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1419 CHS (Design date 07/14) - Page 5 COMMONWEALTH OF AUSTRALIA, 2014
Form
1419 CHSCHINESE SIMPLIFIED
Application for a Visitor visa Tourist stream
Tick where applicable
Please use a pen, and write neatly in English using BLOCK LETTERS.
Up to 3 months
Up to 6 months
How long do you wish to stay in Australia?3
Up to 12 months
Note: The stay period granted may be less than the period requested. You should check the terms of any visa granted.
PHOTOGRAPH
Please attach a recent passport size photograph of yourself.
Outside Australia
In Australia
Indicate if you are applying outside Australia or in Australia:1
Go to Question 2 2
Go to Question 5 5
When do you wish to visit Australia?2 DAY MONTH YEAR
Applicants outside Australia
Give details
No
Yes
Do you intend to enter Australia on more than one occasion?4
Go to Question 7 7
Go to Question 7 7
Specify the date you wish to extend your stay to
5
Applicants in Australia
Provide detailed reasons for requesting this further stay6
Date
to
from
DAY MONTH YEAR
1419 CHS (Design date 07/14) - Page 6 COMMONWEALTH OF AUSTRALIA, 2014
10 Are you or have you been known by any other name? (including name at birth, previous married names, aliases)
Give details
No
Yes
Note: If this visa application is approved, your current visa may cease.Yes
Do you currently hold an Australian visa?11
12 Have you applied for a Parent (subclass 103) visa?103
Please provide your queue dateYes
List countries
Are you a citizen of any other country?14
13 Do you currently hold, or have you applied for, an APEC Business Travel Card (ABTC)?
Note: If this visa application is approved, the Australian visa associated with your ABTC will cease.
ABTC
8 Place of birth
Town/city
State/province
Country
9 Relationship status
Married
De facto
Engaged Divorced
Separated
Widowed
Never married or been in a de facto
relationship
Date of birth
Passport number
Country of passport
Nationality of passport holder
Date of issue
Date of expiry
Place of issue/issuing authority
Part A Your detailsA Give the following details exactly as they appear in your passportMake sure your passport is valid for the period of stay you are applying for.
7
Family name
Given names
Sex Male Female
Yes
Yes
No
No
No
No
DAY MONTH YEAR
DAY MONTH YEAR
DAY MONTH YEAR
Give details
Do you have other current passports?15
Passport number
Country of passport
Yes
No
1419 CHS (Design date 07/14) - Page 7 COMMONWEALTH OF AUSTRALIA, 2014
Type of document
Identity number
Country of issue
23 Do you agree to the department communicating with you by email and/or fax?
This may include receiving notification of the outcome of this application.
Note: We can communicate about this application more quickly using email and/or fax.
Fax number
Email address
( ) ( )
COUNTRY CODE AREA CODE NUMBER
20
POSTCODE
Your current residential address Note: A street address is required as a post office box address cannot be accepted.
21 Address for correspondence (If the same as your residential address, write AS ABOVE)
Country
Country
22 Contact telephone numbers
Home( ) ( )
COUNTRY CODE AREA CODE NUMBER
Office( ) ( )
Mobile/cell
POSTCODE
Do you hold an identity card or identity number issued to you by your government (eg. National identity card) (if applicable)?Note: If you are the holder of multiple identity numbers because you are a citizen of more than one country, you need to enter the identity number on the card from the country that you live in.
16
Family name
Given names
Give details
No
Yes
Give details
No
Yes19 What is the purpose of your stay in your current location and what isyour visa status?
17 In what country are you currently located?
Give details
18 What is your legal status in your current location?
Citizen
Visitor
Work visa
Other
Permanent resident
Student
No legal status
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Are you travelling to, or are you currently in, Australia with any family members?24
Full name Relationship to you Name of sponsor (if applicable)
Give details of each family member Make sure all the applications are lodged at the same time.
Part B Family travelling to Australia with youB
Do you have a partner, any children, or fianc who will NOT be travelling, or has NOT travelled, to Australia with you?25
Full nameDate of birth
Relationship to you Their address while you are in Australia DAY MONTH YEAR
/ /
/ /
/ /
/ /
Part C Family NOT travelling to Australia with youC
If insufficient space, give details at Part OO
If insufficient space, give details at Part OO
Yes
Give details
No
Yes
No
1419 CHS (Design date 07/14) - Page 9 COMMONWEALTH OF AUSTRALIA, 2014
Do you have any relatives in Australia?27
Full nameDate of birth Relationship
to you Address Citizen or permanent resident of Australia
DAY MONTH YEAR
/ /
/ /
/ /
/ /
Full nameDate of birth Relationship
to you Address Citizen or permanent resident of Australia
DAY MONTH YEAR
/ /
/ /
/ /
/ /
If insufficient space, give details at Part O
If insufficient space, give details at Part O
O
O
Do you have any friends or contacts in Australia?28
No Yes
Give details
No
Yes
Give details
No
Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
Is it likely you will be travelling from Australia to any other country (eg. New Zealand, Singapore, Papua New Guinea) and back to Australia?26
Attach itinerary details
Part D Details of your visit to AustraliaD
Yes
No
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30 Do you intend to do a course of study while in Australia?
Name of the course
Name of the institution
How long will the course last?
In the last 5 years, have you visited or lived outside your country of passport for more than 3 consecutive months?Do not include time spent in Australia.
31
Country(s)
Country(s)
Country(s)
1.
2.
3.
Part E Health detailsE
If insufficient space, give details at Part OO
32 Do you intend to enter a hospital or health care facility (including nursing homes) while in Australia?
Give details
No
Yes
Give details
No
Yes
Give details
No
Yes
Why do you want to visit Australia? Include details of any dates that are of special significance to your visit.
29
If insufficient space, give details at Part OO
Date
Date
Date
to
to
to
from
from
from
DAY
DAY
DAY
MONTH
MONTH
MONTH
YEAR
YEAR
YEAR
1419 CHS (Design date 07/14) - Page 11 COMMONWEALTH OF AUSTRALIA, 2014
35
36 Do you require assistance with mobility or care due to a medical condition?
37 Have you undertaken a health examination for an Australian visa in the last 12 months?
Note: If you are applying for a long stay Visitor visa or are 75 years or over, you will be asked to undergo a health assessment and may be asked to show that you have medical insurance to cover your intended stay in Australia. Please contact your nearest office of the department for further advice before lodging your application. If additional medical consultations are required, a decision on your visa application will be delayed.
required hospital admission or oxygen therapy
During your proposed visit to Australia, do you expect to incur medical costs, or require treatment or medical follow up for:
Give details
No
Yes
Give details
No
Yes
Give details (including HAP ID if available) HAP ID
No
Yes
33 Do you intend to work as, or study to be, a doctor, dentist, nurse or paramedic during your stay in Australia?
34 Have you: ever had, or currently have, tuberculosis?been in close contact with a family member that has active tuberculosis?ever had a chest x-ray which showed an abnormality?
Give details
No
Yes
Give details
No
Yes
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If you answered Yes to any of the above questions, give ALL relevant details below.
If insufficient space, give details at Part OO
Part F Character details
38 Have you ever:
F
represent a risk to Australian national security?
Government or any public authority in Australia?
No Yes
No Yes
country (including any conviction which is now removed from official records)?
currently awaiting legal action?
other offence on the grounds of mental illness, insanity or unsoundness of mind?
country (including Australia)?
deported?
country (including Australia)?
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
commission of war crimes or crimes against humanity or human rights? No Yes
convicted of any offence, relating to the illegal movement of people to any country (including Australia)?
sponsored/private militia, undergone any military/paramilitary training, or been trained in weapons/explosives use (however described)?
No Yes
No Yes
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Part G Employment status
What is your employment status?39
Telephone number
Employed/self-employed Give details
Employer/business name
POSTCODE
Address
Position you hold
How long have you been employed by this employer/business?
Retired Year of retirement
Student Give details
Your current course
Name of educational institution
How long have you been studying at this institution?
Other Give details
Unemployed
Explain why you are unemployed and give details of your last employment (if applicable)
( ) ( )
COUNTRY CODE AREA CODE NUMBER
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Part H Funding for stayH All visitors to Australia must be able to demonstrate they have adequate funds to cover all costs associated with their visit. Providing evidence of funds will help expedite the processing of a visitor visa application. Examples may include personal bank statements showing a financial history, pay slips, audited accounts, taxation records or details of funds that visitors will be taking with them or funds that are available to them. Relevant factors may also include the number of persons your are supporting, the type of activities planned and the length of stay sought.
40 Give details of how you will maintain yourself financially while you are in Australia
Is your sponsor or someone else providing support for your visit to Australia?
Note: This includes support from an organisation.
41
Full nameDate of birth Relationship
to you Their address while you are in AustraliaType of support provided
DAY MONTH YEAR
Financial Accommodation Other
/ /
/ /
/ /
/ /
If insufficient space, give details at Part O
Attach details. The person or people you have listed will need to provide evidence of their ability to provide this support.
O
Give details
No
Yes
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42
If you answered Yes to any of the above questions, give details
Have you ever:
been in Australia and not complied with visa conditions or departed Australia outside your authorised period of stay?
had an application for entry to or further stay in Australia refused, or had a visa for Australia cancelled?
Part I Previous applicationsI
Please give details of the person who assisted you
No
Yes
43 Did you receive assistance in completing this form?
J Part J Assistance with this form
Go to Part K K
Family name
Given names
Title: Mr Mrs Miss Ms Other
POSTCODE
Address
Telephone number or daytime contact
Office hours
Mobile/cell
44 Is the person an agent registered with the Office of the Migration Agents Registration Authority (Office of the MARA)?
Office of the MARA
45 Is the person/agent in Australia?
46 Did you pay the person/agent and/or give a gift for this assistance?
Part K Options for receiving written communicationsK
47 All written communications about this application should be sent to: (Tick one box only)
Myself
956A
You should complete form 956A Appointment or withdrawal of an authorised recipient
Authorised recipient
Migration agent
Exempt person
Your migration agent/exempt person should complete form 956 Advice by a migration agent/exempt person of providing immigration assistance
956
OR
OR
OR
No Yes
No Yes
No
Yes
No
Yes
Go to Part K K
No
Yes
( ) ( )
COUNTRY CODE AREA CODE NUMBER
Go to Part K K
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Part L Payment detailsL
48 IMPORTANT: You must refer to the departments website at www.immi.gov.au/fees-charges to complete this part of your application. The website shows reference tables with the Visa Application Charges applicable to each visa subclass.
www.immi.gov.au/fees-charges
AUD
AUD
AUD
AUD
AUD
AUD
AUD
AUD
AUD
Visa subclass you are applying for
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.
Non-internet Application Charge (if applicable)
(1)
(2)
(3)
(4)
(5)
+
+
+
=
+
Additional Applicant Charge aged 18 years or over at the time your application is lodged18
Additional Applicant Charge under 18 years of age at the time your application is lodged18
Subsequent Temporary Application Charge (if applicable)
Total (1) + (2) + (3) + (4) + (5) (1) + (2) + (3) + (4) + (5)
Total
=
=
=
Write the amount shown on the reference table for your visa subclass
Write the amount shown on the reference table for your visa subclass
Write the amount shown on the reference table for your visa subclass
18
Number of additional applicants aged 18 years or over
18
Number of additional applicants under 18 years of age
Number of applicants
Base Application Charge Write the amount shown on the reference table for your visa subclass
(multiplied by)
( )X
(multiplied by)
( )X
(multiplied by)
( )X
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49 How will you pay your application charge? Note: A surcharge may apply to payments made by credit card. Further information is available from www.immi.gov.au/fees-charges/how-to-pay.htm
If applying in Australia, debit card or credit card are the preferred methods of payment. Debit cards cannot be used for applications lodged by mail. If paying by bank cheque or money order please make payable to the Department of Immigration and Border Protection.
If applying outside Australia, please check with the Australian Government office where you intend to lodge your application as to what methods of payment and currencies they can accept and to whom the payment should be made payable.
www.immi.gov.au/fees-charges/how-to-pay.htm debit card
money order the Department of Immigration and Border
Protection
Give details below
Bank cheque Money order
Debit card
Credit card
MasterCard
American Express
Visa
Diners Club
JCB
Payment by (tick one box) Australian Dollars
AUD
Credit card number
:
: : : :
MONTH
:
: : :: :: :: :: :: : :
YEAR
Expiry date
Cardholders name
Address
POSTCODE
Signature of cardholder
Credit card information will be used for charge paying purposes only.
Telephone number
Cannot be used for applications lodged by mail
( ) ( )
COUNTRY CODE AREA CODE NUMBER
As the cardholder I acknowledge and accept that a credit card surcharge may apply to the transaction.
Part M Application checklistM
50 With your completed and signed application form 1419, you must include:
1419
a certified copy of the identity page (showing photo and personal details) of a valid passport and other pages which provide evidence of travel to any other countries
a recent passport photograph (not more than 6 months old) of yourself
the Visa Application Charge (if applicable)
a completed form 1257 Undertaking declaration, for applicants under 18 years of age, staying in Australia with someone other than a parent, legal guardian or relative (if applicable)
1257
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evidence of access to funds to support your stay
evidence of your medical/travel insurance (if requested)
medical examination or tests (if requested)
a letter from your employer confirming your leave
evidence of enrolment at school, college or university
If visiting a close family member in Australia (who is a citizen or permanent resident of Australia):
a letter of invitation to visit
other information to show that you have an incentive and authority to return to your country of residence, such as property or other significant assets in your home country
Under the Migration Act 1958, decision-makers are not obliged to seek additional information from the applicant before making a decision on a visa application. It is therefore in the your best interest to submit the following documentation, if applicable, with your application:
Important: Do not provide original documents unless requested. You should provide certified copies of original documentation. Documents not in English should be accompanied by accredited English translations.
Additional documents
When you have lodged your application, you should attach your receipt to this sheet.
a completed form 1229 Consent to grant an Australian visa to a child under the age of 18 years, for applicants under 18 years of age, travelling alone or without one or both of their parents or legal guardians (if applicable)
1229
If you authorise another person to receive all written communications about your application with the department:
completed Part K Options for receiving written communications; and form 956 Advice by a migration agent/exempt person of providing immigration assistance; orform 956A Appointment or withdrawal of an authorised recipient
956
956A
1419 CHS (Design date 07/14) - Page 19 COMMONWEALTH OF AUSTRALIA, 2014
51
the information given is complete, correct and up-to-date;
I understand that the visa I am applying for does not permit me to work in Australia;
I understand that the visa I am applying for does not permit me to study for longer than 3 months in Australia;
my intention to visit Australia is genuine and I will abide by the conditions and period of stay of the visa;
I have access to adequate funds to meet all costs associated with the visit to and from Australia;
I have never had tuberculosis or any serious condition likely to endanger or be a cost to Australia (otherwise, I attach details);
I understand that if a no further stay 8503 condition is imposed on this visa, it will limit my ability to remain in Australia beyond the authorised period of the visa;
in any part of this form which has been completed with the assistance of another person, that the information as set down is true and correct and has been included with my full knowledge, consent and understanding;
if granted a visa, I will advise the Australian Visa Office should my circumstances change;
I understand that if I do not abide by the conditions imposed on my visa, my visa may be cancelled or I may be subject to other penalties. If applicable, my sponsor may also be penalised;
I have truthfully declared all relevant details requested of me in this application;
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;
if documents are found to be fraudulent or information to be incorrect after the grant of a visa, the visa may subsequently be cancelled.
8503
1442i Privacy notice
1442i Privacy notice
WARNING: Giving false or misleading information or documents is a serious offence.
Having read the Conditions for a Visitor visa to Australia on page 1 of this form, I declare that:
Part N Declaration and consent
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If insufficient space, attach additional details.
Question number Additional information52
Part O Additional informationO
Signature of applicant
Date
DAY MONTH YEAR
We strongly advise that you keep a copy of your application and all attachments for your records.
For offshore applicants who are required to provide their fingerprints and facial image.
I declare that:
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;
the department using the information obtained for the purposes of the Migration Act 1958 or the Australian Citizenship Act 2007.
1958 2007
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