Form

Refugee and special

humanitarian proposal 681

Who should use this form? Your role as a proposer is to assist in the settlement of the
entrants you have proposed. This includes:
This form should be used by persons wishing to propose
applicants under the Refugee and Special Humanitarian • meeting the entrants at the airport;
Programme, including those eligible under the ‘split family’ • providing accommodation for the entrants on arrival;
provisions that apply to immediate family members.* • assisting the entrants to find permanent accommodation; and
Proposals may be submitted by individuals or by organisations • introducing the entrants to relevant services.
operating in Australia. To be eligible to propose as an individual,
you must be: The Department of Social Services (DSS) provides settlement
services to humanitarian entrants. A Humanitarian Settlement
• an Australian citizen; or Services (HSS) service provider will contact you to settle those
• a permanent resident of Australia; or you have proposed.
• an eligible New Zealand citizen.
You must not be an illegal maritime arrival who arrived on or after After a visa has been granted
13 August 2012. More information is available on the Department If the people you are proposing are granted a humanitarian visa
of Immigration and Border Protection (the Department) website before they leave for Australia, please encourage them to attend:
www.border.gov.au/trav/refu/offs/proposing-an-applicant • the Australian Cultural Orientation Programme (AUSCO).
If you are eligible to propose, you will also need form 842 AUSCO courses prepare participants for their life in Australia.
Application for an Offshore Humanitarian visa to be completed More information is available on the Department of Social
by the visa applicant and submitted together with this form. Services website www.dss.gov.au; and
This form must not be used for applications under the • a departure health check (DHC). Visa holders undergo
Community Proposal Pilot. a health check within 72 hours of departure for Australia
to ensure they are ‘fit to fly’ and to identify any medical
About this form conditions requiring treatment on arrival in Australia.
Important – Please read this information carefully before you
complete your proposal. Once you have completed your Integrity of application
proposal we strongly advise that you keep a copy for your The Department is committed to maintaining the integrity of the
records. visa and citizenship programmes. Please be aware that if you or
the person you are proposing provide us with fraudulent
What is required of proposers? documents or information, this may result in processing delays
and possibly the application being refused.
If you are proposing applicants who are granted a subclass 202
(Global Special Humanitarian) visa you and the applicants are
responsible for the applicants’ travel to Australia, including Immigration assistance
airfares. A person gives immigration assistance to you if he or she uses, or
If you are proposing applicants under the ‘split family’ provisions, claims to use, his or her knowledge or experience in migration
and any of the following visa subclasses are granted: procedure to assist you with your visa application, request for
200 – Refugee; ministerial intervention, cancellation review application,
sponsorship or nomination.
201 – In-country Special Humanitarian;
In Australia a person may only lawfully give immigration
203 – Emergency Rescue; assistance if he or she is a registered migration agent or is exempt
204 – Woman at Risk; from being registered. Only registered migration agents may
the Australian Government will arrange and pay for the receive a fee or reward for providing immigration assistance.
applicants’ travel to Australia. If an unregistered person in Australia, who is not exempt from
An ‘applicant’ who is granted a visa and travels to Australia, registration, gives you immigration assistance they are
becomes an ‘entrant’ on arrival. committing a criminal offence and may be prosecuted.

Migration agents in Australia

Special Humanitarian Programme applications and proposals Migration agents in Australia must be registered with the Office
should now be lodged via email. Instructions and guidance of the Migration Agents Registration Authority (Office of the
are available on the Department’s website MARA) unless they are exempt from registration.
www.border.gov.au/trav/refu/offs/lodging-certain-
humanitarian-applications-in-australia Migration agents outside Australia
Migration agents who operate outside Australia do not have to be
registered. The Department may give some overseas agents an
ID number. This number does not mean that they are registered.
* Under the ‘split family’ provisions, holders of humanitarian (Class XB), or
Note: Some Australian registered migration agents operate
permanent Protection (Class XA) or Resolution of Status (Class CD) visas,
overseas.
may support the applications of immediate family members to enter
Australia under the Humanitarian Programme. ‘Immediate family’ means
the spouse or de facto partner (including same-sex partner), dependent
child, or parent (if the proposer is under 18 years of age).
© COMMONWEALTH OF AUSTRALIA, 2017 681 (Design date 02/17) - Page 1
Migration agent information Options for receiving communications
A migration agent is someone who can: If you do not appoint a migration agent/exempt person you may
• advise you on the visa that may best suit you; still authorise another person, in writing, to receive
• tell you the documents you need to submit with your communications on your behalf. This person is called the
application; authorised recipient.
• help you fill in the application and submit it; and Authorised recipient information
• communicate with the Department on your behalf. All communication about your application will be sent to your
If you appoint a migration agent, the Department will assume authorised recipient, unless you indicate that you wish to have
that your migration agent will be your authorised recipient, health and/or character information sent directly to you.
unless you indicate otherwise. The Department will communicate with the most recently
Your migration agent will be the person with whom the appointed authorised recipient as you may only appoint one
Department will discuss your application and from whom it will authorised recipient at any time for a particular application.
seek further information when required. You will be taken to have received any documents sent to that
You are not required to use a migration agent. However, if you person as if they had been sent to you.
use a migration agent, the Department encourages you to use a To appoint an authorised recipient you should complete:
registered migration agent. Registered agents are bound by the
• Part F – Options for receiving communications; and
Migration Agents Code of Conduct, which requires them to act
professionally in their clients’ lawful best interests. • form 956A Appointment or withdrawal of an authorised
recipient.
Information on migration agents, including a list of registered
migration agents, is available on the Office of the MARA website Note: Being a proposer does not authorise you to receive written
www.mara.gov.au communications on behalf of the visa applicants you are
proposing. If the visa applicants wish you to receive written
You can also access information about migration agents on the
correspondence on their behalf, the main applicant must
Department’s website www.border.gov.au
complete Question 17 and Question 46 on form 842 Application
Exempt persons for an Offshore Humanitarian visa.
The following people do not have to be a registered migration Note: Migration agents/exempt persons do not need to complete
agent in order to provide immigration assistance, but they must form 956A.
not charge a fee for their service: Form 956A is available from the Department’s website
• a close family member (spouse, de facto partner, child, parent, www.border.gov.au/allforms/
brother or sister);
• a member of parliament or their staff; Electronic communication
• an official whose duties include providing immigration The Department will communicate with you via email.
assistance (eg. a Legal Aid provider); To process your application the Department may need to
• a member of a diplomatic mission, consular post or communicate with you about sensitive information, for example,
international organisation. health, police checks, financial viability and personal relationships.
The email address you provide will only be used by the
Appointing a migration agent/exempt person Department for the purpose for which you have provided it,
To appoint a migration agent/exempt person you should complete unless there is a legal obligation or necessity to use it for another
Part F – Options for receiving communications. purpose, or you have consented to use it for another purpose. It
Your migration agent/exempt person should complete form 956 will not be added to any mailing list.
Advice by a migration agent/exempt person of providing The Australian Government accepts no responsibility for the
immigration assistance. security or integrity of any information sent to the Department
Form 956 is available from the Department’s website over the internet or by other electronic means.
www.border.gov.au/allforms/ If you authorise another person to receive documents on your
behalf and they wish to be contacted electronically, their
signature is required on form 956 or 956A to indicate their
consent to this form of communication.

Important information about privacy

Your personal information is protected by law, including the
Privacy Act 1988. Important information about the collection,
use and disclosure (to other agencies and third parties, including
overseas entities) of your personal information, including
sensitive information, is contained in form 1442i Privacy notice.
Form 1442i is available from the Department’s website
www.border.gov.au/allforms/ or offices of the Department.
You should ensure that you read and understand form 1442i
before completing this form.

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Application Process
Home page www.border.gov.au
Step 1 – Complete this form
General Telephone 131 881 during business hours
Carefully read and fully complete this form. enquiry line in Australia to speak to an operator (recorded
information available outside these hours).
Step 2 – Establish your eligibility to propose
If you are outside Australia, please contact
If you are proposing as an individual, you must provide your nearest Australian mission.
evidence of your eligibility to propose (see Question 20).
Please provide a certified copy of your:
• Australian birth certificate/certificate of Australian citizenship; or
• evidence of your permanent residence in Australia; or
• evidence that you are an eligible New Zealand citizen.
Copies of documents must be certified as true copies of the
original by a Justice of the Peace, a Commissioner for
Declarations or a person before whom a statutory declaration
may be made under the Statutory Declarations Act 1959.
If you are proposing as an organisation, you must provide the
names of office holders, and a statement of the organisation’s
objectives, activities and funding (see Part C).

Step 3 – Send documents to the applicant

Once completed, send this form to the applicant, along with:
• Evidence of your eligibility to propose (whether you are
proposing as an individual or an organisation, as stated in
Step 2); and
• form 842 Application for an Offshore Humanitarian visa.

Step 4 – Applicant completes and signs application form

When the applicants you are proposing receive the documents
mentioned in Step 3, they should fully complete form 842, in
accordance with the instructions on that form.

Step 5 – Lodge the completed application

You should lodge this form (form 681) and the completed and
signed form 842 Application for an Offshore Humanitarian visa
via email.
For further information, please see the information sheet
Lodging Certain Humanitarian Applications in Australia
available from the Department’s website
www.border.gov.au/trav/refu/offs/lodging-certain-
humanitarian-applications-in-australia

Step 6 – Receipt of application

The office processing the visa application will acknowledge
receipt of the application accompanying your proposal via email.

How to complete this form

• Please open this form using Adobe Acrobat Reader.
Either type (in English) in the fields provided or print this
form and complete it (in English) using a pen and BLOCK
LETTERS.
• Tick where applicable.
• Answer all questions truthfully and completely.
• Where there is insufficient space for your answer please
continue on a separate page of paper. Clearly mark the
separate page with the question number it relates to.
• Email this completed proposal, along with application
form 842, to the Department as specified in Step 5.
For information on how to make a valid application, see
information form 1025i Visa applications.

Please keep these information pages for your reference

© COMMONWEALTH OF AUSTRALIA, 2017 681 (Design date 02/17) - Page 3
This page is intentionally blank
 Form
Refugee and special
humanitarian proposal 681

Please open this form using Adobe Acrobat Reader. 10 Relationship status
Either type (in English) in the fields provided or print this form Married legally Engaged Widowed
and complete it (in English) using a pen and BLOCK LETTERS.
Married by De facto Never married or
Tick where applicable 3 tradition/custom Separated been in a de facto
relationship
All questions on this form need to be completed (unless instructed Married religiously Divorced
otherwise via steps).

11 Precise relationship of main applicant to you (give full details)

Part A – Details of the persons you wish to
propose for entry to Australia
1 How many people are included in your proposal?
12 Full residential address (not post office box)
2 Give details of the main applicant
Family name
A1 Postcode

Given names
13 Give details of all other dependent family members of the main
applicant who are included in this proposal
A2
3 Has the person you are proposing been known by any other names?
(such as name at birth, alias, previous married name) Family name
No
Yes Give details Given names

Family name Sex Male Female

Day Month Year
Given names Date of birth
Relationship status
4 Citizenship
Married legally Engaged Widowed
Married by De facto Never married or
tradition/custom Separated been in a de facto
relationship
5 Sex Male Female Married religiously Divorced

Day Month Year Precise relationship to the main applicant

6 Date of birth

7 Place of birth
Town/city

Country

8 Current country of residence

Day Month Year

9 Date of arrival in current country of residence

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 A3 A6

Family name Family name

Given names Given names

Sex Male Female Sex Male Female

Day Month Year Day Month Year

Date of birth Date of birth

Relationship status Relationship status
Married legally Engaged Widowed Married legally Engaged Widowed
Married by De facto Never married or Married by De facto Never married or
tradition/custom Separated been in a de facto tradition/custom Separated been in a de facto
relationship relationship
Married religiously Divorced Married religiously Divorced
Precise relationship to the main applicant Precise relationship to the main applicant

A4 A7

Family name Family name

Given names Given names

Sex Male Female Sex Male Female

Day Month Year Day Month Year

Date of birth Date of birth

Relationship status Relationship status
Married legally Engaged Widowed Married legally Engaged Widowed
Married by De facto Never married or Married by De facto Never married or
tradition/custom Separated been in a de facto tradition/custom Separated been in a de facto
relationship relationship
Married religiously Divorced Married religiously Divorced
Precise relationship to the main applicant Precise relationship to the main applicant

If insufficient space, attach additional details

A5

Family name

Given names

Sex Male Female

Day Month Year

Date of birth
Relationship status
Married legally Engaged Widowed
Married by De facto Never married or
tradition/custom Separated been in a de facto
relationship
Married religiously Divorced
Precise relationship to the main applicant

681 (Design date 02/17) - Page 6 © COMMONWEALTH OF AUSTRALIA, 2017

 Part B – Proposer’s details – Individual 24 The Department will communicate with you via email.
Provide at least one primary and any secondary email addresses with
Note: This part should only be completed if you are proposing visa which you may be contacted:
applicants in your private capacity as an individual, and not as the Primary
representative of an organisation.
Secondary
14 Are you submitting this proposal as an individual?
Secondary
No Go to Part C – Proposer’s details – Organisation
Yes Complete the details below
25 Your current occupation (if not employed, write ‘unemployed’)
15 Family name
For how many years have you been
in this occupation?
Given names
26 Your partner’s occupation (if applicable)

16 Sex Male Female For how many years has your partner been
in this occupation?
Day Month Year

17 Date of birth 27 List all Australian visas you have held including your current visa
(if appropriate)
18 Place of birth
Town/city

Country

Day Month Year

19 If born outside Australia:
Date of arrival in Australia

20 Are you an Australian citizen, Australian permanent resident or an

eligible New Zealand citizen?
No You are unable to propose
Yes Please provide evidence as described on page 3

21 Full residential address (not postal address)

Postcode

22 Postal address
(If the same as your residential address, write ‘AS ABOVE’)

Postcode

23 Your contact telephone numbers (if available)

Country code Area code Number

Office hours ( ) ( )

After hours ( ) ( )

Mobile/cell
Note: If your contact details change before this application is finalised,
it is your responsibility to notify the office of the Department at which the
application is being processed.

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 Part C – Proposer’s details – Organisation 35 Please attach a written statement explaining your organisation’s
objectives (clearly mark this statement as ‘Question 35’)
Note: This part should only be completed if you are representing an Is the statement attached?
organisation, and you have the authority to represent your organisation. No
Yes
28 Organisation’s full name/title
36 The Department will communicate with you via email.
Provide at least one primary and any secondary email addresses with
which you may be contacted:
Primary
29 Name of person authorised to sign this form on behalf of the organisation
Secondary
Family name
Secondary
Given names

30 Position held by this person in above organisation Part D – Previous proposals

37 Have you (or your organisation) previously proposed these visa
applicants or any other applicants for a humanitarian visa?
No
31 Please list all other office holders Yes Please provide the following details
Name of the visa applicant you have proposed

Day Month Year

Date of previous application

File number
Office of the Department where the application was lodged

Outcome of the application

Granted Refused Not yet decided

Name of the visa applicant you have proposed

32 Full street address of organisation (not post office box) Day Month Year

Date of previous application

File number
Postcode Office of the Department where the application was lodged

33 Postal address Outcome of the application

(If the same as street address, write ‘AS ABOVE’)
Granted Refused Not yet decided

If you have proposed more than 2 applicants, please attach

details on a separate sheet.
Postcode

34 Contact telephone numbers of person authorised to sign this form

Country code Area code Number

Office hours ( ) ( )

After hours ( ) ( )

Mobile/cell
Note: If the contact details of the person signing this form on behalf of
the organisation change before the application is finalised, it is your
responsibility to notify the office of Department at which the application
is being processed.
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 Part E – Assistance with this form Part G – Acknowledgement
38 Did you receive assistance in completing this form? WARNING: Giving false or misleading information is a serious offence.
No Go to Part F 43 • I acknowledge that the applicants and I are responsible for
Yes Please give details of the person who assisted you arranging and paying for the travel to Australia by the applicants I
have proposed if they are granted a subclass 202 (Global Special
Title: Mr Mrs Miss Ms Other Humanitarian) visa.
• I give permission for the information in this form to be given to other
Family name agencies and contracted service providers to assist me in my role as
the proposer of humanitarian entrants and to assist in the settlement
Given names of the entrants.
Address • I acknowledge that the information on my record as a proposer may
be used by the Department in deciding visa applicants made under
the Refugee and Special Humanitarian Programme where I am the
proposer.
Postcode I declare that:
• I have read the information contained in form 1442i Privacy notice.
Telephone number or daytime contact
Country code Area code Number • I understand the Department may collect, use and disclose my
personal information (including biometric information and other
Office hours ( ) ( )
sensitive information) as outlined in form 1442i Privacy notice.
Mobile/cell Note: In order for the Humanitarian Settlement Services (HSS) service
provider to help you with relevant advice and assistance, it is necessary
for the information that you give in this form to be made available to the
39 Is the person an agent registered with the Office of the Migration Agents provider. This acknowledgement enables the Department to share the
Registration Authority (Office of the MARA)? information on this form with the HSS service provider and other
No settlement service providers as appropriate.
Yes Go to Part F Printed name

40 Is the person/agent in Australia?

No Go to Part F Signature
of proposer
Yes
-
41 Did you pay the person/agent and/or give a gift for this assistance? Day Month Year

No Date
Yes
We strongly advise that you keep a copy of your proposal and
all attachments for your records.
Part F – Options for receiving
communications
42 All communications about this application should be sent to:
(Tick one box only)
Myself

OR

Authorised You should complete form 956A Appointment

recipient or withdrawal of an authorised recipient
OR

Migration agent Your migration agent/exempt person should

complete form 956 Advice by a migration
OR agent/exempt person of providing immigration
Exempt person assistance

Note: All communications about this application will be via email.

© COMMONWEALTH OF AUSTRALIA, 2017 681 (Design date 02/17) - Page 9