable Go to Question 29
No You are not eligible to apply for a second Work and Holiday
visa.
Yes ✔ Please provide evidence of 3 months of specified work in
Australia, see ‘gather your documents’ at
https://immi.homeaffairs.gov.au/visas/getting-a-
visa/visa-listing/work-holiday-462/second-work-
holiday-462#HowTo

© COMMONWEALTH OF AUSTRALIA, 2022 1208 (Design date 09/22) - Page 7

26 If you are applying for a third Work and Holiday visa, have you Provide a detailed description of your specified work duties
undertaken 6 months of specified work in Australia from 1 July 2019 on
a second Work and Holiday (subclass 462) visa?
See https://immi.homeaffairs.gov.au/what-we-do/whm-
program/specified-work-conditions/specified-work-462
Not applicable Go to Question 29
No You are not eligible to apply for a third Work and Holiday
visa.
Yes Please provide evidence of 6 months of specified work in
Australia, see ‘gather your documents’ at
https://immi.homeaffairs.gov.au/visas/getting-a-
visa/visa-listing/work-holiday-462/third-work-and-
holiday-462#HowTo

27 Details of your employment

1. ABN
Company name

Employment type
2. ABN
Industry type Company name

Work address Employment type

Industry type
Postcode

Day Month Year Day Month Year

Work address
Date from to
Work conditions
Total hours worked
Postcode

Day Month Year Day Month Year

Total actual days worked Date from to
Work conditions
Was the applicant employed under a piece rate agreement? Total hours worked
No
Yes
Total actual days worked
Hourly rate of pay AUD
Employer contact person details
Was the applicant employed under a piece rate agreement?
Family name
No
Yes
Given name Hourly rate of pay AUD
Employer contact person details
Position Family name

Mobile phone Given name

Email address
Position

Mobile phone

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 Email address
Part C – Health
Provide a detailed description of your specified work duties
29 In the last 5 years, have you visited, or lived, outside your country of
passport for more than 3 consecutive months?
No
Yes Give details

1. Country(s)
Day Month Year Day Month Year

Date from to

2. Country(s)
Day Month Year Day Month Year

Date from to

3. Country(s)
Day Month Year Day Month Year

Date from to

30 Do you intend to enter a hospital or a health care facility (including

nursing homes) while in Australia?
If you have worked for more than 2 employers, attach additional details. No
Yes Give details
28 Was your specified work paid in accordance with relevant Australian
legislation and awards?
No
Yes You must attach payslips and any other relevant
documentation for all specified work.

31 Do you intend to work as, or study or train to be, a health care worker or
work within a health care facility while in Australia?
No
Yes Give details of the occupation

32 Do you intend to work, study or train within aged care or disability care
while in Australia?
No
Yes Give details

33 Do you intend to work, or be a trainee, at a child care centre (including

preschools and creches) while in Australia?
No
Yes Give details

© COMMONWEALTH OF AUSTRALIA, 2022 1208 (Design date 09/22) - Page 9

34 Have you: Part D – Character
• ever had, or currently have, tuberculosis?
• been in close contact with a family member that has active
tuberculosis?
39 Have you ever:
• ever had a chest x-ray which showed an abnormality? • been charged with any offence that is
No currently awaiting legal action? No Yes
Yes Give details • been convicted of an offence in any country
(including any conviction which is now
removed from official records)? No Yes
• been charged or convicted of family or
domestic violence offences or similar related
offences? No Yes
• been the subject of a domestic or family
violence order, or any other order, of a tribunal
or court or other similar authority, for the
35 During your proposed visit to Australia, do you expect to incur medical
personal protection of another person? No Yes
costs, or require treatment or medical follow up for:
• blood disorder; • been the subject of an arrest warrant or
• cancer; Interpol notice? No Yes
• heart disease; • been found guilty of a sexually based offence
• hepatitis B or C and/or liver disease; involving a child (including where no
• HIV infection, including AIDS; conviction was recorded)? No Yes
• kidney disease, including dialysis; • been named on a sex offender register? No Yes
• mental illness; • been acquitted of any offence on the grounds
• pregnancy; of unsoundness of mind or insanity? No Yes
• respiratory disease that has required
• been found by a court not fit to plead? No Yes
hospital admission or oxygen therapy;
• other? • been directly or indirectly involved in, or
No associated with, activities which would
represent a risk to national security in
Yes Give details Australia or any other country? No Yes
• been charged with, or indicted for: genocide,
war crimes, crimes against humanity, torture,
slavery, or any other crime that is otherwise of
a serious international concern? No Yes
• been associated with a person, group or
organisation that has been/is involved in
criminal conduct? No Yes
36 Do you require assistance with mobility or care due to a medical
• been associated with an organisation engaged
condition?
in violence or engaged in acts of violence
No (including war, insurgency, freedom fighting,
Yes Give details terrorism, protest) either overseas or in
Australia? No Yes
• served in a military force, police force, state
sponsored/private militia or intelligence
agency (including secret police)? No Yes
• undergone any military/paramilitary training,
been trained in weapons/explosives or in the
manufacture of chemical/biological products? No Yes
37 Do you hold health insurance to cover your stay in Australia? • been involved in people smuggling or people
Note: See page 1 of this form for further information about health insurance. trafficking offences? No Yes
No ✔ • been removed, deported or excluded from any
Yes country (including Australia)? No Yes
• overstayed a visa in any country (including
38 Have you undertaken a health examination for an Australian visa in the Australia)? No Yes
last 12 months? • had any outstanding debts to the Australian
No ✔ Government or any public authority in
Yes Give details (including HAP ID if available) Australia? No Yes

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If you answered ‘Yes’ to any question at Question 39, give details,
including the date of the charge, the outcome and any penalty imposed.
Part E – Assistance with this form
Also attach court documents (for example sentencing remarks or court
40 Did you receive assistance in completing this form?
transcripts).
No Go to Part F
Where relevant, provide a copy of all declared orders (for example, any
domestic or family violence orders, child protection orders, or orders that Yes ✔ Please give details of the person who assisted you
prohibit the applicant from having contact with another person for their
Title: Mr Mrs Miss Ms Other
personal protection). You are only requested to declare an order where
the applicant is the respondent or subject of the order. You are not asked Family name
to declare an order where the applicant is the person requiring personal
protection. Given names
Address

Postcode

Telephone number or daytime contact

Country code Area code Number

Office hours ( ) ( )

Mobile/cell

41 Is the person a registered migration agent, Australian legal practitioner

or an exempt person?
No
Yes Go to Part F

42 Did you pay the person and/or give a gift for this assistance?
No ✔
Yes

If insufficient space attach a separate sheet

Part F – Options for receiving written
communications
43 All written communications about this application should be sent to:
(Tick one box only)
Myself

OR
Authorised You should complete form 956A Appointment
recipient or withdrawal of an authorised recipient
OR
Migration agent

OR Your migration agent/legal practitioner/

exempt person should complete form 956
Legal
practitioner Appointment of a registered migration agent,
legal practitioner or exempt person
OR

Exempt person

© COMMONWEALTH OF AUSTRALIA, 2022 1208 (Design date 09/22) - Page 11

 Part G – Payment details
44 IMPORTANT: You must refer to the Department’s website at https://immi.homeaffairs.gov.au/visas/visa-pricing-estimator 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 (2)

Additional Applicant Charge aged 18 years or over at the time your application is lodged
+
Write the amount shown on the Number of additional applicants
reference table for your visa subclass aged 18 years or over
AUD X (multiplied by) = AUD (3)

Additional Applicant Charge under 18 years of age at the time your application is lodged
+
Write the amount shown on the Number of additional applicants
reference table for your visa subclass under 18 years of age
AUD X (multiplied by) = AUD (4)

Subsequent Temporary Application Charge (if applicable)

+
Write the amount shown on the
reference table for your visa subclass Number of applicants
AUD X (multiplied by) = 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.

45 Payment details
Make your payment electronically through the ‘My Payments’ section of ImmiAccount. Sign into, or create, your ImmiAccount and select
My Payments>Manage Payments>Pre-Pay Paper Service, at www.homeaffairs.gov.au/immiaccount
Do not provide credit card details on this form. Make your credit card payment electronically through the ‘My Payments’ section of ImmiAccount.
If you are outside Australia and cannot pay online in ImmiAccount check the Department’s website for alternative payment methods for your location
www.homeaffairs.gov.au/locations
Payment receipt number from the ‘My Payments’ section of ImmiAccount

Attach a copy of your printed receipt.

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 Part H – Signatures Australian values statement
I confirm that I have read, or had explained to me, information provided
by the Australian Government on Australian society and values.
46 BIOMETRICS DECLARATION AND CONSENT
I understand that Australian society values:
This declaration and consent is for offshore visa applicants.
• respect for the freedom and dignity of the individual;
If I am requested or required to provide my fingerprints and facial image:
• freedom of religion (including the freedom not to follow a particular
I consent to:
religion), freedom of speech, and freedom of association;
• the collection of my fingerprints and facial image.
• commitment to the rule of law, which means that all people are
I declare that: subject to the law and should obey it;
• I understand that my fingerprints and facial image and my • parliamentary democracy whereby our laws are determined by
biographical information held by the Department may be given to parliaments elected by the people, those laws being paramount and
Australian law enforcement agencies to help identify me, to help overriding any other inconsistent religious or secular ‘laws’;
determine my eligibility for grant of the visa I have applied for, and for
• equality of opportunity for all people, regardless of their gender,
law enforcement purposes.
sexual orientation, age, disability, race, or national or ethnic origin;
I consent to:
• a ‘fair go’ for all that embraces:
• Australian law enforcement agencies disclosing my biometric,
– mutual respect;
biographical and criminal record information to the Department for
any of the purposes outlined above; and – tolerance;
• the Department using the information obtained for the purposes of – compassion for those in need;
the Migration Act 1958 or the Australian Citizenship Act 2007. – equality of opportunity for all;
• the English language as the national language, and as an important
Signature of unifying element of Australian society.
applicant I undertake to conduct myself in accordance with these values of
- Australian society during my stay in Australia and to obey the laws of
Day Month Year Australia.
Date
Signature of
applicant
47 DECLARATION -
WARNING: Giving false or misleading information or documents is a Day Month Year
serious offence.
Date
I declare that:
• the information on this form is complete, correct and up-to-date; Please check all questions are answered. If your form is
• I have read the notes at the front of this application, and am aware incomplete, there may be delays in processing your application.
that I am required to abide by the conditions that are placed on my
visa; We strongly advise that you keep a copy of your application
• after applying, I will notify the Department of any change in my and all attachments for your records.
circumstances including my address details;
• I have read the information contained in form 1442i Privacy notice;
• 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;
• I understand that if any fraudulent documents or false or misleading
information has been provided with this application, or if I fail to satisfy
the Minister of my identity, my application may be refused and I, and
any other member of my family unit, may become unable to be
granted a visa for specified periods of time; and
• if documents are found to be fraudulent or information to be incorrect
after the grant of a visa, the visa may subsequently be cancelled.
• I have read and understood that I am liable for the cost of any health
related services that I receive while in Australia. This does not include
costs otherwise covered, such as by health insurance, Medicare (if
eligible), or treatment for certain community health risks such as
tuberculosis.
• I understand that if my visa ceases to be in effect and I do not hold
another visa to remain in Australia at that time, I will be an unlawful
non-citizen under the Migration Act 1958. As such, I will be expected
to depart from Australia, and be subject to removal under the
Migration Act 1958.

© COMMONWEALTH OF AUSTRALIA, 2022 1208 (Design date 09/22) - Page 13