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| 1) Type of Visa: |
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Stay UP TO 3 months per visit. Multiple re-entry permitted. * Conditions apply NOTE: Australian Holiday, Tourist, Travel and Visitor visas are now all the SAME. |
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| 2) Country you are in now: |
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| 3) Contact Phone: |
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| 3a) Mobile / Cell Phone: Pls turn this phone ON |
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| Please include mobile / cell number for urgent messages |
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 4) Email: |
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| 4a) Confirm Email: |
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| 5) Applicants Passport Number: |
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| 5a) Confirm Passport Number: |
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| 6) Which country is the passport from ? |
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6a) National or Personal ID Number * IF applicable >> See more info below.
This ID number is in your passport. |
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 * IF applicable - this ID number will be shown in your passport.- Brunei = National IC number
- Hong Kong = HKID number
- Singapore = IC number
- Malaysia = Nombor Pengenalan
- Korea = Personal Number
- Pls double check with applicant if you are applying for someone else.
- AMERICANS: (NOT your SSN - social security number)
- EUROPEANS: Your Personal ID number is listed in your passport. This number is either all numbers or numbers with a hyphen (eg: 123456-7890)
- This personal ID Number will be listed in your passport. IF NOT shown in passport, please continue.
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| 7) Applicants Date Of Birth: |
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| YEAR |
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| 8) Gender of Applicant: |
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| 9) Country Of Birth: |
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| 10) Passport Issue Date: |
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| MONTH |
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| YEAR |
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| 11) Passport Expiry Date: |
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| MONTH |
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| YEAR |
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| 12) Issuing |
| Where was this passport issued from? Shown in passport. |
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| * IF OTHER, enter here |
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| 13) APPLICANTS NAMES |
- NO TITLES / Do not put any titles
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| 13a) SURNAME = LAST Name = FAMILY NAME |
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IMPORTANT, Please read.- NO ALIAS NAMES
- NO NAMES IN BRACKETS
 DO NOT REPEAT SURNAME IN GIVEN NAMES- NO TITLES (Do not put Ms, Miss, Mr, Mrs, Dr, Herr, Frau etc)
- NO Middle TITLES such as Bin, Binte, Bte, S/O, D/O, Anak etc
- NO POST TITLES (Do not put Jr, Snr, I, II, III, IV etc)
- DOUBLE CHECK Dates, especially Americans
- DOUBLE CHECK names are exactly as listed in passport, especially Americans
- ** Most Muslims and Indians call the Surname their FATHERS NAME
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| 13b) First / Given Name in Passport: |
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| 13c) ALL MIDDLE Names in Passport: |
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| DO NOT REPEAT SURNAME IN GIVEN NAMES |
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14) RESIDENTIAL ADDRESS OF APPLICANT
PO Boxes are NOT accepted. |
| Residential Country: |
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| Residential Address 1: |
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| Residential Address 2: |
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| [District / Suburb / City]: example {Bondi} or {Paddington} etc |
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| Post Code: +State: |
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Residential address ONLY, Suburb and post code >> DO NOT repeat country
PO Boxes are NOT accepted. |
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| 15) CRIMINAL RECORD |
Has the applicant ever been sentenced to 12 months or more in jail?
(regardless of whether they served any time in jail) Details are NOT required. |
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| 16) Name Changes: IMPORTANT - NEW NOV 2019 |
Has the applicant ever legally been known by another name? or Alias ?
This includes IF the applicant changed their names when married (Maiden Name) etc. |
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| IF YES, please fill in the following details: IF NO, please go to question 17 |
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| 17) Other Citizenship? |
| Does the applicant hold Citizenship for ANY OTHER COUNTRIES ? |
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If YESDoes the applicant have a Passport for that country? |
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| 18) MEDICAL RECORD |
Has the applicant ever had any of the following?
Details are NOT required.
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| 19) DOMESTIC VIOLENCE |
Has the applicant ever had any of the following? Details are NOT required. |
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Question 1:
Has the applicant ever been charged or convicted of a family or domestic violence offence or any similar related offence?
YES
NO
Question 2:
Has the applicant ever had a domestic violence or family violence order, or any other similar order, of a tribunal or court or other similar authority for the personal protection of another person - taken out against them?
YES
NO
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| 20) I AGREE that I have double checked the above information. |
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