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PERSONAL INFORMATION REQUIRED FOR THE PREPARATION OF YOUR TEMPORARY RESIDENCE SUBCLASS 457 BUSINESS (LONG STAY) VISA

APPLICATION
Sponsoring company
Main visa applicant name

Your full name (as per your passport)

Previous names Please indicate other names you have been known by, if applicable.

Your current home address

Postcode Your address for delivery of documents Please note we will usually return original documents by courier. Therefore, the address below should be a street address (not a PO box).

Postcode Contact details Home: ( Work: ( ) ______________________ ) ______________________

Mobile: __________________________ Email: __________________________

Fragomen Australia Pty Ltd 2008-2010. 5 March 2010

Marital status (mark more than 1 where appropriate) Never Married Divorced Married Separated Engaged De facto

If married, please provide date of marriage: ____/____/____ If engaged, please provide date of intended marriage: ____/____/____ If de facto, please provide the date your relationship began: ____/____/____ National identity cards/numbers Please provide details of any National Identity cards, social security cards or alien registration numbers you or any accompanying family members hold or have held in the past. Type of card Country of issue Number Citizenship - yourself Please provide the following details regarding yours and your familys Citizenship(s)? Details Present country of citizenship Do you or any of your accompanying family members hold citizenship of another country? If yes, please provide details. Citizenship: Date of grant:

Visa History Details Details of any current or previous Australian visas held Visa number: V_ _ _>_ _ _ _ _ _ _ _ _ _ Visa Type/Subclass: Year of application: Place of application: Visa expiry date: Have you or any person included in your visa application, ever had an Australian visa refused or cancelled Have you or any person included in your visa application, ever held an Australian bridging visa E? (E - usually given to people who have no other visa, to facilitate departure) Date of last entry to Australia (if applicable) If in Australia, details of any proposed travel during the preparation and processing of this visa application If you or a family member are currently in Australia as the holder of a student visa do you receive financial support from the Australian government through AusAid, or a foreign government? Yes No - please provide details Yes No Yes No (If yes, please give details) (If yes, please give details)

Fragomen Australia Pty Ltd 2008-2010. 5 March 2010

Health & character declarations No In the last five (5) years, have you or any person in this application visited or lived outside your country of passport (i.e. the country that your passport is issued by)? for more than three (3) consecutive months (not including Australia)? Yes (give details)

Name: Countries: Date: From:

To:

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? intend to work as, or study to be, or train to be, a doctor, dentist, nurse or paramedic during your stay in Australia? intend to work, or be a trainee, at a child care centre (including preschools and creches) while in Australia? intend to be in a classroom situation for more than 3 months (e.g. as either a student, teacher, lecturer, or observer) while in Australia? Explanation: This is the specific wording on the Department of Immigrations visa application form. Your response will assist us in identifying if any additional health examinations need to be completed. Please identify the person that each relevant scenario applies to.

Have you (or any accompanying family members) ever had or currently have tuberculosis (TB), been in close contact with a person who has active TB or ever had an abnormal chest x-ray? During the proposed stay in Australia, will you (or any accompanying family member/s) expect to incur medical costs, or require treatment or medical follow up for: blood disorders: cancer; heart disease; hepatitis B or C; HIV infection, including AIDS; kidney disease, including dialysis; liver disease; mental illness pregnancy; respiratory disease that has required hospital admission or oxygen therapy; any form of surgery; or any other health concerns

Fragomen Australia Pty Ltd 2008-2010. 5 March 2010

Health & character declarations contd No Do you (or any accompanying family member/s) require assistance with mobility or care in Australia or overseas? Do you or any person in this application, intend to work as, or study to be, a doctor, dentist, nurse or paramedic during your stay in Australia? Do you (or any accompanying family member/s) have any character declarations to be made? Been convicted of a crime or offence in a country (including those now removed from official records) Been charged with an offence which is currently awaiting legal action or acquitted of a criminal offence on the grounds of mental illness, insanity or unsoundness of mind Been removed or deported from any country, or left any country to avoid being removed or deported / been excluded or asked to leave any country Committed, or been involved in the commission of war crimes or crimes against humanity or human rights, been involved in activities which would present a risk to the Australian national security Had any outstanding debts to the Australian Government or any public authority in Australia Been involved in any activity, relating to the illegal movement of people into the country Have you (or any accompanying family members) ever served in a military force or state sponsored/private militia, undergone any military/paramilitary training or been trained in weapons/explosives use (other than compulsory military service)? If yes, please provide all relevant details including dd/mm/yy training/service began and dd/mm/yy training/service was completed, rank, etc. Please note copies of discharge papers may be required. Yes (give details)

Health Insurance Do you hold health insurance for yourself and your accompanying family members? Yes - please forward us a copy of the certificate with this questionnaire. No

Fragomen Australia Pty Ltd 2008-2010. 5 March 2010

Declarations Australian values statement Australian values include respect for the freedom and dignity of the individual, freedom of religion, commitment to the rule of law, Parliamentary democracy, equality of men and women and a spirit of egalitarianism that embraces mutual respect, tolerance, fair play and compassion for those in need and pursuit of the public good. Australian society also values equality of opportunity for individuals, regardless of their race, religion or ethnic background. I will respect these Australian values during my stay in Australia and obey the laws of Australia. Fraudulent documents I understand that this visa application may be refused where bogus documents or information that is false or misleading is presented to the Department, including by a third party acting on our behalf. I understand that this also applies to a previous application relating to myself, or a member of my family unit included in this application. I also understand that if information or documents submitted in support of an application are found to be fraudulent or misleading after the grant of a visa, it may subsequently be cancelled. Signature: Health Insurance I understand that I must provide a letter from my insurer confirming that I and any other applicants included in the application have made adequate arrangements for health insurance during the period of my/our intended stay in Australia. I will abide by the conditions of the visa. Signature: I authorise Fragomen to act on my behalf with regard to my application for a subclass 457 visa and understand they may receive written communication regarding myself or any secondary applicants in this application in relation to the visa process. All applicants aged 18 and above must sign this declaration:

Signature:

Signature: Signature:.

Signature:

Signature:

Fragomen Australia Pty Ltd 2008-2010. 5 March 2010

AUTHORISATION TO LODGE VISA APPLICATION


I .(insert name) and I .(insert spouse name if applicable) certify that: The information on this form is true and correct and I authorise Fragomen to populate the visa form on the basis of the information and supporting documents that I have provided, and that my employer has provided (such information and documents may include passport information, resume, employment contract and salary information). I authorise the application to be lodged with the Department of Immigration & Citizenship on my and my familys behalf. Applicant 1 Sign: . (main applicant) Applicant 2 Sign: .(family member 18 years or over) Applicant 3 Sign: .(family member 18 years or over)

Fragomen Australia Pty Ltd 2008-2010. 5 March 2010

PRIVACY STATEMENT AND CONSENT TO FRAGOMEN


Disclosure by you and your family (You) of personal information to Fragomen (Us) in the course of providing Services to You, is subject to the Privacy Act 1988 (Privacy Act) in Australia. Fragomen are required to comply with the Privacy Act. In order to perform our services to You, We will need to collect and disclose personal information required by the relevant immigration authorities, other government bodies, or other parties including but not limited to, skills assessing authorities, tribunals and courts. The Privacy Act requires that You agree to the collection and disclosure of certain information about You. The information we need to collect may include, amongst other things, your name, date and place of birth, nationality, marital or other relationship status, employment status and membership of professional associations, salary information, current immigration status, and information relating to any criminal and medical history. We will also require similar information regarding any family members included in the application. By signing the Privacy Statement and Consent to Fragomen, You consent to the collection by Fragomen of this information from You. Whilst we will endeavour, where reasonable and practical to do so, to collect this information directly from You, we may also collect personal information about You from other persons that may hold this information, including information from your employer. You acknowledge and agree that the disclosure of personal information to Us is for a purpose related to the performance of the Services. This information may be disclosed to the Department of Immigration in Australia and other relevant government departments in relation to your visa processing, and, where relevant, to similar government departments overseas. The Departments in Australia are similarly bound to protect your privacy. Where we represent you in tribunals or courts, we may also disclose information to relevant parties in the furtherance of your claim/matter (eg. to the court, other parties to the litigation, experts, barristers etc.) If your Visa application involves the nomination or sponsorship of an Employer then the information you provide may also be disclosed to the Employer, or service providers nominated to Fragomen or by the Employer for the purposes of ensuring that they are fully aware of all issue relevant to the Visa process. The Employer or their nominated service provider may also access this data via protected Employer Client and Fragomen technology products. If your visa application involves a sponsorship by another person (the Sponsor) for whom we also act, then the information you provide to us may be disclosed to the Sponsor for the purpose of ensuring that they are fully aware of all issues relevant to their sponsorship of you. If your visa application includes members of your family, then we may also disclose to them any information relevant to their combined visa application and we will take this form as consent for us to discuss any aspect of your matter with them. The information we may disclose to the Sponsor, the Employer or their nominated service provider and any family member, may include a copy of your Visa application and supporting documents, medical results, and criminal record checks. It may also include the Visa approval letter and confirmation of your visa details and immigration status, including, the conditions attached to any visa held by you, and the date of visa expiry. It may also include the content of any advice that we have provided to you about your immigration status or Visa application and any inquiries you have made of us concerning those matters. In circumstances where we are acting for your employer and you ask us to provide you with advice about your options for permanent residence or about any other visa option, we may disclose this information to your employer. You should be aware that we will also disclose to your employer any information that you disclose to us which may affect your employers interest. This would include information about your intentions to apply for permanent residence or to transfer to another employer. We would also advise your employer of any permanent residence application that you have made. Provision of Your personal information to your Sponsor the Employer or their nominated service provider or member of your family would not be limited to the period of providing services to You. By signing the Privacy Statement and Consent to Fragomen, you agree to such disclosure. You should also be aware that disclosure of personal information may be compelled by law (eg. under the Social Security Act) and we would be obliged to disclose personal information in these circumstances. From time to time we may contact you to provide you with information on visa and immigration matters and our services. By signing this form, you consent to us doing so. The information supplied by you is expected to be true and accurate. If you believe that the personal information we hold about you is incorrect in some way, please inform Fragomen of the inaccuracies and we will correct the information held about you in our records. In addition, Fragomen will take
Fragomen Australia Pty Ltd 2008-2010. 5 March 2010

reasonable steps to make sure that the personal information it collects uses or discloses is accurate, complete and up-to-date. If You establish that the information is not accurate, complete or up-to-date, Fragomen will take reasonable steps to correct the information so that it is accurate, complete and up-to-date. We take all reasonable steps to secure your personal information in our possession from misuse, unauthorized access and modification. The information provided may be accessed by all Fragomen employees worldwide, or Fragomen engaged immigration and visa co-counsel or third party vendors, in the course of their duties and may extend beyond the initial immigration matter engaged by you and your employer. You can obtain details of the personal information we hold about you by contacting us directly. A request for access to your personal information will be dealt with in a reasonable time and in compliance with the provisions of the Privacy Act. You should contact your Fragomen local contact should you wish to access any personal information about You. Maintaining your privacy is important to Fragomen and we strictly adhere to the National Privacy Principles contained in the Privacy Act. All employees of Fragomen are required to comply with the principles and procedures contained in this Act and set out in this document. By signing the consent form, you and your family members consent to the use of the information by Fragomen for the purposes described. By signing the consent form and returning this form to Us, we may commence work for You. If you have any questions about this statement, or have issues regarding the signing of this statement, please contact your Fragomen representative immediately.

CONSENT We the undersigned provide the following consent to Fragomen collecting, using and disclosing personal information about me/us in the manner set out in this Privacy Statement and Consent. ................................................ Print Name in full ................................................ Print Name in full ................................................ Print Name in full Date: ______________________ ....................................... Signature ....................................... Signature ....................................... Signature

Fragomen Australia Pty Ltd 2008-2010. 5 March 2010

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