Application for a
Medical Treatment visa
Form
48ME
About this form
Integrity of application
Important Please read this information carefully before you
complete your application. Once you have completed your
application we strongly advise that you keep a copy for your
records.
The department is committed to maintaining the integrity of
the visa and citizenship programmes. In relation to this
application, if you or a member of your family unit:
All forms are available from the Department of Immigration
and Border Protection (the department) website
www.border.gov.au/allforms/
Who should use this form?
Use this form to apply for a visa to visit Australia for medical
treatment or to accompany someone who is seeking medical
treatment.
You may be eligible for a Medical Treatment visa if:
you have made arrangements to undergo medical
treatment (including organ transplant or organ donation)
or consultations in Australia, including arrangements for
payment; and
you do not have a condition which could be a threat to
public health in Australia; and
no Australian citizen or permanent resident will be
disadvantaged by your treatment or consultation; and
you have enough funds to support yourself and any
accompanying persons during your visit.
OR
you are a citizen of Papua New Guinea residing in the Western
Province and are to be medically evacuated to a hospital in
Queensland for treatment or are currently receiving treatment.
OR
you are 50 or over and have applied for permanent residence
and have met all visa criteria except the health criterion.
OR
provide, or have provided in a previous application,
fraudulent documents or false or misleading information
(knowingly or not); and/or
fail to satisfy, or have failed to satisfy in a previous
application, the Minister of your or their identity;
this visa application may be refused and you, and any
members of your family unit, may become unable to be
granted a visa for specified periods of time, as set out in
migration legislation.
If documents are found to be fraudulent or information to be
incorrect after the grant of a visa, the visa may subsequently
be cancelled.
Who can you include in this application?
Only one passport-holder can apply on one form. You can
include in your application any children on your passport who
will be travelling to Australia with you.
Children under 18 years of age, travelling without one or both
of their legal guardians, require authorisation from the nonaccompanying guardian(s) to travel to Australia.
Additional information
You may have to fill out more forms or obtain certain reports
or documents to include with your application.
Part H Application checklist tells you which documents you
must provide.
The Australian government office will tell you if any other
form or requirements are needed.
you are accompanying one of the above people.
Residential address
Note: Medical Treatment visas are not available for the
purposes of surrogate motherhood.
You must provide the address of where you intend to live
during the period that your application is being considered.
Failure to give your residential address will result in this
application being invalid. A post office box address will not be
accepted as your residential address.
You will need to meet the criteria and present evidence that:
(i) arrangements have been made with the doctor and/or
hospital to provide you with medical and/or hospital care,
that is, a firm date for treatment has been made;
(ii) arrangements have been made to pay the full cost of that
treatment and you can demonstrate you have the means
to pay;
(iii) if the treatment is in a public hospital, the hospital has
agreed to your admission and treatment.
Additional information on obtaining a visa for medical
treatment in Australia is available on the departments website
www.border.gov.au/trav/visa-1/602-
Let the department know if you change your address
If you change your residential address for more than 14 days
while your application is being processed, you must tell the
department your new address and how long you will be there.
The department will send communication about your
application to the latest address for correspondence you have
provided.
Communication about your application can be sent to another
person that you have authorised, but you will be taken to have
received the communication that the department sends to
that person. The department must be informed (in writing) of
any address change for either you or your authorised person.
COMMONWEALTH OF AUSTRALIA, 2016
48ME (Design date 04/16) - Page 1
Passport information
Step 2 How to fill in this form
Most visa applicants will be required to hold a valid passport
before they can be granted a visa. It is strongly recommended
that the passport be valid for at least 6 months.
This form is available as a PDF file and can be completed on
screen, printed and mailed to the department or you can print
a copy and use a black or blue pen, write neatly in English
using BLOCK LETTERS.
If you change your passport after you have been granted the
visa you must notify the nearest Australian Visa Office or office
of the department.
You will be required to select the appropriate purpose of your
visit.
If you do not provide us with the details of any new or
additional passport you use to travel to Australia, you
may experience significant delays at the airport and
may be denied permission to board your plane.
If you need more space to answer questions or wish to
provide additional relevant information, give details at Part J or
attach a signed and dated sheet giving the required details.
Do NOT send your passport with your visa application.
You will need to supply 2 recent passport-sized photographs
of each person included in your application.
Provide with your visa application a certified copy of the page
from your passport showing your photo and details. We will
advise you if your application has been approved. Please keep
a copy of the Visa Grant Notification in a safe place for your
reference.
Any alterations made on the form must be initialled and dated.
A travel agent or other representative may help you fill
out the form, but you must sign it. If unable to sign, a
parent or guardian may sign on your behalf.
Step 3 Making your visa application
Health requirements
Check if a Visa Application Charge is required.
All applicants must meet Australias health requirements. You
and any family members included in this application may be
required to undergo a chest x-ray and medical examination in
order to meet the criteria for the grant of a subclass 602 visa.
Not all applications attract a charge. If a prescribed charge is
applicable, the application will not be valid unless payment
has been received.
Information on health examinations is available on the
departments website www.border.gov.au/trav/visa/heal
If a charge is required, payment must accompany your
application. Payment of the charge does not guarantee this
application will be successful and is generally not refundable.
Conditions
Method of payment
Visa condition 8101
Before making a payment outside Australia, please check with
the Australian Government office where you intend to lodge
your application as to what methods of payment and
currencies they can accept and to whom the payment should
be made payable.
If your visa application is approved, it will be subject to
condition 8101. Visa holders must not engage in work in
Australia.
Visa condition 8201
If your visa application is approved, it will be subject to
condition 8201. Visa holders must not engage in any studies or
training for more than 3 months while in Australia.
Visa condition 8503
If your visa application is approved, it may be subject to
condition 8503. Visa holders will not, after entering Australia,
be granted a substantive visa, other than a protection visa,
while they remain in Australia.
How to apply
What happens next?
Your application will be considered and you may be asked to
provide additional information to enable a decision to be
made.
If you want to change any details after you have made the
application, or if you want to withdraw it, please contact the
office where you made the application.
You should also advise the office if any of the information you
gave in your application changes while your application is
being considered.
Step 1 Check your passport
You will be advised in writing whether your application has
been approved or not.
Make sure you have a passport which is valid for your period
of stay in Australia. It is strongly recommended that passports
be valid for at least 6 months.
If your application is approved you will be advised that you
have been granted a subclass 602 visa.
If you are already in Australia and are eligible to apply in
Australia, check the expiry date of your current visa. If you can
apply whilst in Australia, you should make your visa
application before your current visa expires.
If your application is refused, you will be given a reason for the
decision as well as information about your review rights.
Note: If you already have a visa for travel to Australia and you
are granted another visa, the first visa will cease.
48ME (Design date 04/16) - Page 2
COMMONWEALTH OF AUSTRALIA, 2016
Immigration assistance
Appointing a migration agent/exempt person
A person gives immigration assistance to you if he or she uses,
or claims to use, his or her knowledge or experience in
migration procedure to assist you with your visa application,
request for ministerial intervention, cancellation review
application, sponsorship or nomination.
To appoint a migration agent/exempt person you should
complete Part F Options for receiving written
communications.
In Australia a person may only lawfully give immigration
assistance if he or she is a registered migration agent or is
exempt from being registered. Only registered migration
agents may receive a fee or reward for providing immigration
assistance.
If an unregistered person in Australia, who is not exempt from
registration, gives you immigration assistance they are
committing a criminal offence and may be prosecuted.
Migration agents in Australia
Migration agents in Australia must be registered with the
Office of the Migration Agents Registration Authority (Office of
the MARA) unless they are exempt from registration.
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.
Note: Some Australian registered migration agents operate
overseas.
Your migration agent/exempt person should complete
form956 Advice by a migration agent/exempt person of
providing immigration assistance.
Form 956 is available from the departments website
www.border.gov.au/allforms/
Options for receiving written communications
If you do not appoint a migration agent/exempt person you
may still authorise another person, in writing, to receive
written communications on your behalf. This person is called
the authorised recipient.
Authorised recipient information
All written communication about your application will be sent to
your authorised recipient, unless you indicate that you wish to
have health and/or character information sent directly to you.
The department will communicate with the most recently
appointed authorised recipient as you may only appoint one
authorised recipient at any time for a particular application.
You will be taken to have received any documents sent to that
person as if they had been sent to you.
To appoint an authorised recipient you should complete:
Migration agent information
Part F Options for receiving written communications; and
A migration agent is someone who can:
form 956A Appointment or withdrawal of an authorised
recipient.
advise you on the visa that may best suit you;
tell you the documents you need to submit with your
application;
help you fill in the application and submit it; and
communicate with the department on your behalf.
If you appoint a migration agent, the department will assume
that your migration agent will be your authorised recipient,
unless you indicate otherwise.
Your migration agent will be the person with whom the
department will discuss your application and from whom it
will seek further information when required.
You are not required to use a migration agent. However, if you
use a migration agent, the department encourages you to use
a registered migration agent. Registered agents are bound by
the Migration Agents Code of Conduct, which requires them
to act professionally in their clients lawful best interests.
Information on migration agents, including a list of registered
migration agents, is available on the Office of the MARA
website www.mara.gov.au
You can also access information about migration agents on the
departments website www.border.gov.au
Exempt persons
The following people do not have to be a registered migration
agent in order to provide immigration assistance, but they
must not charge a fee for their service:
a close family member (spouse, de facto partner, child,
parent, brother or sister);
a member of parliament or their staff;
an official whose duties include providing immigration
assistance (eg. a Legal Aid provider);
a member of a diplomatic mission, consular post or
international organisation.
Note: Migration agents/exempt persons do not need to
complete form 956A.
Form 956A is available from the departments website
www.border.gov.au/allforms/
Consent to communicate electronically
The department may use a range of means to communicate
with you. However, electronic means such as fax or email will
only be used if you indicate your agreement to receiving
communication in this way.
To process your application the department may need to
communicate with you about sensitive information, for
example, health, police checks, financial viability and personal
relationships. Electronic communications, unless adequately
encrypted, are not secure and may be viewed by others or
interfered with.
If you agree to the department communicating with you by
electronic means, the details you provide will only be used by
the department for the purpose for which you have provided
them, unless there is a legal obligation or necessity to use
them for another purpose, or you have consented to use for
another purpose. They will not be added to any mailing list.
The Australian Government accepts no responsibility for the
security or integrity of any information sent to the department
over the internet or by other electronic means.
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.
Note: Electronic communication is the fastest means of
communication available and the department prefers to
communicate electronically because this results in faster
processing.
COMMONWEALTH OF AUSTRALIA, 2016
48ME (Design date 04/16) - Page 3
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 departments
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.
Home page www.border.gov.au
General Telephone 131 881 during business hours
enquiry line in Australia to speak to an operator (recorded
information available outside these hours).
Ifyou are outside Australia, please contact
your nearest Australian mission.
Please keep these information pages for your reference
48ME (Design date 04/16) - Page 4
COMMONWEALTH OF AUSTRALIA, 2016
Form
Application for a
Medical Treatment visa
Please use a pen, and write neatly in English using BLOCK LETTERS.
Tick where applicable
48ME
PHOTOGRAPH
Please attach 2 recent
photographs of yourself
AND
each person included in
your passport and
travelling with you.
Part A Your details
1
Give the following details exactly as they appear in your passport
Make sure your passport is valid for the period of stay you are applying for.
Are you or have you been known by any other name?
(including name at birth, previous married names, aliases)
No
Family name
Yes
Give details
Given names
Sex
Male
DAY
Female
MONTH
YEAR
Do you currently hold an Australian visa?
Date of birth
No
Passport number
Yes
Country of passport
Nationality of
passport holder
DAY
MONTH
Note: If this visa is approved, your current visa may cease.
Do you hold an identity card or identity number issued to you by your
government (eg. National identity card) (if applicable)?
Note: If you are the holder of multiple identity numbers because you
are a citizen of more than one country, you need to enter the identity
number on the card from the country that you live in.
YEAR
Date of issue
Date of expiry
No
Place of issue/
issuing authority
Yes
Give details
Family name
Given names
Place of birth
Town/city
State/province
Type of document
Country
Identity number
Country of issue
Relationship status
Married
Separated
Engaged
Divorced
De facto
Widowed
Never married or
been in a de facto
relationship
Of which countries are you a citizen?
Usual country of residence
COMMONWEALTH OF AUSTRALIA, 2016
48ME (Design date 04/16) - Page 5
Your current residential address
Note: A street address is required as a post office box address cannot
be accepted.
15 For what period do you wish to remain in Australia?
DAY
Date
MONTH
YEAR
from
DAY
MONTH
YEAR
to
16 I am applying as:
(Tick one box only)
OFFSHORE
POSTCODE
A person who will undergo
medical treatment
Country
A person who will attend a
medical consultation
10 Address for correspondence
(If the same as your residential address, write AS ABOVE)
Go to Question 17
A person who will be receiving an organ
A person who will be donating an organ
A person who will be accompanying one
of the above people
Go to Question 23
A citizen of Papua New Guinea residing
in the Western Province
Go to Question 17
POSTCODE
Country
11 Contact telephone numbers
ONSHORE
COUNTRY CODE
AREA CODE
A person who will undergo
medical treatment
NUMBER
Home
) (
Office
) (
A person who will attend a
medical consultation
Mobile/cell
A person who will be receiving an organ
12 Do you agree to the department communicating with you by email
and/or fax?
This may include receiving notification of the outcome of this application.
Note: We can communicate about this application more quickly using
email and/or fax.
A person who will be donating an organ
A person who will be accompanying one
of the above people
Go to Question 23
A citizen of Papua New Guinea residing
in the Western Province
Go to Question 17
No
Yes
A person who is 50 or over and has
been refused a permanent visa on
health grounds
Give details
Email address
COUNTRY CODE
Fax number
AREA CODE
) (
of family unit) of a person who already holds a subclass 602 visa on
the basis of being 50 or over and unfit to depart Australia?
No
Give details of the person you intend to remain with
in Australia
A Medical Treatment visa holder who is
requesting permission to work due to
exceptional circumstances
Go to Question 21
A current Medical Treatment visa holder
who is requesting permission to study
due to exceptional circumstances
Go to Question 22
Family name
Given names
Sex
Male
DAY
Female
MONTH
YEAR
Date of birth
Passport
number
14 Number of people included in this application?
Include yourself and any children who are named on
your passport and will be travelling to Australia with you.
48ME (Design date 04/16) - Page 6
Go to Question 23
A person who is a member of the family
unit of the above person
NUMBER
13 Are you applying on the basis of being a secondary person (ie. member
Yes
Go to Question 17
COMMONWEALTH OF AUSTRALIA, 2016
Medical details
Study details
17 For what period will you be under medical care while in Australia?
DAY
Date
MONTH
YEAR
from
DAY
MONTH
YEAR
22 For onshore applicants who are applying for permission to study,
please provide brief reasons for requesting permission to study
to
18 Briefly describe the medical treatment in Australia you have arranged
and estimated cost
Relatives in Australia
23 Do you have any close relatives in Australia?
No
Yes
Give details of each close relative in Australia
1. Family name
Given names
Attach your medical treatment plan to this form.
Relationship to you
19 Give details of the doctor in your home country who referred you for
treatment in Australia (if applicable)
Permanent resident of Australia?
Name of doctor in your home country
Address
No
Yes
Address
POSTCODE
POSTAL CODE
2. Family name
Given names
20 Give details of the doctor and/or hospital in Australia who will be
providing you with medical treatment
Name of doctor and/or hospital in Australia
Relationship to you
Permanent resident of Australia?
No
Yes
Address
Address
POSTCODE
POSTCODE
Go to Question 24
If more than 2 close relatives, give details at Part J
Work details
21 For onshore applicants who are applying for permission to work,
please provide brief reasons for requesting permission to work
Go to Question 24
COMMONWEALTH OF AUSTRALIA, 2016
48ME (Design date 04/16) - Page 7
Children included
Part B Funding for stay
Include in this application all children included in your passport
who will be travelling to Australia with you.
All visitors to Australia must be able to demonstrate that they have
adequate funds to cover all costs associated with their visit. Providing
evidence of funds with an application will often help expedite the
processing of a visitor visa application. Examples include showing
personal bank statements, pay slips, audited accounts, taxation records.
Children under 18 years of age, travelling alone or without one or both
of their parents or legal guardians, require documents identifying
custody and access arrangements from the non-accompanying
parent(s) or guardian(s) to travel to Australia.
If a child under 18 years of age is staying in Australia with someone
other than a parent, legal guardian or relative, a declaration signed by
the person responsible for that child in Australia, is required to be
completed. See form 1257 Undertaking declaration.
If someone else is offering to help meet the cost associated with your
visit, they may be asked to provide evidence of their ability to provide
such support, including the nature of their relationship with you.
26 How will you be maintaining yourself financially while you are in
Australia?
24 Are there any children in your passport who will be travelling to
Using your own funds give details
Australia with you?
No
Give details of each child
Yes
1. Family name
Someone else will be providing support give details
Given names
Sex
Family name
Male
DAY
Given names
Female
MONTH
YEAR
Date of birth
Relationship to you
DAY
Country of birth
MONTH
YEAR
Date of birth
Relationship you
Address
2. Family name
Given names
POSTCODE
What support are they providing you?
Sex
Male
DAY
Financial
Female
MONTH
Accommodation
YEAR
Date of birth
Other
Country of birth
Relationship you
If more than 2 children, give details at Part J
Attach a consent to travel statement where one or more custodial
parents/guardians are not accompanying the dependent child.
25 Will any of the children listed above receive medical treatment
while in Australia?
No
Yes
Give details
48ME (Design date 04/16) - Page 8
COMMONWEALTH OF AUSTRALIA, 2016
Give details
Part C Health details
30 Have you, or any other person included in this application:
27 In the last 5 years, have you, or any other person included in this
application, visited or lived outside your country of passport for more
than 3 consecutive months?
Do not include time spent in Australia.
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
No
Yes
Yes
Give details
Give details
1. Full name
Country(s)
DAY
Date
MONTH
DAY
YEAR
from
MONTH
YEAR
to
31 During your proposed visit to Australia, do you, or any other person
2. Full name
Country(s)
DAY
Date
MONTH
YEAR
from
DAY
MONTH
YEAR
DAY
MONTH
YEAR
to
3. Full name
Country(s)
DAY
Date
MONTH
YEAR
from
to
included in this application, expect to incur medical costs, or require
treatment or medical follow up 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;
other?
No
Yes
If insufficient space, give details at Part J
Give details
28 Do you, or any other person included in this application, intend to
enter a hospital or a health care facility (including nursing homes)
while in Australia?
No
Yes
Give details
32 Do you, or any other person included in this application, require
assistance with mobility or care due to a medical condition?
No
Yes
Give details
29 Do you, or any other person included in this application, intend to
work as, or study to be, a doctor, dentist, nurse or paramedic during
your stay in Australia?
No
Yes
Give details
33 Have you, or any other person included in this application, undertaken
a health examination for an Australian visa in the last 12 months?
No
Yes
COMMONWEALTH OF AUSTRALIA, 2016
Give details (including HAP ID if available)
48ME (Design date 04/16) - Page 9
Part D Character details
If you answered Yes to any of the questions at Question 34, you must
give all the relevant details including dates
34 Answer the following questions to see if there is anything you
must declare about your character.
These questions apply to yourself and any children included in
your application.
Have you, or any person included in this
application, ever:
been charged with any offence that is
currently awaiting legal action?
No
Yes
been convicted of an offence in any country
(including any conviction which is now
removed from official records)?
No
Yes
been the subject of an arrest warrant or
Interpol notice?
No
Yes
been found guilty of a sexually based offence
involving a child (including where no
conviction was recorded)?
No
Yes
been named on a sex offender register?
No
Yes
been acquitted of any offence on the grounds
of unsoundness of mind or insanity?
No
Yes
been found by a court not fit to plead?
No
Yes
been directly or indirectly involved in, or
associated with, activities which would
represent a risk to national security in
Australia or any other country?
No
Yes
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?
No
Yes
been associated with a person, group or
organisation that has been/is involved in
criminal conduct?
No
Yes
been associated with an organisation
engaged in violence or engaged in acts of
violence (including war, insurgency, freedom
fighting, terrorism, protest) either overseas or
in Australia?
No
Yes
served in a military force, police force, state
sponsored/private militia or intelligence
agency (including secret police)?
No
Yes
undergone any military/paramilitary training,
been trained in weapons/explosives or in the
manufacture of chemical/biological products?
No
Yes
been involved in people smuggling or people
trafficking offences?
No
Yes
been removed, deported or excluded from
any country (including Australia)?
No
Yes
overstayed a visa in any country (including
Australia)?
No
Yes
had any outstanding debts to the Australian
Government or any public authority in
Australia?
No
Yes
48ME (Design date 04/16) - Page 10
If insufficient space, give details at Part J
COMMONWEALTH OF AUSTRALIA, 2016
Part E Assistance with this form
Part F Options for receiving written
communications
35 Did you receive assistance in completing this form?
No
Go to Part F
Yes
Please give details of the person who assisted you
Title:
Mr
Mrs
39 All written communications about this application should be sent to:
Miss
Ms
(Tick one box only)
Myself
Other
OR
Family name
Authorised
recipient
Given names
You should complete form 956A Appointment
or withdrawal of an authorised recipient
OR
Address
Migration agent
OR
POSTCODE
Exempt person
Your migration agent/exempt person should
complete form 956 Advice by a migration
agent/exempt person of providing
immigration assistance
Telephone number or daytime contact
COUNTRY CODE
Office hours
AREA CODE
) (
NUMBER
)
Mobile/cell
36 Is the person an agent registered with the Office of the Migration
Agents Registration Authority (Office of the MARA)?
No
Yes
Go to Part F
37 Is the person/agent in Australia?
No
Go to Part F
Yes
38 Did you pay the person/agent and/or give a gift for this assistance?
No
Yes
COMMONWEALTH OF AUSTRALIA, 2016
48ME (Design date 04/16) - Page 11
Part G Payment details
40 IMPORTANT: You must refer to the departments website at www.border.gov.au/trav/visa/fees to complete this part of your
application. The website shows reference tables with the Visa Application Charges applicable to each visa subclass.
Visa subclass you are applying for
Base Application Charge
(1)
AUD
Write the amount shown on the reference table for your visa subclass
+
Non-internet Application Charge (if applicable)
Additional Applicant Charge aged 18 years or over at the time your application is lodged
Write the amount shown on the
reference table for your visa subclass
Number of additional applicants
aged 18 years or over
X (multiplied by)
AUD
Write the amount shown on the
reference table for your visa subclass
Number of additional applicants
under 18 years of age
X (multiplied by)
(4)
AUD
Subsequent Temporary Application Charge (if applicable)
Write the amount shown on the
reference table for your visa subclass
(3)
AUD
Additional Applicant Charge under 18 years of age at the time your application is lodged
AUD
(2)
AUD
+
Number of applicants
X (multiplied by)
AUD
(5)
AUD
=
Total
Total (1) + (2) + (3) + (4) + (5)
AUD
You must pay the total amount or your visa application will not be valid.
Note: A second instalment of the Visa Application Charge must also be
paid before we can grant some visas.
41 How will you pay your application charge?
Note: A surcharge may apply to payments made by credit card. Further information is available from
www.border.gov.au/trav/visa/fees/how-to-pay-for-an-application
If applying in Australia, credit card is the preferred method of payment. If paying by bank cheque or money order please make payable to the
Department of Immigration and Border Protection.
If applying outside Australia, please check with the Australian Government office where you intend to lodge your application as to what methods
of payment and currencies they can accept and to whom the payment should be made payable.
Bank cheque
Money order
Credit card
Give details below
Payment by (tick one box)
Australian Dollars
MasterCard
Diners Club
American Express
JCB
Telephone
number
Address
AUD
COUNTRY CODE
(
AREA CODE
) (
NUMBER
)
Visa
POSTCODE
Credit card number
:
MONTH
YEAR
Expiry date
Cardholders name
As the cardholder I acknowledge and accept that a credit card
surcharge may apply to the transaction.
Signature of
cardholder
Credit card information will be used for charge paying purposes only.
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COMMONWEALTH OF AUSTRALIA, 2016
Part H Application checklist
42 Please attach the following documents to this application
(Keep a copy of the documents for your own records.)
If you are applying in Australia you must include the Visa
Application Charge
Attach evidence of your own funds
Attach statements from any people or organisations
who will be providing you with financial assistance, such
as paying any of your costs, providing services free, or
maintaining you while you are in Australia
Attach written confirmation from the doctor or
hospital who will be treating you in Australia, stating:
that they agree to treat you;
that satisfactory arrangements have been made for
the payment of all costs associated with the
treatment;
the nature of the treatment;
the admission date (if applicable);
the period you will be under medical care in Australia;
no Australian citizen or permanent resident will be
disadvantaged in obtaining medical treatment.
If you will be receiving treatment in a public hospital in
Australia, attach written approval from the hospital
If your visit is for an organ transplant, attach evidence
that arrangements have been made for all the travel and
expenses of the donor, and that payment of these costs
will not be a charge on Australia
If a child under 18 years of age will be travelling without
one or both parents/guardians, the non-accompanying
parent(s)/guardian(s) must provide documents identifying
custody and access arrangements for the child to travel
to Australia
If applying together with another person, your
applications should be clipped together or placed in an
envelope
To establish your identity
You must provide:
Identity page (showing photo and personal details)
of your passport
Passport size photograph
Full birth certificate
Depending on your circumstances, you may also be required to provide:
Family Register Document
Identity card
Details of any name change (eg. by marriage or
deed poll)
To establish the identity of children included in this application,
for each child
You must provide:
Identity page (showing photo and personal details)
of their passport
Passport size photograph
Full birth certificate
Depending on their circumstances, you may also be required to provide:
Family Register Document
Identity card
Details of any name change (eg. by deed poll)
Note: If anyone in Australia will be paying for your tickets, providing you
with funds, or maintaining you while you are in Australia, you may be
asked to arrange for that person to send details about their financial
position to the visa office where you lodge your visa application.
You may have to fill out more forms or obtain certain reports or
documents to include in your application. The Australian Visa Office will
tell you if this is necessary.
COMMONWEALTH OF AUSTRALIA, 2016
48ME (Design date 04/16) - Page 13
Part I Signatures
44 DECLARATION
WARNING: Giving false or misleading information or documents is a
serious offence.
43 BIOMETRICS DECLARATION AND CONSENT
This declaration and consent is for offshore visa applicants.
If I am requested or required to provide my fingerprints and facial image:
Before you sign the following declaration, you must read the Conditions
on page 2.
I consent to:
I declare that:
the collection of my fingerprints and facial image.
I have read and understood the information provided in this
application;
I declare that:
I understand that my fingerprints and facial image and my
biographical information held by the department may be given to
Australian law enforcement agencies to help identify me, to help
determine my eligibility for grant of the visa I have applied for, and
for law enforcement purposes.
I consent to:
Australian law enforcement agencies disclosing my biometric,
biographical and criminal record information to the department for
any of the purposes outlined above; and
the department using the information obtained for the purposes of
the Migration Act 1958 or the Australian Citizenship Act 2007.
Signature of
applicant
DAY
Date
I have provided complete and correct information in every detail on
this application, and on any attachments to it;
I will inform the department in writing immediately as I become
aware of a change in circumstances (including change of address)
or if there is any change relating to information I have provided in or
with this application, while it is being considered;
I understand that if any fraudulent documents or false or misleading
information has been provided with this application, or if I fail to
satisfy the Minister of my identity, my application may be refused
and I, and any other member of my family unit, may become unable
to be granted a visa for specified periods of time;
if documents are found to be fraudulent or information to be
incorrect after the grant of a visa, the visa may subsequently be
cancelled.
If a visa is granted, I understand that:
MONTH
YEAR
I must abide by the conditions of the visa;
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.
I have read the information contained in form 1442i Privacy notice.
I understand the department may collect, use and disclose my personal
information (including biometric information and other sensitive
information) as outlined in form 1442i Privacy notice.
Signature of
applicant
DAY
MONTH
YEAR
Date
We strongly advise that you keep a copy of your application
and all attachments for your records.
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COMMONWEALTH OF AUSTRALIA, 2016
Part J Additional information
45
Question number
Additional information
If insufficient space, attach additional details.
COMMONWEALTH OF AUSTRALIA, 2016
48ME (Design date 04/16) - Page 15
