Visa Questionnaire

To view our Personal Information Collection Statement, click here

Mandatory fields are marked with an *.

Name of the person completing the form *

Email address of the person completing the form *

I. Primary Passport

1. Surname (as per passport) *

2. Given name(s) (as per passport) *

3. Passport number *

4. Country of passport *

5. Issue date of passport *

(day/month/year)

6. Expiry date of passport *

(day/month/year)

7. In which country are you currently located? *

8. Your legal status in that country (please select one) *

Citizen
Permanent Resident
Work Visa
Visitor

9. Do you have other passports? *

10. Date of arrival for Australian engagement *

(day/month/year)

11. Date of departure from Australian engagement *

(day/month/year)

11. Place of birth *

Town/city *

Town/city

State/province *

State/province

Country *

Country

14. Have you ever been known by any other name (e.g. stage name or other name)? *

15. Are you a citizen of any other country? *

16. Have you ever been to Australia before? *

Please provide details.

17. Usual country of residence *

18. Residential address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

19. Is your postal address the same as above? *

20. Contact phone number *

21. Contact email address *

22. In the last 10 years, have you lived in any country other than the country listed in Question 18 for 12 months or more in total? *

II. Health

HEALTH INSURANCE

23. Do you have health insurance to cover you while you are in Australia? *

HEALTH DECLARATION

24. In the last five years, have you visited, or lived, outside your country of passport for more than 3 consecutive months? *

25. Have you ever had, or currently have, tuberculosis, been in close contact with a family member that has active tuberculosis, or ever had a chest x-ray which showed an abnormality? *

26. During your visit, do you expect to incur medical costs, or require treatment for blood disorder; cancer; heart disease; hepatitis B or C and/or liver disease; HIV infection, including AIDS; kidney disease, including dialysis; mental illness; pregnancy; respiratory disease that has required hospital admission or oxygen therapy; any other condition? *

27. Does any applicant require assistance with mobility or care due to a medical condition? *

III. Character Declarations

28. Have you ever been charged with any offence that is currently awaiting legal action? *

29. Have you ever been convicted of an offence in any country (including any conviction which is now removed from official records)? *

30. Have you ever been the subject of a domestic violence or family violence order, or any other order, of a tribunal or court or other similar authority, for the personal protection of another person? *

31. Have you ever been the subject of an arrest warrant or Interpol notice? *

32. Have you ever been found guilty of a sexually based offence involving a child (including where no conviction was recorded)? *

33. Have you ever been named on a sex offender register? *

34. Have you ever been acquitted of any offence on the grounds of unsoundness of mind or insanity? *

35. Have you ever been found by a court not fit to plead? *

36. Have you ever been directly or indirectly involved in, or associated with, activities which would represent risk to national security in Australia or any other country? *

37. Have you ever 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? *

38. Have you ever been associated with a person, group or organisation that has been, or is involved in, criminal conduct? *

39. Have you ever been associated with an organisation engaged in violence or engaged in acts of violence (including war, insurgency, freedom fighting, terrorism, protest) either overseas of in Australia? *

40. Have you ever served in a military force, police force, state sponsored/private militia or intelligence agency (including secret police)? *

If you answered “Yes” to the question above, please provide details.

41. Have you ever undergone any military/paramilitary training, been trained in weapons/explosives or in the manufacture of chemical/biological products? *

If you answered “Yes” to the question above, please provide details.

42. Have you ever been involved in people smuggling or people trafficking offences? *

43. Have you ever been removed, deported or excluded from any country (including Australia)? *

44. Has any applicant ever overstayed a visa in any country (including Australia)? *

45. Has any applicant ever had any outstanding debts to the Australian Government or any public authority in Australia? *