Please bear in mind this was filled in as an example only – the intending applicant’s answers may be different, for example if they have travelled to Australia before – or they wish to enter Australia more than once (for example, if visiting New Zealand in the middle of a visit to Australia, etc. etc. This is an EXAMPLE only.
Transaction Reference Number (TRN): ____________________(This will be assigned to you)
Are all the applicants currently outside Australia?
Yes
Give the current location of the applicant and their legal status at this location.
Current location
UNITED STATES
Legal status
Citizen
Purpose of stay
Has the applicant been invited to participate in specific event(s) by organisation(s) in Australia?
Yes
Will the applicant receive a payment from an organisation in Australia for their participation in the event?
Yes
Will the applicant undertake highly specialised non-ongoing work?
Yes
Will the applicant be performing as an entertainer in Australia or supporting an entertainer or group of entertainers performing in Australia?
No
Will the applicant be directing, producing or taking any other part in a production that will be shown in Australia (including theatre, film, television, radio, concert or recording)?
No
Group processing
Will this application be required to be processed with other applications?
No
Primary applicant
Primary applicant
Information: Entering names incorrectly may result in denial of permission to board an aircraft to Australia, or result in delays in
border processing on arrival in Australia, even if the applicant has been granted a visa.
Passport details
Enter the following details as they appear in the applicant's passport.
Family name
Doe
Given names
Jane Marie
Sex
Female
Date of birth
01 Jan 1955
Passport number
XXXXXXXXX
Country of passport
UNITED STATES
Nationality of passport holder
UNITED STATES
Date of issue
07 Sep 2010
Date of expiry
06 Sep 2020

Place of issue / issuing authority
USA
It is strongly recommended that the passport be valid for at least six months.
Place of birth
Town / City
Portland
State / Province
Oregon
Country of birth
UNITED STATES
Relationship status
Married
Other names / spellings: Is this applicant currently, or have they ever been known by any other names?
Yes
Other names / spellings #1
Family name
Jones
Given names
Jane Marie
Reason for name change
Marriage
Citizenship: Is this applicant a citizen of the country of passport?
Yes
Is this applicant a citizen of any other country?
No
Other passports: Does this applicant have other current passports?
No
National identity documents: Does this applicant have national identity documents?
No
Health examination: Has this applicant undertaken a health examination for an Australian visa in the last 12 months?
No
Previous travel to Australia
Has this applicant previously travelled to Australia or previously applied for a visa?
No
Accompanying family members
Are there any accompanying family members included in this application?
No
Contact details
Usual country of residence
UNITED STATES
Department office
The applicant may be required to attend an Australian Government Office for an interview. Which is the closest office to the applicant’s current location?
Washington
Note that a street address is required. A post office address cannot be accepted as a residential address.
Country
UNITED STATES
Address
1000 McKenzie Drive
Address 2
Suburb / Town
Portland
State or Province
Oregon
Postal code
XXXXX
Home phone
XXXXXXXXXXX

Business phone
Mobile / Cell phone
XXXXXXXXXX
Is the postal address the same as the residential address?
Yes
Does the applicant agree to this department communicating via email and/or fax? This may include receiving notification of the outcome of the application.
Yes
Email address xxxxxxxxxxxxxxxxxxxx
Give details of the proposed period of stay in Australia.
Date from
20 Sep 2014
Date to
10 Oct 2014
Multiple entries
Does the applicant intend to enter Australia on more than one occasion?
No
Events
Give details of the event(s) in which the applicant will participate.
Event details #1
Give details of the event.
Event name
Textile Gathering
Inviting organisation
XXXXXXXXXXXXXXXXXXXXXXXXXXX
Business registration type
Australian Business Number (ABN)
Business registration ID xxxxxxxxxxx
Is the inviting organisation the event organiser?
Yes
Date from
26 Sep 2014
Date to
05 Oct 2014
Applicant's role in event
Specialist artist
Applicant's role description
Present information about personal work, tutor and demonstrate methods and exhibit artwork
Give details of the organisation for whom the work will be undertaken in Australia.
Organisation details
Legal registered name
XXXXXXXXXXXXXXXXXXXXX
Trading name
XXXXXXXXXXXXXXXXXXXX
Industry type
Arts and Recreation Services
Give details of a registration identifier for the business / organisation.
Business registration type
Australian Business Number (ABN)
Business registration ID xxxxxxxxxxx
Note that a street address is required. A post office address cannot be accepted as an organisation address.

Country
AUSTRALIA
Address
XXXXXXXXXXXXXXXXXX
Address 2
Suburb / Town
XXXXXXXXXXXX
State / Territory
XXXXXXXXXXXXXXX
Postcode
XXXX
Give details of the contact person within the organisation.
Family name
XXXXXXXXXX
Given names
XXXXXXXXX
Position
CEO
Business phone
XXXXXXXXXXXX
Mobile / Cell phone
XXXXXXXXXXXXXXXX
Work address
Is this address the same as organisation address?
Yes
Give details of the type of work or activity the applicant will be undertaking.
Date from
26 Sep 2014
Date to
05 Oct 2014
Position
Presenter
Occupation grouping
Other
Occupation
Artist
Duties / Activities
Present information about personal work, tutor and demonstrate methods and exhibit artwork
Employment status
Self employed
Qualifications, skills and experience
Give details of the applicant's qualifications, skills and experience that are relevant to the proposed work or activity in Australia.
Relevant qualifications
Experienced exhibiting artist
Relevant skills
Technical ability with textiles and design
Relevant experience
20 years of free lance work
Registration / Licensing / Professional membership requirements
(It’s okay not to put anything here, If you do then something like ‘Member of the Artists League of Portland’ is an example. I
don’t think they expect Artists to belong to a lot of professional associations although some do. )
Will the applicant receive payment for undertaking the work or activity in Australia?
Yes
Give details of the organisation providing payment to the applicant.
Current overseas employer

Will any applicants be undertaking formal studies or training while in Australia?
No
Are any applicants currently or have any applicants previously been an AusAID subsidised student or recipient?
No
Australia's interest
The department will only consider the work or activity to be in Australia's interest in limited circumstances (eg. emergency workers assisting in a natural disaster).
Will Australia's national interest be affected if the applicant does not undertake the work or activity for which they are intending to enter Australia?
No
Health declarations
In the last five years, has any applicant visited, or lived, outside their country of passport, for more than 3 consecutive months?
Do not include time spent in Australia.
No
Does any applicant intend to enter a hospital or a health care facility (including nursing homes) while in Australia?
No
Does any applicant intend to work as, or study to be a doctor, dentist, nurse or paramedic during their stay in Australia?
No
Does any applicant intend to work or be a trainee at a child care centre (including preschools and creches) while in Australia?
No
• 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?
No
Does any applicant have any of the following medical conditions that may incur medical costs, require treatment or medical follow up?
• 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
• other
No
Does any applicant require assistance with mobility or care due to a medical condition?
No
Character declarations
Has any applicant ever been convicted of a crime or offence in any country (including any conviction which is now removed from official records)?
No
Has any applicant ever been charged with any offence that is currently awaiting legal action?
No

Has any applicant ever been acquitted of any criminal offence or other offence on the grounds of mental illness, insanity or unsoundness of mind?
No
Has any applicant ever been removed or deported from any country (including Australia)?
No
Has any applicant ever left any country to avoid being removed or deported?
No
Has any applicant ever been excluded from or asked to leave any country (including Australia)?
No
Has any applicant ever committed or been involved in the commission of war crimes or crimes against humanity or human rights?
No
Has any applicant ever been involved in any activities that would represent a risk to Australian national security?
No
Has any applicant ever had any outstanding debts to the Australian Government or any public authority in any other country?
No
Has any applicant ever been involved in any activity, or been convicted of any offence, relating to the illegal movement of people to any country (including Australia)?
No
Has any applicant ever:
• served in a military force or state sponsored or private militia, or
• undergone any military or paramilitary training, or
• been trained in weapons or explosives use (however described), other than in the course of compulsory national military service?
No
The applicants declare that they:
Have read and understood the information provided to them in this application.
Yes
Have provided complete and correct information in every detail on this form, and on any attachments to it.
Yes
Understand that if any fraudulent or misleading documents or information is found, this application is likely to be refused and they may become ineligible to be granted a visa for a period of time.
Yes
Will inform the Department of Immigration and Citizenship in writing immediately as they become aware of a change in circumstances (including change of address) or if there is any change relating to information they have provided in or with this application, while it is being considered.
Yes
Understand that they must abide by the conditions of the visa.
Yes
Understand that if a no further stay 8503 condition is imposed on this visa, it will limit the ability to remain in Australia beyond the authorised period of stay of the visa.
Yes
Will be responsible for any registration or licensing that is required before the applicant can begin work in Australia.
Yes
Understand that they must abide by Australian employment conditions and awards.
Yes
If a visa is granted, the family members included in this application:
They will not be allowed to undertake any work while in Australia.
Yes
Understand that, if required to provide their fingerprints and facial image, the applicant's fingerprints and facial image and biographical information held by the Department of Immigration and Citizenship may be given to Australian law enforcement

agencies to help identify the applicant and determine eligibility for grant of the visa being applied for, and for law enforcement purposes.
Yes
Give consent to Australian law enforcement agencies disclosing the applicant’s biometric, biographical and criminal record information to the Department of Immigration and Citizenship to help identify the applicant, to determine eligibility for grant of a visa and for law enforcement purposes.
Yes
Give consent to the Department of Immigration and Citizenship using the applicant’s biometric, biographical and criminal record information obtained for the purposes of the Migration Act 1958 or the Citizenship Act 2007. Yes