1419 CHS (Design date 07/14) - Page 5 COMMONWEALTH OF AUSTRALIA,
2014
Form
1419 CHSCHINESE SIMPLIFIED
Application for a Visitor visa Tourist stream
Tick where applicable
Please use a pen, and write neatly in English using BLOCK
LETTERS.
Up to 3 months
Up to 6 months
How long do you wish to stay in Australia?3
Up to 12 months
Note: The stay period granted may be less than the period
requested. You should check the terms of any visa granted.
PHOTOGRAPH
Please attach a recent passport size photograph of yourself.
Outside Australia
In Australia
Indicate if you are applying outside Australia or in
Australia:1
Go to Question 2 2
Go to Question 5 5
When do you wish to visit Australia?2 DAY MONTH YEAR
Applicants outside Australia
Give details
No
Yes
Do you intend to enter Australia on more than one occasion?4
Go to Question 7 7
Go to Question 7 7
Specify the date you wish to extend your stay to
5
Applicants in Australia
Provide detailed reasons for requesting this further stay6
Date
to
from
DAY MONTH YEAR
1419 CHS (Design date 07/14) - Page 6 COMMONWEALTH OF AUSTRALIA,
2014
10 Are you or have you been known by any other name? (including
name at birth, previous married names, aliases)
Give details
No
Yes
Note: If this visa application is approved, your current visa
may cease.Yes
Do you currently hold an Australian visa?11
12 Have you applied for a Parent (subclass 103) visa?103
Please provide your queue dateYes
List countries
Are you a citizen of any other country?14
13 Do you currently hold, or have you applied for, an APEC
Business Travel Card (ABTC)?
Note: If this visa application is approved, the Australian visa
associated with your ABTC will cease.
ABTC
8 Place of birth
Town/city
State/province
Country
9 Relationship status
Married
De facto
Engaged Divorced
Separated
Widowed
Never married or been in a de facto
relationship
Date of birth
Passport number
Country of passport
Nationality of passport holder
Date of issue
Date of expiry
Place of issue/issuing authority
Part A Your detailsA Give the following details exactly as they
appear in your passportMake sure your passport is valid for the
period of stay you are applying for.
7
Family name
Given names
Sex Male Female
Yes
Yes
No
No
No
No
DAY MONTH YEAR
DAY MONTH YEAR
DAY MONTH YEAR
Give details
Do you have other current passports?15
Passport number
Country of passport
Yes
No
1419 CHS (Design date 07/14) - Page 7 COMMONWEALTH OF AUSTRALIA,
2014
Type of document
Identity number
Country of issue
23 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.
Fax number
Email address
( ) ( )
COUNTRY CODE AREA CODE NUMBER
20
POSTCODE
Your current residential address Note: A street address is
required as a post office box address cannot be accepted.
21 Address for correspondence (If the same as your residential
address, write AS ABOVE)
Country
Country
22 Contact telephone numbers
Home( ) ( )
COUNTRY CODE AREA CODE NUMBER
Office( ) ( )
Mobile/cell
POSTCODE
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.
16
Family name
Given names
Give details
No
Yes
Give details
No
Yes19 What is the purpose of your stay in your current location
and what isyour visa status?
17 In what country are you currently located?
Give details
18 What is your legal status in your current location?
Citizen
Visitor
Work visa
Other
Permanent resident
Student
No legal status
1419 CHS (Design date 07/14) - Page 8 COMMONWEALTH OF AUSTRALIA,
2014
Are you travelling to, or are you currently in, Australia with
any family members?24
Full name Relationship to you Name of sponsor (if
applicable)
Give details of each family member Make sure all the
applications are lodged at the same time.
Part B Family travelling to Australia with youB
Do you have a partner, any children, or fianc who will NOT be
travelling, or has NOT travelled, to Australia with you?25
Full nameDate of birth
Relationship to you Their address while you are in Australia DAY
MONTH YEAR
/ /
/ /
/ /
/ /
Part C Family NOT travelling to Australia with youC
If insufficient space, give details at Part OO
If insufficient space, give details at Part OO
Yes
Give details
No
Yes
No
1419 CHS (Design date 07/14) - Page 9 COMMONWEALTH OF AUSTRALIA,
2014
Do you have any relatives in Australia?27
Full nameDate of birth Relationship
to you Address Citizen or permanent resident of Australia
DAY MONTH YEAR
/ /
/ /
/ /
/ /
Full nameDate of birth Relationship
to you Address Citizen or permanent resident of Australia
DAY MONTH YEAR
/ /
/ /
/ /
/ /
If insufficient space, give details at Part O
If insufficient space, give details at Part O
O
O
Do you have any friends or contacts in Australia?28
No Yes
Give details
No
Yes
Give details
No
Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
Is it likely you will be travelling from Australia to any other
country (eg. New Zealand, Singapore, Papua New Guinea) and back to
Australia?26
Attach itinerary details
Part D Details of your visit to AustraliaD
Yes
No
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30 Do you intend to do a course of study while in Australia?
Name of the course
Name of the institution
How long will the course last?
In the last 5 years, have you visited or lived outside your
country of passport for more than 3 consecutive months?Do not
include time spent in Australia.
31
Country(s)
Country(s)
Country(s)
1.
2.
3.
Part E Health detailsE
If insufficient space, give details at Part OO
32 Do you intend to enter a hospital or health care facility
(including nursing homes) while in Australia?
Give details
No
Yes
Give details
No
Yes
Give details
No
Yes
Why do you want to visit Australia? Include details of any dates
that are of special significance to your visit.
29
If insufficient space, give details at Part OO
Date
Date
Date
to
to
to
from
from
from
DAY
DAY
DAY
MONTH
MONTH
MONTH
YEAR
YEAR
YEAR
1419 CHS (Design date 07/14) - Page 11 COMMONWEALTH OF
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35
36 Do you require assistance with mobility or care due to a
medical condition?
37 Have you undertaken a health examination for an Australian
visa in the last 12 months?
Note: If you are applying for a long stay Visitor visa or are 75
years or over, you will be asked to undergo a health assessment and
may be asked to show that you have medical insurance to cover your
intended stay in Australia. Please contact your nearest office of
the department for further advice before lodging your application.
If additional medical consultations are required, a decision on
your visa application will be delayed.
required hospital admission or oxygen therapy
During your proposed visit to Australia, do you expect to incur
medical costs, or require treatment or medical follow up for:
Give details
No
Yes
Give details
No
Yes
Give details (including HAP ID if available) HAP ID
No
Yes
33 Do you intend to work as, or study to be, a doctor, dentist,
nurse or paramedic during your stay in Australia?
34 Have you: 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?
Give details
No
Yes
Give details
No
Yes
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If you answered Yes to any of the above questions, give ALL
relevant details below.
If insufficient space, give details at Part OO
Part F Character details
38 Have you ever:
F
represent a risk to Australian national security?
Government or any public authority in Australia?
No Yes
No Yes
country (including any conviction which is now removed from
official records)?
currently awaiting legal action?
other offence on the grounds of mental illness, insanity or
unsoundness of mind?
country (including Australia)?
deported?
country (including Australia)?
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
commission of war crimes or crimes against humanity or human
rights? No Yes
convicted of any offence, relating to the illegal movement of
people to any country (including Australia)?
sponsored/private militia, undergone any military/paramilitary
training, or been trained in weapons/explosives use (however
described)?
No Yes
No Yes
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Part G Employment status
What is your employment status?39
Telephone number
Employed/self-employed Give details
Employer/business name
POSTCODE
Address
Position you hold
How long have you been employed by this employer/business?
Retired Year of retirement
Student Give details
Your current course
Name of educational institution
How long have you been studying at this institution?
Other Give details
Unemployed
Explain why you are unemployed and give details of your last
employment (if applicable)
( ) ( )
COUNTRY CODE AREA CODE NUMBER
1419 CHS (Design date 07/14) - Page 14 COMMONWEALTH OF
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Part H Funding for stayH All visitors to Australia must be able
to demonstrate they have adequate funds to cover all costs
associated with their visit. Providing evidence of funds will help
expedite the processing of a visitor visa application. Examples may
include personal bank statements showing a financial history, pay
slips, audited accounts, taxation records or details of funds that
visitors will be taking with them or funds that are available to
them. Relevant factors may also include the number of persons your
are supporting, the type of activities planned and the length of
stay sought.
40 Give details of how you will maintain yourself financially
while you are in Australia
Is your sponsor or someone else providing support for your visit
to Australia?
Note: This includes support from an organisation.
41
Full nameDate of birth Relationship
to you Their address while you are in AustraliaType of support
provided
DAY MONTH YEAR
Financial Accommodation Other
/ /
/ /
/ /
/ /
If insufficient space, give details at Part O
Attach details. The person or people you have listed will need
to provide evidence of their ability to provide this support.
O
Give details
No
Yes
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42
If you answered Yes to any of the above questions, give
details
Have you ever:
been in Australia and not complied with visa conditions or
departed Australia outside your authorised period of stay?
had an application for entry to or further stay in Australia
refused, or had a visa for Australia cancelled?
Part I Previous applicationsI
Please give details of the person who assisted you
No
Yes
43 Did you receive assistance in completing this form?
J Part J Assistance with this form
Go to Part K K
Family name
Given names
Title: Mr Mrs Miss Ms Other
POSTCODE
Address
Telephone number or daytime contact
Office hours
Mobile/cell
44 Is the person an agent registered with the Office of the
Migration Agents Registration Authority (Office of the MARA)?
Office of the MARA
45 Is the person/agent in Australia?
46 Did you pay the person/agent and/or give a gift for this
assistance?
Part K Options for receiving written communicationsK
47 All written communications about this application should be
sent to: (Tick one box only)
Myself
956A
You should complete form 956A Appointment or withdrawal of an
authorised recipient
Authorised recipient
Migration agent
Exempt person
Your migration agent/exempt person should complete form 956
Advice by a migration agent/exempt person of providing immigration
assistance
956
OR
OR
OR
No Yes
No Yes
No
Yes
No
Yes
Go to Part K K
No
Yes
( ) ( )
COUNTRY CODE AREA CODE NUMBER
Go to Part K K
1419 CHS (Design date 07/14) - Page 16 COMMONWEALTH OF
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Part L Payment detailsL
48 IMPORTANT: You must refer to the departments website at
www.immi.gov.au/fees-charges to complete this part of your
application. The website shows reference tables with the Visa
Application Charges applicable to each visa subclass.
www.immi.gov.au/fees-charges
AUD
AUD
AUD
AUD
AUD
AUD
AUD
AUD
AUD
Visa subclass you are applying for
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.
Non-internet Application Charge (if applicable)
(1)
(2)
(3)
(4)
(5)
+
+
+
=
+
Additional Applicant Charge aged 18 years or over at the time
your application is lodged18
Additional Applicant Charge under 18 years of age at the time
your application is lodged18
Subsequent Temporary Application Charge (if applicable)
Total (1) + (2) + (3) + (4) + (5) (1) + (2) + (3) + (4) +
(5)
Total
=
=
=
Write the amount shown on the reference table for your visa
subclass
Write the amount shown on the reference table for your visa
subclass
Write the amount shown on the reference table for your visa
subclass
18
Number of additional applicants aged 18 years or over
18
Number of additional applicants under 18 years of age
Number of applicants
Base Application Charge Write the amount shown on the reference
table for your visa subclass
(multiplied by)
( )X
(multiplied by)
( )X
(multiplied by)
( )X
1419 CHS (Design date 07/14) - Page 17 COMMONWEALTH OF
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49 How will you pay your application charge? Note: A surcharge
may apply to payments made by credit card. Further information is
available from www.immi.gov.au/fees-charges/how-to-pay.htm
If applying in Australia, debit card or credit card are the
preferred methods of payment. Debit cards cannot be used for
applications lodged by mail. 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.
www.immi.gov.au/fees-charges/how-to-pay.htm debit card
money order the Department of Immigration and Border
Protection
Give details below
Bank cheque Money order
Debit card
Credit card
MasterCard
American Express
Visa
Diners Club
JCB
Payment by (tick one box) Australian Dollars
AUD
Credit card number
:
: : : :
MONTH
:
: : :: :: :: :: :: : :
YEAR
Expiry date
Cardholders name
Address
POSTCODE
Signature of cardholder
Credit card information will be used for charge paying purposes
only.
Telephone number
Cannot be used for applications lodged by mail
( ) ( )
COUNTRY CODE AREA CODE NUMBER
As the cardholder I acknowledge and accept that a credit card
surcharge may apply to the transaction.
Part M Application checklistM
50 With your completed and signed application form 1419, you
must include:
1419
a certified copy of the identity page (showing photo and
personal details) of a valid passport and other pages which provide
evidence of travel to any other countries
a recent passport photograph (not more than 6 months old) of
yourself
the Visa Application Charge (if applicable)
a completed form 1257 Undertaking declaration, for applicants
under 18 years of age, staying in Australia with someone other than
a parent, legal guardian or relative (if applicable)
1257
1419 CHS (Design date 07/14) - Page 18 COMMONWEALTH OF
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evidence of access to funds to support your stay
evidence of your medical/travel insurance (if requested)
medical examination or tests (if requested)
a letter from your employer confirming your leave
evidence of enrolment at school, college or university
If visiting a close family member in Australia (who is a citizen
or permanent resident of Australia):
a letter of invitation to visit
other information to show that you have an incentive and
authority to return to your country of residence, such as property
or other significant assets in your home country
Under the Migration Act 1958, decision-makers are not obliged to
seek additional information from the applicant before making a
decision on a visa application. It is therefore in the your best
interest to submit the following documentation, if applicable, with
your application:
Important: Do not provide original documents unless requested.
You should provide certified copies of original documentation.
Documents not in English should be accompanied by accredited
English translations.
Additional documents
When you have lodged your application, you should attach your
receipt to this sheet.
a completed form 1229 Consent to grant an Australian visa to a
child under the age of 18 years, for applicants under 18 years of
age, travelling alone or without one or both of their parents or
legal guardians (if applicable)
1229
If you authorise another person to receive all written
communications about your application with the department:
completed Part K Options for receiving written communications;
and form 956 Advice by a migration agent/exempt person of providing
immigration assistance; orform 956A Appointment or withdrawal of an
authorised recipient
956
956A
1419 CHS (Design date 07/14) - Page 19 COMMONWEALTH OF
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51
the information given is complete, correct and up-to-date;
I understand that the visa I am applying for does not permit me
to work in Australia;
I understand that the visa I am applying for does not permit me
to study for longer than 3 months in Australia;
my intention to visit Australia is genuine and I will abide by
the conditions and period of stay of the visa;
I have access to adequate funds to meet all costs associated
with the visit to and from Australia;
I have never had tuberculosis or any serious condition likely to
endanger or be a cost to Australia (otherwise, I attach
details);
I understand that if a no further stay 8503 condition is imposed
on this visa, it will limit my ability to remain in Australia
beyond the authorised period of the visa;
in any part of this form which has been completed with the
assistance of another person, that the information as set down is
true and correct and has been included with my full knowledge,
consent and understanding;
if granted a visa, I will advise the Australian Visa Office
should my circumstances change;
I understand that if I do not abide by the conditions imposed on
my visa, my visa may be cancelled or I may be subject to other
penalties. If applicable, my sponsor may also be penalised;
I have truthfully declared all relevant details requested of me
in this application;
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;
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.
8503
1442i Privacy notice
1442i Privacy notice
WARNING: Giving false or misleading information or documents is
a serious offence.
Having read the Conditions for a Visitor visa to Australia on
page 1 of this form, I declare that:
Part N Declaration and consent
1419 CHS (Design date 07/14) - Page 20 COMMONWEALTH OF
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If insufficient space, attach additional details.
Question number Additional information52
Part O Additional informationO
Signature of applicant
Date
DAY MONTH YEAR
We strongly advise that you keep a copy of your application and
all attachments for your records.
For offshore applicants who are required to provide their
fingerprints and facial image.
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;
the department using the information obtained for the purposes
of the Migration Act 1958 or the Australian Citizenship Act
2007.
1958 2007
1: 2: 3: 1_2: 2_2: 3_2: 4: 5: 6: 7: 8: Given names: issuing
authority: undefined_5: undefined_6: undefined_7: 1_3: 2_3: 3_3:
1_4: 2_4: 3_4: fill_5: fill_6: fill_7: fill_1: fill_2: fill_3:
fill_4: fill_5_2: fill_6_2: fill_7_2: fill_8: fill_9: fill_10:
fill_11: fill_12: fill_13: fill_14: fill_15: fill_16: fill_17:
fill_18: fill_19: fill_20: fill_21: fill_22: fill_23: fill_24:
fill_25: fill_26: fill_27: fill_28: fill_29: fill_30: fill_31:
fill_32: fill_33: fill_34: fill_35: fill_36: fill_37: fill_38:
fill_39: fill_40: fill_41: fill_42: fill_1_2: fill_2_2: fill_3_2:
fill_4_2: fill_5_3: fill_6_3: fill_7_3: fill_8_2: fill_9_2:
fill_10_2: fill_11_2: fill_12_2: fill_13_2: fill_14_2: fill_15_2:
fill_16_2: fill_17_2: fill_18_2: fill_19_2: fill_20_2: fill_21_2:
fill_22_2: fill_23_2: fill_24_2: fill_25_2: fill_26_2: fill_27_2:
fill_28_2: fill_29_2: fill_30_2: fill_31_2: fill_32_2: fill_33_2:
fill_34_2: fill_35_2: fill_36_2: fill_37_2: fill_38_2: fill_39_2:
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fill_46: fill_47: fill_48: 1_5: 2_5: 3_5: 4_2: 5_2: 6_2: 1_6: 2_6:
3_6: 4_3: 5_3: 6_3: course: institution: Countrys: fill_14_3:
Countrys_2: fill_16_3: Countrys_3: fill_20_3: fill_21_3: fill_22_3:
fill_23_3: 1_7: 2_7: 3_7: 1_8: 2_8: 3_8: 1_9: 2_9: 3_9: fill_7_4:
fill_8_3: fill_9_3: 1_10: 2_10: 3_10: toggle_3: Ontoggle_5:
toggle_9: toggle_11: toggle_13: toggle_15: toggle_17: toggle_19:
toggle_21: toggle_4: Offtoggle_6: toggle_10: toggle_12: toggle_14:
toggle_16: toggle_18: toggle_20: toggle_22: toggle_1: toggle_2:
toggle_8: toggle_7: 1_11: 2_11: 3_11: 4_4: 5_4: 6_4: 7_2: 8_2: 9:
10: 11: 12: 13: 14: fill_6_4: fill_8_4: fill_10_3: fill_14_4:
fill_15_3: fill_16_4: fill_17_3: fill_18_3: fill_19_3: 1_12: 2_12:
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fill_20_4: fill_21_4: fill_22_4: fill_23_4: fill_25_3: fill_26_3:
fill_27_3: fill_28_3: fill_29_3: fill_30_3: fill_32_3: fill_33_3:
fill_34_3: 1_14: 2_14: 3_14: 4_7: 5_7: 6_7: fill_7_6: fill_8_6:
undefined_8: AUD: AUD_2: Row1: AUD_3: fill_3_3: AUD_4: Address 1:
Address 2: fill_2_4: fill_3_6: fill_4_5: fill_5_6: fill_6_7:
fill_7_8: fill_8_8: fill_9_6: fill_10_5: fill_11_4: fill_12_4:
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fill_37_3: fill_38_3: fill_39_3: : : : Text4: Text5: Text6: Text7:
Text8: Text9: Text10: Text11: Text12: Text13: Text14: Located:
country add: ZIP CODE: GUOJIA: POSTCODE: HOMETEL: OFFICETEL:
MOBILE: EMAIL: FAX: BIRTH3: BIRTH34: SHENGRI: PENGYOU:
GONGZUODANWEI: TUIXIU13: XUEXIDUOJIU: Text33: douliushijian: Check
Box35: OffCheck Box36: OffCheck Box37: OffCheck Box38: OffCheck
Box39: Check Box40: Check Box41: Check Box42: Check Box43: Check
Box44: Check Box45: OffCheck Box46: OffCheck Box47: OffCheck Box48:
Check Box49: Check Box50: Check Box51: Check Box52: Check Box53:
Check Box54: Check Box55: Check Box56: Check Box57: Check Box58:
Check Box59: Check Box60: Check Box61: Check Box62: Check Box63:
Check Box64: Check Box65: Check Box66: Check Box67: Check Box68:
Check Box69: Check Box70: Check Box71: OffCheck Box72: OffCheck
Box73: Check Box74: Check Box75: Check Box76: Check Box77: Check
Box78: Check Box79: Check Box80: Text81: Text82: Text83: Check
Box84: Check Box85: Check Box86: Check Box87: Check Box88: Check
Box89: Check Box90: Check Box91: Check Box92: Check Box93: Check
Box94: Check Box95: Check Box96: Check Box97: Check Box98: Check
Box99: Check Box100: Check Box101: Check Box102: Check Box103:
Check Box104: Check Box105: Check Box106: Check Box107: Check
Box108: Check Box109: Check Box110: Check Box111: Check Box112:
Check Box113: Check Box114: Check Box115: 0: Off0: 1: 2: 3: 4: 5:
6: 7: