Data form 2024

Data collection for Visa Form

Name as it appears on Passport(Required)

Given Name/s Last Name/s

Upload a scan of your passport details page here

Max. file size: 8 MB.

Does your passport expire before the 19th May 2025?(Required)

Yes

Country of Residence(Required)

Legal Status(Required)

Citizen

Permanent Resident

Work Visa

Student Visa

Do you have a National identity card?(Required)

Yes

if yes – Name

Given Name/s Last Name/s

Identification Number:

Country of Issue

Issue Date

Expiry Date

What is your place of birth?

Town/City:(Required)

State/Province:(Required)

Country of Birth:(Required)

Relationship status – select one(Required)

Are you known by any other names?(Required)

Yes

If yes – Name

Given Name/s Last Name/s

Reason for name change:

Deed Poll

Marriage

Other

If other give details

Are you a citizen of the country shown in your passport?(Required)

Yes

Are you a citizen of any other country?(Required)

Yes

If yes – List countries:

Do you have other current passports?(Required)

Yes

Name on Passport

Given Name/s Last Name/s

Passport number:

Country of passport:

Nationality of Passport Holder:

Place of issue / issuing authority:

Issue Date:

Expiry Date:

Do you have any other additional passports:

Yes

Name on Passport

Given Name/s Last Name/s

Passport number:

Country of passport:

Issue Date:

Expiry Date:

Have you undertaken a health examination for an Australian visa in the last 12 months?(Required)

Yes

If yes – please give details:

Residential STREET Address (can not be a post office address)

Country of Residence(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is your POSTAL Address the same as your residential STREET address?(Required)

Yes

If no – Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone Numbers:

Home:

Business:

Mobile/Cell:

Email:

In the last 10 years have you lived in a country other than your normal country of residence for 12 months or more?(Required)

Yes

If yes – Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date From

Date To

In the last 10 years have you lived in any other country for 12 months or more?(Required)

Yes

If yes – Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date From

Date To

In the last 5 years have your visited or lived outside your country of passport for more than 3 consecutive months?(Required)

Yes

If yes – Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

In the last 5 years have your visited or lived in any other countries outside your country of passport for more than 3 consecutive months?(Required)

Yes

If yes – Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Have you ever had, or currently have, tuberculosis?(Required)

Yes

If yes – provide details

Have you been in close contact with a family member that has active tuberculosis?(Required)

Yes

If yes – provide details

Have you ever had a chest x-ray which showed an abnormality?(Required)

Yes

If yes – provide details

In Australia do you expect to need medical treatment for any of the following

If you answered Yes to any of the above please provide details:

Check the box to answer Yes for the following questions:

If you answered Yes to any of the above please provide details:

Do you declare the following is true? That you

Check the box for Yes

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Phone

This field is for validation purposes and should be left unchanged.