842 (Application For An Offshore Humanitarian Visa)
842 (Application For An Offshore Humanitarian Visa)
842 (Application For An Offshore Humanitarian Visa)
Form
842
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.
Children under 18
Children under the age of 18 who have no parents, or who have been separated from their parents, may also be granted a visa in one of the subclasses listed above. However, the Australian Government must be satisfied the childs entry to Australia is in the best interest of the child and that the rights of the parents, if any, are properly considered. If any children under 18 who are members of the family unit and included in this application are not your biological children, you must provide information and documentation as to who their birth parents are/were.
To be eligible for the grant of a humanitarian visa under the split family provisions for immediate family: you must apply within 5 years of the permanent Protection, permanent humanitarian or Resolution of Status visa being granted to your proposer; your proposer must complete a form 681 Refugee and Special Humanitarian Proposal (available from offices of the department in Australia or the immigration website) for you to submit together with your own visa application; your proposer must have declared you to the department as an immediate family member before the grant of their own visa.
Partner
Partner means your spouse or de facto partner (including same-sex partners).
Residential address
You must advise the department where you intend to live while your application is being dealt with, or if you change your residential address after your application has been lodged. Failure to give a residential address will result in your application being invalid. A post office box address will not be accepted as your residential address.
Your application
You should answer the questions in this form truthfully and fully and attach any supporting documents. Forms that are incomplete could delay a decision being made on your application, or your application could be refused. Not all applicants are interviewed and a decision may be taken on the information provided in your application only. You need to make sure you include all details about your situation in your application. If you need more space than is provided in this form for any of your answers, attach a separate page, clearly marking the question number the page relates to. Additional pages must be signed and dated by each person aged 18 years or over included in this application.
Split family provisions for immediate family of permanent Protection (Class XA), permanent humanitarian (Class XB) or Resolution of Status (Class CD) visa holders.
You should use this form if, within the last 5 years a member of your immediate family was granted either a: permanent Protection visa (subclass 866); or permanent humanitarian visa (subclasses 200, 201, 202, 203 or 204); or Resolution of Status (Class CD) visa (subclass 851). Note: Your proposer must not have been an illegal maritime arrival. Note: Under the split family provisions, Immediate family means you are the spouse, de facto partner (including same-sex partner), dependent child or in certain circumstances a parent of the person in Australia who is proposing your entry (that is, your proposer has completed form 681). Note: You can only apply as a parent under these split family provisions if your child in Australia is under 18 years of age.
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 or your application being refused.
For applicants residing in any other country apart from those listed above, applications must be lodged at the following address: NSW Offshore Humanitarian Processing Centre By Post: GPO Box 9984 Sydney NSW 2001 AUSTRALIA By Courier (no hand deliveries) 26 Lee Street Sydney NSW 2001 AUSTRALIA For further information, please see the information sheet Lodging Certain Humanitarian Applications in Australia available from the departments website www.immi.gov.au
Supporting documents
The documents you must provide are requested throughout this form. There is also a document checklist in Part O of this form and you should carefully check you have provided all the listed documents. You should also provide all documents necessary to support your humanitarian claims. Copies of documents must be certified as true copies of the original by a Justice of the Peace, Commissioner for Declarations, or a person before whom a Statutory Declaration may be made under the Statutory Declarations Act 1959. Outside Australia, a person who is equivalent to a Justice of the Peace or a Commissioner for Declarations must certify copies. If you do not provide all the necessary documents, a decision may be made on the information you have provided. It is in your interest to support your application with as much information as possible at the time of application. If you are not able to provide any of the documents listed at Part O, please provide a written explanation why the documents are not available. Under no circumstances should you submit false documents.
Change of circumstances
If your circumstances change in any way after you have lodged this form (eg. if you or a family member enters into a new relationship, becomes engaged, or marries), you must inform the office where the application was lodged. If a child is born to you (or any other person included in this application) after the application is lodged, the child will be included in your application if details are provided before a final decision is made on your application.
Processing information
You should be aware that there is strong interest in this class of visa and it may take a long time to finalise your application. You may need to have a medical and an x-ray examination as part of the assessment of your application. You may also be asked to undergo medical treatment as part of the assessment of the visa application. The Australian Government reserves the right to conduct character checks on all adult applicants. Details of your application are not passed on to your home country. The Australian Government will pay the costs related to medical examinations for all humanitarian visa applicants, except visa applicants in the Community Proposal Pilot. All visa subclasses, except Global Special Humanitarian (subclass 202) visa holders and visa holders in the Community Proposal Pilot, will also have their travel costs paid by the Australian Government. Note: For applicants in the Community Proposal Pilot, the APO must pay the costs of medical examinations and, if a visa is granted, the cost of airfares to Australia.
Review rights
If your application is refused, it is not possible to obtain a review of the decision by the Migration Review Tribunal or the Refugee Review Tribunal.
Settlement services
If you are granted a humanitarian visa (subclasses 200, 201, 202, 203 or 204), information on the personal possessions that you may take with you to Australia is available from the office that granted your visa. The Australian Government provides a range of services to help refugee and humanitarian entrants settle in Australia. This assistance may include being met on arrival by a service provider and taken to accommodation, help to register for income support, help to arrange medical appointments, information about your new community, and attending English language classes. Note: If you are granted a humanitarian visa in the Community Proposal Pilot, settlement services will be provided to you by your APO, in conjunction with any Supporting Community Organisation.
Exempt persons
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.
Immigration assistance
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. 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. Restrictions on giving immigration assistance, charging fees for immigration assistance and restrictions on charging fees for immigration representations apply even where the APO lodges form 842 (this form) on behalf of a client in the Community Proposal Pilot.
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.
Form
842
PHOTOGRAPHS
Please attach eight (8) recent passport sized photographs of yourself AND all members of your family unit included in this application Note: Clearly write the name of the person on the back of each photograph
Please use a pen, and write neatly in English using BLOCK LETTERS.
1 2
How many people are included in this application? Give details of the main applicant Family name Given names Name in own language or ethnic script Sex Date of birth Place of birth Town/city Country Citizenship Male
DAY MONTH
For your relationship status (other than never married or been in a de facto relationship), give the following details:
DAY MONTH YEAR
Do you currently have more than one partner (other than any partner included in this visa application)? No Yes Please provide details
Select
Status in this country
Status in this country codes C = Citizen PR = Permanent resident TR = Temporary resident S = Student V = Visitor/Tourist R = Refugee I = Illegal resident A = Asylum/protection applicant O = Other give details on a separate page
Give details of all other people included in this application 1. Family name Given names
A2
A3
Name in own language or ethnic script Sex Date of birth Place of birth Town/city Country Citizenship Male
DAY MONTH
Male
DAY MONTH
Female
YEAR
Yes
Yes
A4
A5
Name in own language or ethnic script Sex Date of birth Place of birth Town/city Country Citizenship Male
DAY MONTH
Male
DAY MONTH
Female
YEAR
Yes
Yes
A6
A7
Name in own language or ethnic script Sex Date of birth Place of birth Town/city Country Citizenship Male
DAY MONTH
Male
DAY MONTH
Female
YEAR
Yes
Yes
If you need more space, please attach a separate page with the details
Attach evidence of identity of each person included in this application (eg. certified copies of birth certificates, marriage certificates, passport, national identity card)
Name
Country of registration
Do you agree to the department communicating with you by fax, email or other electronic means? No Yes Give details
COUNTRY CODE AREA CODE ) ( ) NUMBER (
POSTAL CODE
Address where we should write to you about this application if different from your residential address Note: You must tell us if your address changes after you lodge this form
Note: If you wish to nominate a person other than yourself to receive written communications about this application, you must indicate this at Part M.
POSTAL CODE
( (
How did the relationship end? Names of all children from this previous relationship
How did the relationship end? Names of all children from this previous relationship
If you need more space, please attach a separate page with the details
Attach a certified copy of previous marriage/divorce documents or death certificate (if applicable/available)
9
2. Family name Given names
Do you or any other person included in this application have children from a previous marriage/relationship, including customary/traditional marriage? No Yes Do they have sole custody of any children under 18 years of age who are included in this application? No Yes Attach a certified copy of the custody documents (if available)
Note: Where custody documents are not provided or assessed as unsatisfactory, the former partner will need to provide evidence that he/she consents to any children of that relationship entering Australia.
How did the relationship end? Names of all children from this previous relationship
10 Are there any children included in this application who are not the
biological children of either you (the main applicant) or your partner? No Yes Give details of each child
DAY
MONTH
YEAR
Date of birth Relationship to you Full name of biological father Full name of biological mother Whereabouts of biological parents (if deceased or unknown, please state)
DAY
MONTH
YEAR
Date of birth Relationship to you Full name of biological father Full name of biological mother Whereabouts of biological parents (if deceased or unknown, please state)
Has this child been adopted (formally, customarily or traditionally) by the main applicant and/or partner? No Yes Date custody commenced
DAY MONTH YEAR
Has this child been adopted (formally, customarily or traditionally) by the main applicant and/or partner? No Yes Date custody commenced
DAY MONTH YEAR
If you need more space, please attach a separate page with the details
For each adopted child, attach a certified copy of the adoption papers (if available) or attach a statement which explains the circumstances of the adoption
DAY
MONTH
YEAR
Date of birth Relationship to you Full name of biological father Full name of biological mother Whereabouts of biological parents (if deceased or unknown, please state)
Has this child been adopted (formally, customarily or traditionally) by the main applicant and/or partner? No Yes Date custody commenced
DAY MONTH YEAR
A dependant is a person who is wholly or substantially dependent on you or your partner for financial, psychological or physical support.
No Yes Give details and explain why they do not intend to migrate with you as part of this visa application
Relationship to you Last contact (when, where and how you were separated) Full residential address (if known)
POSTAL CODE
Date of birth Relationship to you Reason they are not applying with you
Date of birth Relationship to you Reason they are not applying with you
Date of birth (DAY/MONTH/YEAR) Relationship to you Last contact (when, where and how you were separated) Full residential address (if known)
POSTAL CODE
DAY
MONTH
YEAR
Date of birth Relationship to you Reason they are not applying with you
Date of birth (DAY/MONTH/YEAR) Relationship to you Last contact (when, where and how you were separated) Full residential address (if known)
POSTAL CODE
If you need more space, please attach a separate page with the details
If you need more space, please attach a separate page with the details
Name
Sex M/F
Date of birth
DAY MONTH YEAR
Your parents
Select
Select
Select
Relationship status codes N = Never married or been in a de facto relationship M = Married legally E = Engaged to be married S = Separated F = In a de facto relationship D = Divorced W = Widowed MT = Married by tradition/custom MR = Married religiously Relationship to main applicant codes PB = Parent Biological PA = Parent Adoptive PS = Parent Step PO = Parent Other (attach explanation) SB = Sibling Biological (full) SA = Sibling Adoptive SS = Sibling Step SO = Sibling Other (attach explanation) CB = Child Biological CA = Child Adoptive CS = Child Step CO = Child Other (attach explanation) Status in country of residence codes C = Citizen PR = Permanent resident TR = Temporary resident S = Student V = Visitor/Tourist R = Refugee I = Illegal resident A = Asylum/protection applicant O = Other give details on a separate page
Select
Select
Select
Your non-dependent children (all children who are not included as dependants in this application)
Select
Select
If you need more space, please attach a separate page listing further names
COMMONWEALTH OF AUSTRALIA, 2014 842 (Design date 03/14) - Page 15
Name
Sex M/F
Date of birth
DAY MONTH YEAR
Relationship status
(use codes on right)
Select
Select
Select
Your partners mothers maiden name Your partners brothers and sisters
Relationship status codes N = Never married or been in a de facto relationship M = Married legally E = Engaged to be married S = Separated F = In a de facto relationship D = Divorced W = Widowed MT = Married by tradition/custom MR = Married religiously
Select
Select
Select
Relationship to main applicants partner codes PB = Parent Biological PA = Parent Adoptive PS = Parent Step PO = Parent Other (attach explanation) SB = Sibling Biological (full) SA = Sibling Adoptive SS = Sibling Step SO = Sibling Other (attach explanation) CB = Child Biological CA = Child Adoptive CS = Child Step CO = Child Other (attach explanation)
Your partners non-dependent children (all children who are not included as dependants in this application)
Select
Select
Status in country of residence codes C = Citizen PR = Permanent resident TR = Temporary resident S = Student V = Visitor/Tourist R = Refugee I = Illegal resident A = Asylum/protection applicant O = Other give details on a separate page
If you need more space, please attach a separate page listing further names
842 (Design date 03/14) - Page 16 COMMONWEALTH OF AUSTRALIA, 2014
Family and given name (If all persons included in this application, write ALL)
If you need more space, please attach a separate page with the details
16 Do you or your partner have any relatives NOT INCLUDED IN THIS VISA APPLICATION
who have current Australian visa applications under consideration? No Yes Give details
Family and given name
DAY
Date of application
MONTH YEAR
If you need more space, please attach a separate page with the details
17 Is any person included in this application being proposed (on form 681 or form 1417)
for entry to Australia by a person or organisation in Australia? No Yes Give details of your proposer or Approved Proposing Organisation (in case of a Community Proposal Pilot application) Family name Given names OR Organisation name Contact person Relationship of the proposer to you Address of the proposer
POSTCODE
Telephone number
(AREA CODE
Note: Proposers in the Global Special Humanitarian (subclass 202) program must complete form 681 Refugee and Special Humanitarian Proposal and lodge both form 681 and this form (form 842) together. There is no charge for lodging or processing form 681. Note: APOs under the Community Proposal Pilot must complete form 1417 Proposal for refugee and special humanitarian entrants by Approved Proposing Organisation and lodge both form 1417 and this form (form 842) together. For charges associated with lodging and processing form 1417, refer to the Visa Pricing Table www.immi.gov.au/fees-charges/visa-pricing-table.htm These forms are available from the department's website www.immi.gov.au
COMMONWEALTH OF AUSTRALIA, 2014 842 (Design date 03/14) - Page 17
Immediate family means a spouse or de facto partner (including same-sex partner), dependent children, or parent (if your child in Australia is under 18 years of age)
No Yes Give details of the immediate family member who was granted the visa Family name Given names File number (if known) Name of the person in this application they are related to Relationship Where did they last live together?
DAY MONTH YEAR
When did they last live together? How did they become separated?
Attach a completed form 681 Refugee and Special Humanitarian Proposal to this application (there is no charge for lodging or processing form 681) Your proposer should complete form 681 for lodgement with this visa application. Form 681 is available from any office of the department, or from the departments website www.immi.gov.au Attach a certified copy of the immediate family members Australian visa and evidence of the relationship (eg. a marriage certificate, birth certificate etc.) if available Provide details of humanitarian claims at Part G, Questions 24 36
19 Do any people included in this application have any other relatives residing in Australia?
No Yes Give details
Select
Details of the relative in Australia Date of birth
DAY MONTH YEAR
Name
Address
Given names
Relationship to applicant
1.
2.
3.
4.
5.
If you need more space, please attach a separate page with the details
A3 Given names
Does this person have a travel or identity document? No Yes Attach a statement explaining what happened to your documents Give details
Select
Main applicant
Do you have a travel or identity document? No Yes Attach a statement explaining what happened to your documents Give details
Country of issue
DAY MONTH YEAR
Select
Date of issue Date of expiry Issuing authority/Place of issue as shown in passport (or other document)
Country of issue
DAY MONTH YEAR
Date of issue Date of expiry Issuing authority/Place of issue as shown in passport (or other document)
A4 Given names
Does this person have a travel or identity document? No Yes Attach a statement explaining what happened to your documents Give details
Select
Other applicants
A2 Given names
Does this person have a travel or identity document? No Yes Attach a statement explaining what happened to your documents Give details
Country of issue
DAY MONTH YEAR
Select
Country of issue
DAY MONTH YEAR
A5 Given names
Date of issue Date of expiry Issuing authority/Place of issue as shown in passport (or other document)
Does this person have a travel or identity document? No Yes Attach a statement explaining what happened to your documents Give details
Select
Country of issue
DAY MONTH YEAR
Date of issue Date of expiry Issuing authority/Place of issue as shown in passport (or other document)
Type of document codes P = Passport UN = UN Convention travel document or Titre de voyage A = Alien/Asylum Registration Card CI = Certificate or document of identity S = Seafarer identity document NIC = National identity card
842 (Design date 03/14) - Page 20 COMMONWEALTH OF AUSTRALIA, 2014
A6 Given names
Does this person have a travel or identity document? No Yes Attach a statement explaining what happened to your documents Give details
Select
Country of passport
DAY MONTH YEAR
Date of issue Date of expiry Issuing authority/Place of issue as shown in passport (or other document)
A7 Given names
Does this person have a travel or identity document? No Yes Attach a statement explaining what happened to your documents Give details
Select
Country of issue
DAY MONTH YEAR
Date of issue Date of expiry Issuing authority/Place of issue as shown in passport (or other document)
If you need more space, please attach a separate page with the details
Attach certified copies of the travel documents and identity documents, if available
Type of document codes P = Passport UN = UN Convention travel document or Titre de voyage A = Alien/Asylum Registration Card CI = Certificate or document of identity S = Seafarer identity document NIC = National identity card
COMMONWEALTH OF AUSTRALIA, 2014 842 (Design date 03/14) - Page 21
Family and given names (If all persons included in this application, write ALL)
Which country?
If you need more space, please attach a separate page with the details
23 For EACH person included in this application list every address where they
have lived during the last 10 years
Address where you are living now Date you started to live at this address
DAY MONTH YEAR
Given names of people included in this application who live at this address (if all, write ALL)
Town
Given names of people included in this application who lived at this address (if all, write ALL)
1.
TO
MONTH
YEAR
Town
Country
FROM MONTH YEAR
2.
TO
MONTH
YEAR
Town
Country
FROM MONTH YEAR
3.
TO
MONTH
YEAR
Town
Country
FROM MONTH YEAR
4.
TO
MONTH
YEAR
Town
Country
FROM MONTH YEAR
5.
TO
MONTH
YEAR
Town
Country
24 For ALL the people included in this application list the ethnic group to which
they belong, their religion and any political party/group to which they belong
Given names
A1
A2
A3
A4
A5
A6
A7
If you need more space, please attach a separate page with the details
COMMONWEALTH OF AUSTRALIA, 2014 842 (Design date 03/14) - Page 23
DAY
MONTH
YEAR
27 Why did you leave the country you fear returning to?
Your answer should pay special attention to what happened to you, not the general situation in that country.
If you need more space, please attach a separate page with details
28 How did you leave the country you fear returning to?
Legally Illegally Give details of your exit permit Describe how you arranged to leave illegally
29
What do you believe may happen to you, or the people included in your application, if you were to return to that country?
You should give full details of what you think may happen to you and reasons why that would happen
If you need more space, please attach a separate page with details
30 Who do you think may harm or mistreat you if you go back to that country?
If you need more space, please attach a separate page with details
31 Do you think the authorities of that country can and will protect you if you return to that country?
No Please explain why Yes
32 Did you travel through, or stay, in any other countries before arriving in the country where you are now living?
No Yes Give details including length of stay and dates
Dates From Country
DAY MONTH YEAR DAY
To
MONTH YEAR
33 Has this application been lodged based on the United Nations High Commissioner for Refugees (UNHCR)
referring you to Australia for refugee resettlement? No Yes Attach a full copy of your UNHCR Resettlement Registration Form (RRF)
Given names Country served Name of military/paramilitary organisation Rank in this organisation Dates of membership of this organisation Why did this person leave this organisation?
FROM TO FROM TO
If you need more space, please attach a separate page with the details
Attach certified copies of any discharge papers if available
35 Has any person included in this application ever lived in a refugee camp,
collective accommodation centre for refugees, or detention centre? No Yes Give details
Name of camp/centre Location Who ran the camp/centre?
FROM TO
Given names of people included in this application who lived there (if all, write ALL)
1. 2. 3. 4. 5. 6.
If you need more space, please attach a separate page with the details
36 If selected for an interview about your application, will you need an interpreter?
No Yes Which language(s)?
If you are selected for an interview we will advise you if you are required to provide your own interpreter
Name of employer
Location of employer
Type of business
A1
FROM TO FROM TO FROM TO FROM TO FROM TO FROM TO
Main applicant
Other applicants
A2
FROM TO FROM TO FROM TO FROM TO FROM TO
Name
A3
FROM TO FROM TO FROM TO
Name
A4
FROM TO FROM TO FROM TO
Name
(Question 37 continued)
Dates of employment
DAY MONTH YEAR
Name of employer
Location of employer
Type of business
A5
FROM TO FROM TO FROM TO FROM TO
Name
A6
FROM TO FROM TO FROM TO FROM TO
Name
A7
FROM TO FROM TO FROM TO FROM TO
Name
Name
FROM TO FROM TO FROM TO
Name
FROM TO FROM TO FROM TO
If you need more space, please attach a separate page with the details
COMMONWEALTH OF AUSTRALIA, 2014 842 (Design date 03/14) - Page 29
A2 A3 A4 A5 A6 A7
If you need more space, please attach a separate page with the details
39 For EACH person included in this application, give details of their education
Primary school Given names
A1
DAY MONTH YEAR
Secondary school
DAY MONTH YEAR
Post-secondary education
DAY MONTH YEAR
Highest educational qualification obtained (eg. school certificate, electrician certificate, BA, PhD)
FROM TO
FROM TO
FROM TO
A2
FROM TO
A3
FROM TO
A4
FROM TO
A5
FROM TO
A6
FROM TO
A7
If you need more space, please attach a separate page with the details
English language codes 1 = Very well (eg. can speak English with little hesitation and few errors in most situations) 2 = Well (eg. can speak English well enough to deal with basic social and work situations) 3 = Not well (eg. can speak only a little English) 4 = Not at all
842 (Design date 03/14) - Page 30 COMMONWEALTH OF AUSTRALIA, 2014
Part J Health
40 Have you, or any other person included in this application, undertaken a
health examination for an Australian visa in the last 12 months? No Yes Give details (including HAP ID if available)
Part K Character
41 Has any person included in this application ever:
been convicted of a crime or offence in any country? been charged with any offence that is currently awaiting legal action? been found guilty or acquitted of any criminal or other offence on the grounds of mental illness, insanity or unsoundness of mind? been deported from any country? left any country voluntarily prior to the execution of a deportation order? been excluded from or required to leave any country? been involved in any activities that would represent a risk to Australian national security? committed or been involved in the commission of war crimes or crimes against humanity or human rights? been involved in any activity, or been convicted of any offence, relating to the illegal movement of people to any country (including Australia)? had any outstanding debts to the Australian Government or any public authority in Australia? No No Yes Yes
Address
POSTCODE
43 Is the person an agent registered with the Office of the Migration Agents
Registration Authority (Office of the MARA)? No Yes Go to Part M
No
Yes
45 Did you pay the person/agent and/or give a gift for this assistance?
No Yes No Yes
No
Yes
served in a military force or state sponsored/private militia, undergone any military/paramilitary training, or been trained in weapons/explosives use (however described)? No
Yes
Myself OR Proposer OR All written communications will be sent to the address of the proposer provided in this form. Note: If you are applying in the Community Proposal Pilot, you should select this option. You should complete form 956A Appointment or withdrawal of an authorised recipient Your migration agent/exempt person should complete form 956 Advice by a migration agent/exempt person of providing immigration assistance
842 (Design date 03/14) - Page 31
If you answered Yes to any of the above questions, provide all details below. If the matters relate to a criminal conviction, please give the nature of the offence, full details of sentence and dates of any period of imprisonment or other detention.
If you need more space, please attach a separate page with the details
Exempt person
I confirm that I have read, or had explained to me, information provided by the Australian Government on Australian society and values. I understand: Australian society values 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 values equality of opportunity for individuals, regardless of their race, religion or ethnic background; the English language, as the national language, is an important unifying element of Australian society. I undertake to respect these values of Australian society during my stay in Australia and to obey the laws of Australia. I understand that, if I should seek to become an Australian citizen: Australian citizenship is a shared identity, a common bond which unites all Australians while respecting their diversity; Australian citizenship involves reciprocal rights and responsibilities. The responsibilities of Australian citizenship include obeying Australian laws, including those relating to voting at elections and serving on a jury. If I meet the legal qualifications for becoming an Australian citizen and my application is approved I understand that I would have to pledge my loyalty to Australia and its people.
48 This declaration and consent must be signed by you (the main applicant)
and ALL persons aged 18 or over included in this application.
WARNING: Giving false or misleading information is a serious offence. Signature or mark of applicant Date (DAY/MONTH/YEAR) Signature or mark of partner (if applicable) Date (DAY/MONTH/YEAR) Signatures of persons aged 18 years or over who are included in this application (if applicable) Signature or mark Date (DAY/MONTH/YEAR)
I declare that: the information I have supplied on and with this form is complete, correct and up-to-date in every detail. I did not marry or enter a de facto relationship to become eligible for entry to Australia. I understand that if I have given false or misleading information, my application may be refused, or, if a visa has been granted, the visa may be cancelled and I could be removed from Australia. I understand that if I am granted a visa, any person not included in this application will not have automatic right of entry to Australia by way of this application. I undertake to inform the Australian Government of any material changes to my circumstances while my application is being considered, or before I am immigration cleared. (Note: Your visa may be cancelled and you could be removed if you do not advise of changes in circumstances). I authorise the Australian Government to make any enquiries necessary to determine my eligibility for entry to Australia, and to use any information supplied in this application for that purpose. I understand that unless my qualifications have already been recognised by an Australian assessing authority before my departure, they may not be recognised after my arrival. I understand that it is my personal responsibility to assess my own employment prospects in Australia and acknowledge that labour market conditions there can vary significantly from time to time and between regions. I understand that grant of a visa provides no guarantee of employment once in Australia. 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. 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 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 for any of the purposes outlined above; and the department using the information obtained for the purposes of the Migration Act 1958 or the Citizenship Act 2007. For applicants applying in the Community Proposal Pilot: I understand that my Approved Proposing Organisation will be lodging this application on my behalf; and I understand that the information that I provide in this form may be shared with my Approved Proposing Organisation and that my Approved Proposing Organisation may also share this information with any Supporting Community Organisations it works with in order to provide services to help me settle in Australia.
We strongly advise that you keep a copy of your application and all attachments for your records.
Important If your circumstances change after you lodge this application (eg. you change your address, marry or become engaged to be married, or have a baby), you must notify the office where you lodge this application. If your application is supported by a proposal form 681 Refugee and special humanitarian proposal or form 1417 Proposal for refugee and special humanitarian entrants by Approved Proposing Organisations and your proposers circumstances change after you have lodged this application, you should also notify the office where you lodge this application.
COMMONWEALTH OF AUSTRALIA, 2014 842 (Design date 03/14) - Page 33
Q4
Q8 Q9 Q10
Q17
If you have attached additional pages with answers, each page must be marked with the question number it refers to, and signed and dated by each person aged 18 years or over who is included in this application. Please ensure you, your partner and persons aged 18 years or over who are included in this application have signed the Declaration at Part O. If you do not provide all the necessary documents, or you have not provided an adequate explanation why you cannot provide these documents, a decision may be made on the information you have provided. It is in your interest to support your application with as much information as possible at the time of lodging this application. You must lodge your Class XB visa application at the relevant office of the department responsible for visa applications from your country of residence. To find out which office of the department you need to lodge your application with, refer to the departments website at www.immi.gov.au Note: Certain applicants must lodge their application in Australia (see Where can you lodge this application? on page 3).
*In Australia, copies of documents must be certified as true copies of the original by a Justice of the Peace, Commissioner for Declarations, or a person before whom a Statutory Declaration may be made under the Statutory Declarations Act 1959. *Outside Australia, copies of documents must be certified by a person who is the equivalent of a Justice of the Peace or Commissioner for Declarations in the country where the documents are being certified.