Questionnaire

WARNING
Please ensure that all the details you provide are true and correct. The information you provide may be used in the preparation of a visa application. It is an offence under the Migration Act to provide, or cause to be provided, documents or information to the Department of Immigration and Citizenship which is false, fraudulent or misleading. Significant penalties apply. Providing incorrect information may also result in your visa application being refused or any visa granted to you cancelled.

THIS IS NOT AN APPLICATION FORM
Please note that this is not a visa application form. This questionnaire is for our use only. We may use the information you have provided in this questionnaire to prepare a visa application including any application forms. Remember, providing us with all the correct information will help us to prepare your application.

Who is completing this Questionnaire?
Are you the main visa applicant? Yes No

Personal Particulars of the Main Applicant
Insert your details as they appear on your passport

Prefix/Title:

Gender: Male Female

Given Names:

Surname:

Preferred Name:

Insert details of when and where you were born:
Date of Birth:

State/Province:

City/Town of Birth:

Birth Country:

Have you been known by any other name i.e maiden name, alias, other married name? Yes No

Relationship Status

What is your current Relationship Status?

Current Residential Address
Insert details of your current residential address. This must be a physical address, not a PO Box Number:

Street Address

Suburb/Town

State

PostCode

Country

Do you have a different postal address? Yes No

Phone and Email Details
Insert details of your current telephone and email contact details.

Country Code	Cell

Alternate Email

Fax Number

Citizenship Details
Are you the citizen of more than one country? Yes No

Refused Citizenship
Have you ever been refused citizenship of another country? Yes No

Passport Details
Do you currently hold a valid passport? Yes No

Identity Document or Identity Number
Have you been issued with an ID document or number? Yes No

Addresses
Provide details of every address where you have lived during the previous 10 years (Include current address):

Date From

Date To

Country

Address

Do you want to add more addresses Yes No

English Communication Skills

How well do you communicate in English?

Is English your main language? Yes No
Have you completed an IELTS Test or OET Test? Yes No

Other Language Communication Skills
Can you communicate in a language other than English? Yes No

Skills Assessment
Have you ever applied for a Skills Assessment from an Australian Skills Assessing Authority Yes No

Employment Details
Have you ever been employed? Yes No

Education Details
Have you undertaken any form of study or education? Yes No

Business/Investor/Retirement Visa Applicants
Are you seeking an Australian Visa for the purpose of owning a business, or making investments, or retiring in Australia? Yes No
(Only answer Yes if you intend applying for one of the following Subclasses of visas: 132, 160, 161, 162, 163, 164, 165, 405, 890, 891, 892, 893, or 845)

Australian Visa Applications
Have you ever applied for or held a visa to enter or remain in Australia? Yes No
(include applications which have been granted, refused, withdrawn, cancelled or are still pending)

Travel to Australia
Have you previously travelled to, or been in Australia? Yes No

Travel to Other Countries
Other than Australia, have you travelled to any other country in the last 10 years? Yes No

Location at time of Application
If you are applying for an Australian visa, will you be in Australia at the Yes No Do not Know time your visa application is lodged?
Yes No

Father
Insert your Fathers details (please include details even if they are no longer alive)

Given Names

Surname

Other Names Held

Marital Status?

Insert details of when and where your Father was born?

Date of Birth

Place of Birth

Country

Insert details of your Father residency and citizenship status:

Country of primary citizenship

Citizenship acquired date?

Country of other citizenship

Citizenship acquired date?

Does your Father currently reside in Australia? Yes No

Mother
Insert your Mother details (please include details even if they are no longer alive)

Given Names

Surname

Other Names Held

Marital Status?

Insert details of when and where your Mother was born?

Date of Birth

Place of Birth

Country

Insert details of your Mother residency and citizenship status:

Country of primary citizenship

When was this citizenship acquired?

Country of other citizenship

When was this citizenship acquired?

Does your Mother currently reside in Australia? Yes No

Step-Parents
Do you have any Step-Parents? Yes No

Siblings Do you have any brother or sisters (siblings) or step-siblings? Yes No

CHILDREN & DEPENDENT FAMILY MEMBER
Do you or your Spouse/Partner have any children or step children? Yes No
Do you or your Spouse/Partner have any Dependent Family Member? Yes No

*Tick Yes even if these people will not be included in your application.
*You must include children from previous relationships even if they are not your (or your Partner's) biological child.
*A Dependent Family Member is any relative who relies on you or your Spouse/Partner for financial support to meet the first person’s basic needs for food, clothing and shelter.

HEALTH DETAILS
Have you, or any other person included in this application, ever had or currently have tuberculosis; or been in close contact with a person who has or had turberculosis; or had a chest X-ray which showed an abnormality? Yes No

Blood Disorder? Yes No

Cancer ? Yes No

Heart Disease ? Yes No

Hepatitis B or C ? Yes No

HIV or AIDS ? Yes No

Kidney Disease ? Yes No

Liver Disease ? Yes No

Mental Illness ? Yes No

Pregnancy? Yes No

Respiratory illness ? Yes No

Any form of surgery? Yes No

Other health concern? Yes No

Do you, or any other person included in this application intend to, while in Australia:
Enter a hospital, nursing home or other health care facility? Yes No

Work as, or study to be, a doctor, dentist, nurse or paramedic? Yes No

Work, or be a trainee, at a child care centre, preschool or creche? Yes No

Be in a classroom situation for more than 3 months as a teacher, student, lecturer or observer? Yes No

CHARACTER DETAILS
Have you, or any other person included in this questionnaire ever :

(a) Been convicted or found guilty of a crime or offence* in any country (including spent convictions or any conviction which is now removed from official records)? Yes No

(b) Been charged with offence in any country that is currently awaiting legal action? Yes No

(c) Been confined in a prison or psychiatric institution by order of a court made in connection with criminal proceedings overseas or in Australia? Yes No

(d) Been under a probation order, good behaviour bond, on parole, released on licence or subject to periodic detention overseas or in Australia? Yes No

(e) Been acquitted of any criminal offence or other offence on the grounds of mental illness, insanity or unsoundness of mind?
Yes No

(f) Been removed or deported from any country, including Australia, for any reason? Yes No

(g) Left a country (including Australia) to avoid being deported or removed? Yes No

(h) Been excluded from or asked to leave any country (including Australia)? Yes No

(i) Committed, or been involved in the commission of war crimes or crimes against humanity or human rights? Yes No

(j) Been involved in any activities that would represent a risk to Australian national security? Yes No

(k) Incurred a debt to the Australian Government or any public authority in Australia which is still outstanding? Yes No

(l) Been involved in any activity, or been convicted of any offence, relating to the illegal movement of people to any country?
Yes No

(m) Been associated with or received training from an organisation engaged in violence, or been involved in an act of violence (including war, insurgency, freedom fighting, terrorism, protest) overseas or in Australia ? Yes No

(n) Been associated with or involved in a program related to the development of weapons of mass destruction? Yes No

(o) Served in a military force or state sponsored/private militia, undergone any military/paramilitary training, or been trained in weapons/explosives use (however described)? Yes No

(p) Been employed as an intelligence officer or an agent of an intelligence or security agency? Yes No

(q) Not complied with a condition of a visa (whether an Australian visa or other country) or departed any country outside your authorised period of stay? Yes No

(r) Provided information or a document to the Australian Department of Immigration and Citizenship or the Australian Customs Service which was wrong, incorrect, false or misleading? stay? Yes No

(s) Been convicted of a crime or offence in any country (including spent convictions or any conviction which is now removed from official records) relating to persons under the age of 16*? Yes No

(t) Been charged with offence in any country that is currently awaiting legal action relating to persons under the age of 16*?
Yes No

Financial Year Ending	Net Assets of Business	Turnover of Business	Number of Full Time Employees	% of business owned by you (& Spouse)	Balance of your loans to the business	Balance of loans to you from the business	Balance of loans to finance your investment Your	Your Net Assets in the Business

As at the following dates	Date	Asset Value (In Local Currency)	Liability Value (in Local Currency)	Net Value (assets - liabilities)	Exchange Rate 1 LC = ($AUS)	Australian Value (AUD)
Now
End of most recent Financial Year $
End of Financial Year 2
End of Financial Year 3 $

As at the following dates	Date	Asset Value (In Local Currency)	Liability Value (in Local Currency)	Net Value (assets - liabilities)	Exchange Rate 1 LC = ($AUS)	Australian Value (AUD)
Now
End of most recent Financial Year $
End of Financial Year 2
End of Financial Year 3 $

As at the following dates	Date	Asset Value (In Local Currency)	Liability Value (in Local Currency)	Net Value (assets - liabilities)	Exchange Rate 1 LC = ($AUS)	Australian Value (AUD)
Now
End of most recent Financial Year $
End of Financial Year 2
End of Financial Year 3 $

As at the following dates	Date	Asset Value (In Local Currency)	Liability Value (in Local Currency)	Net Value (assets - liabilities)	Exchange Rate 1 LC = ($AUS)	Australian Value (AUD)
Now
End of most recent Financial Year $
End of Financial Year 2
End of Financial Year 3 $

Total Value of Yearly Income (In Local Currency)	Local Currency Name	Country of Income	Exchange Rate 1 LC = ($AUS)	Australian Value (AUD)