Professional Documents
Culture Documents
Form
842
Children under 18
Children under the age of 18 who have no parents, or who have
been separated from their parents, may also be granted a visa in
one of the subclasses listed above. However, the Australian
Government must be satisfied the childs entry to Australia is in
the best interest of the child and that the rights of the parents, if
any, are properly considered.
If any children under 18 who are members of the family unit and
included in this application are not your biological children, you
must provide information and documentation as to who their
birth parents are/were.
Partner
Partner means your spouse or de facto partner (including
same-sex partners).
Residential address
You must advise the department where you intend to live while
your application is being dealt with, or if you change your
residential address after your application has been lodged.
Failure to give a residential address will result in your application
being invalid. A post office box address will not be accepted as
your residential address.
Your application
You should answer the questions in this form truthfully and fully
and attach any supporting documents. Forms that are incomplete
could delay a decision being made on your application, or your
application could be refused.
Not all applicants are interviewed and a decision may be taken on
the information provided in your application only. You need to
make sure you include all details about your situation in your
application.
If you need more space than is provided in this form for any of
your answers, attach a separate page, clearly marking the
question number the page relates to. Additional pages must be
signed and dated by each person aged 18 years or over included
in this application.
Integrity of application
The department is committed to maintaining the integrity of the
visa and citizenship programmes. Please be aware that if you
provide us with fraudulent documents or claims, this may result
in processing delays or your application being refused.
Supporting documents
The documents you must provide are requested throughout this
form. There is also a document checklist in Part Q of this form
and you should carefully check you have provided all the listed
documents.
You should also provide all documents necessary to support
your humanitarian claims.
Copies of documents must be certified as true copies of the
original by a Justice of the Peace, Commissioner for Declarations,
or a person before whom a Statutory Declaration may be made
under the Statutory Declarations Act 1959. Outside Australia, a
person who is equivalent to a Justice of the Peace or a
Commissioner for Declarations must certify copies.
If you do not provide all the necessary documents, a
decision may be made on the information you have
provided. It is in your interest to support your
application with as much information as possible at the
time of application.
If you are not able to provide any of the documents listed
at Part Q, please provide a written explanation why the
documents are not available.
Under no circumstances should you submit false
documents.
Change of circumstances
If your circumstances change in any way after you have lodged
this form (eg. if you or a family member enters into a new
relationship, becomes engaged, or marries), you must inform the
office where the application was lodged. If a child is born to
you (or any other person included in this application)
after the application is lodged, the child will be included
in your application if details are provided before a final
decision is made on your application.
Processing information
You should be aware that there is strong interest in this class of
visa and it may take a long time to finalise your application.
You may need to have a medical and an x-ray examination as part
of the assessment of your application. You may also be asked to
undergo medical treatment as part of the assessment of the visa
application. The Australian Government reserves the right to
conduct character checks on all adult applicants. Details of your
application are not passed on to your home country.
The Australian Government will pay the costs related to medical
examinations for all humanitarian visa applicants, except visa
applicants in the Community Proposal Pilot. All visa subclasses,
except Global Special Humanitarian (subclass 202) visa holders
and visa holders in the Community Proposal Pilot, will also have
their travel costs paid by the Australian Government.
Note: For applicants in the Community Proposal Pilot, the APO
must pay the costs of medical examinations and, if a visa is
granted, the cost of airfares to Australia.
Review rights
If your application is refused, it is not possible to obtain a review
of the decision by the Administrative Appeals Tribunal.
Settlement services
Immigration assistance
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.
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.
Restrictions on giving immigration assistance, charging fees for
immigration assistance and restrictions on charging fees for
immigration representations apply even where the APO lodges
form 842 (this form) on behalf of a client in the Community
Proposal Pilot.
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.
Application for an
Offshore Humanitarian visa
Form
842
Please use a pen, and write neatly in English using BLOCK LETTERS.
PHOTOGRAPH
Relationship status
A1
Family name
Married legally
Engaged
Widowed
Married by
tradition/custom
De facto
Separated
Divorced
Never married or
been in a defacto
relationship
Married religiously
Given names
Name in own
language or
ethnic script
Sex
Day
Month
Year
Male
Day
Month
Year
Date of birth
Country
Citizenship
No
Yes
Day
Month
Year
Select
No
Yes
1. Family name
Given names
Given names
Name in own
language or
ethnic script
Name in own
language or
ethnic script
Sex
Female
Male
Day
Month
Sex
Day
Month
Year
Date of birth
Town/city
Place of birth
Country
Female
Male
Year
Date of birth
Place of birth
A3
2. Family name
Town/city
Country
Citizenship
Citizenship
Married legally
Engaged
Widowed
Married legally
Engaged
Widowed
Married by
tradition/custom
De facto
Separated
Divorced
Never married or
been in a defacto
relationship
Married by
tradition/custom
De facto
Separated
Divorced
Never married or
been in a defacto
relationship
Married religiously
Married religiously
Relationship to
main applicant
Is this person biologically related to the main applicant?
Relationship to
main applicant
Is this person biologically related to the main applicant?
No
No
Yes
Yes
A4
3. Family name
Given names
Given names
Name in own
language or
ethnic script
Name in own
language or
ethnic script
Sex
Female
Male
Day
Month
Sex
Day
Month
Year
Date of birth
Town/city
Place of birth
Country
Female
Male
Year
Date of birth
Place of birth
A5
4. Family name
Town/city
Country
Citizenship
Citizenship
Married legally
Engaged
Widowed
Married legally
Engaged
Widowed
Married by
tradition/custom
De facto
Separated
Divorced
Never married or
been in a defacto
relationship
Married by
tradition/custom
De facto
Separated
Divorced
Never married or
been in a defacto
relationship
Married religiously
Married religiously
Relationship to
main applicant
Is this person biologically related to the main applicant?
Relationship to
main applicant
Is this person biologically related to the main applicant?
No
No
Yes
Yes
A6
5. Family name
Given names
Given names
Name in own
language or
ethnic script
Name in own
language or
ethnic script
Sex
Female
Male
Day
Month
Sex
Day
Month
Year
Date of birth
Town/city
Place of birth
Country
Female
Male
Year
Date of birth
Place of birth
A7
6. Family name
Town/city
Country
Citizenship
Citizenship
Married legally
Engaged
Widowed
Married legally
Engaged
Widowed
Married by
tradition/custom
De facto
Separated
Divorced
Never married or
been in a defacto
relationship
Married by
tradition/custom
De facto
Separated
Divorced
Never married or
been in a defacto
relationship
Married religiously
Married religiously
Relationship to
main applicant
Is this person biologically related to the main applicant?
Relationship to
main applicant
Is this person biologically related to the main applicant?
No
No
Yes
Yes
If you need more space, please attach a separate page with the details
Attach evidence of identity of each person included in this application
(eg. certified copies of birth certificates, marriage certificates,
passport, national identity card)
Give details
Name
Country of mandate
Name
Country of registration
Give details
Country code
Fax number
Postal code
) (
Area code
Number
)
Email address
Note: If you wish to nominate a person other than yourself to receive
written communications about this application, you must indicate this at
Part M.
Postal code
Telephone
number
) (
Area code
Number
)
Mobile/cell
3. Family name
Given names
No
Yes
Day
Dates of
relationship
Month
Year
From
To
How did the relationship end?
1. Family name
Given names
Day
Dates of
relationship
Month
Year
From
If you need more space, please attach a separate page with the details
To
How did the relationship end?
Given names
Previous partners full name
Day
Month
Year
From
To
How did the relationship end?
Yes
2. Family name
Dates of
relationship
10 Are there any children included in this application who are not the
biological children of either you (the main applicant) or your partner?
3. Family name
No
Given names
Yes
Day
Month
Year
Date of birth
1. Family name
Relationship
to you
Full name of biological father
Given names
Day
Month
Year
Date of birth
Full name of biological mother
Relationship
to you
Full name of biological father
Month
Year
If you need more space, please attach a separate page with the details
Date custody commenced
Day
Month
Year
2. Family name
Given names
Day
Month
Year
Date of birth
Relationship
to you
Full name of biological father
Month
Year
No
Yes
Give details and explain when and where you were last
in contact with them
1. Family name
1. Family name
Given names
Given names
Date of birth
Day
Day
Month
Year
Month
Year
Relationship
to you
Last contact (when, where and how you were separated)
Date of birth
Relationship
to you
Reason they are not applying with you
Postal code
2. Family name
Given names
2. Family name
Day
Month
Year
Given names
Date of birth
Day
Relationship
to you
Reason they are not applying with you
Month
Year
Date of birth
Relationship
to you
Last contact (when, where and how you were separated)
3. Family name
Given names
Day
Month
Year
Postal code
Date of birth
Relationship
to you
Reason they are not applying with you
3. Family name
Given names
Day
Month
Year
Date of birth
Relationship
to you
Last contact (when, where and how you were separated)
If you need more space, please attach a separate page with the details
Postal code
If you need more space, please attach a separate page with the details
Name
Sex
M/F
Date of birth
Day
Month
Year
Your parents
Relationship
status
(use codes
on right)
Relationship
to main
applicant
(use codes
on right)
Status in
country of
residence
(use codes
on right)
Select
Select
Select
Select
Select
Select
Select
Select
Your non-dependent children (all children who are not included as dependants in this application)
If you need more space, please attach a separate page listing further names
COMMONWEALTH OF AUSTRALIA, 2016
Name
Sex
M/F
Date of birth
Day
Month
Year
Relationship
status
(use codes
on right)
Relationship
to main
applicant
(use codes
on right)
Status in
country of
residence
(use codes
on right)
Select
Select
Select
Select
Select
Select
Select
Select
Your partners non-dependent children (all children who are not included as dependants in this application)
If you need more space, please attach a separate page listing further names
842 (Design date 07/16) - Page 16
Give details
Date of application
Day
Month
File number
(if known)
Year
Application approved?
No Yes Not decided
If you need more space, please attach a separate page with the details
16 Do you or your partner have any relatives NOT INCLUDED IN THIS VISA APPLICATION who have current Australian visa applications under consideration?
No
Yes
Give details
Date of application
Day
Month
Year
File number
(if known)
If you need more space, please attach a separate page with the details
17 Is any person included in this application being proposed (on form 681 or form 1417) for entry to Australia by a person or organisation in Australia?
No
Yes
Give details of your proposer or Approved Proposing Organisation (in case of a Community Proposal Pilot application)
Family name
Given names
OR
Organisation name
Contact person
Relationship of the
proposer to you
Address of proposer
Postcode
Telephone number
(Area code
Note: Proposers in the Global Special Humanitarian (subclass 202) programme must complete form 681 Refugee and Special Humanitarian
Proposal and lodge both form 681 and this form (form 842) together. There is no charge for lodging or processing form 681.
Note: APOs under the Community Proposal Pilot must complete form 1417 Proposal for refugee and special humanitarian entrants by
Approved Proposing Organisation and lodge both form 1417 and this form (form 842) together. For charges associated with lodging and
processing form 1417, refer to the Visa Pricing Table www.border.gov.au/trav/visa/fees
These forms are available from the departments website www.border.gov.au
Give details of the immediate family member who was granted the visa
Family name
Given names
File number (if known)
Name of the person in this
application they are related to
Relationship
Where did they last live together?
Day
Month
Year
Attach a completed form 681 Refugee and Special Humanitarian Proposal to this application (there is no charge
for lodging or processing form 681)
Your proposer should complete form 681 for lodgement with this visa application. Form 681 is available from
any office of the department, or from the departments website www.border.gov.au
Attach a certified copy of the immediate family members Australian visa and evidence of the relationship
(eg. a marriage certificate, birth certificate etc.) if available
Provide details of humanitarian claims at Part G, Questions 24 36
19 Do any people included in this application have any other relatives residing in Australia?
No
Yes
Give details
Select
Details of the relative in Australia
Date of birth
Name
Day
Month
Year
Relationship
status in
Australia
Address
Given names
Relationship to applicant
(use codes
below)
1.
2.
3.
4.
5.
If you need more space, please attach a separate page with the details
20 Do any people included in this application have any other past or present links to Australia?
No
Yes
Education
Employment
Business
Friend
Other
Details
A3 Given names
Yes
Give details
Select
Type of document
A1 Main applicant
Passport number
No
Country of issue
Yes
Give details
Day
Select
Month
Year
Date of issue
Type of document
(use codes below)
Date of expiry
Passport number
Country of issue
Day
Month
Year
Date of issue
A4 Given names
Date of expiry
Issuing authority/place of issue as shown in passport (or other document)
Yes
Give details
Select
Type of document
Other applicants
Passport number
A2 Given names
Yes
Give details
Country of issue
Day
Month
Year
Date of issue
Select
Date of expiry
Type of document
(use codes below)
Passport number
(or document number)
Country of issue
Day
Month
Year
A5 Given names
Date of issue
Date of expiry
Issuing authority/place of issue as shown in passport (or other document)
No
Yes
Give details
Select
Type of document
(use codes below)
Passport number
(or document number)
Country of issue
Day
Month
Year
Date of issue
Date of expiry
Issuing authority/place of issue as shown in passport (or other document)
Type of document codes
P = Passport
UN = UN Convention travel document or Titre de voyage
A = Alien/Asylum Registration Card
CI = Certificate or document of identity
S = Seafarer identity document
NIC = National identity card
842 (Design date 07/16) - Page 20
A6 Given names
Yes
Give details
Select
Type of document
(use codes below)
Passport number
(or document number)
Country of issue
Day
Month
Year
Date of issue
Date of expiry
Issuing authority/place of issue as shown in passport (or other document)
A7 Given names
Yes
Give details
Select
Type of document
(use codes below)
Passport number
(or document number)
Country of issue
Day
Month
Year
Date of issue
Date of expiry
Issuing authority/place of issue as shown in passport (or other document)
If you need more space, please attach a separate page with the details
Attach certified copies of the travel documents and identity
documents, if available
22 Has any person included in this application applied to migrate to another country, or applied for refugee resettlement or asylum in any country?
No
Yes
Give details
Date of application
Day
Month
Which country?
Year
Type of application
(eg. refugee resettlement,
migration, asylum etc.)
Application approved?
No Yes Not decided
If you need more space, please attach a separate page with the details
23 For EACH person included in this application list every address where they have lived during the last 10 years
Address where you are living now
Town
Month
1.
From
To
Country
2.
From
To
Town
Country
3.
From
To
Town
Country
4.
From
To
Town
Country
5.
From
To
Town
Country
Year
Country
Previous addresses
Town
Year
24 For ALL the people included in this application list the ethnic group to which they belong, their religion and any political party/group to which they belong
Given names
A1
Main applicant
Other applicants
A2
A3
A4
A5
A6
A7
If you need more space, please attach a separate page with the details
COMMONWEALTH OF AUSTRALIA, 2016
25 What is the name of the country you fear living in or returning to?
Month
Year
27 Why do you fear living in or returning to the country you listed at Question 25?
Your answer should pay special attention to what happened to you, not the general situation in that country.
If you need more space, please attach a separate page with the details
842 (Design date 07/16) - Page 24
28 If you have left the country you fear, how did you leave?
Legally
Illegally
29 What do you believe may happen to you, or the people included in your application, if you were to return to or continue living in that country?
You should give full details of what you think may happen to you and reasons why that would happen
If you need more space, please attach a separate page with the details
30 Who do you think may harm or mistreat you if you continue living in or go back to that country?
If you need more space, please attach a separate page with the details
COMMONWEALTH OF AUSTRALIA, 2016
31 Do you think the authorities of that country can and will protect you if you continue living in or return to that country?
No
Yes
32 Did you travel through, or stay, in any other countries before arriving in the country where you are now living?
No
Yes
From
Day
Month
To
Year
Day
Month
Year
33 Has this application been lodged based on the United Nations High Commissioner for Refugees (UNHCR) referring you to Australia for refugee resettlement?
No
Yes
34 Has any person included in this application served in a military organisation (army/airforce/navy) or in a paramilitary organisation?
No
Yes
Give details
1. Given name
2. Given name
Country served
Country served
Rank in this
organisation
Rank in this
organisation
Dates of
membership
of this
organisation
Day
Month
Year
Dates of
membership
of this
organisation
From
To
Why did this person leave this organisation?
Day
Month
Year
From
To
If you need more space, please attach a separate page with the details
Attach certified copies of any discharge papers if available
35 Has any person included in this application ever lived in a refugee camp, collective accommodation centre for refugees, or detention centre?
No
Yes
Give details
Name of camp/centre
Location
1.
Day
Month
Year
From
To
2.
From
To
3.
From
To
4.
From
To
5.
From
To
6.
From
To
If you need more space, please attach a separate page with the details
36 If selected for an interview about your application, will you need an interpreter?
No
Yes
Which language(s)?
If you are selected for an interview we will advise you if you are required to provide your own interpreter
A1
Month
Year
Name of employer
Location of employer
Main applicant
From
To
From
To
From
To
From
To
From
To
From
To
Other applicants
A2
Name
From
To
From
To
From
To
From
To
From
To
A3
Name
From
To
From
To
From
To
A4
Name
From
To
From
To
From
To
Type of business
(Question 37 continued)
Dates of employment
Day
A5
Month
Year
Name of employer
Location of employer
Type of business
Name
From
To
From
To
From
To
From
To
A6
Name
From
To
From
To
From
To
From
To
A7
Name
From
To
From
To
From
To
From
To
Name
From
To
From
To
From
To
Name
From
To
From
To
From
To
If you need more space, please attach a separate page with the details
COMMONWEALTH OF AUSTRALIA, 2016
Select
A1
Main applicant
Other applicants
A2
A3
A4
A5
A6
A7
If you need more space, please attach a separate page with the details
39 For EACH person included in this application, give details of their education
Primary school
Given names
Day
A1
Main applicant
Month
Secondary school
Year
Day
Month
Post-secondary education
Year
Day
From
From
From
To
To
To
From
From
From
To
To
To
From
From
From
To
To
To
From
From
From
To
To
To
From
From
From
To
To
To
From
From
From
To
To
To
From
From
From
To
To
To
From
From
From
To
To
To
From
From
From
To
To
To
Month
Year
Highest educational
qualification obtained
(eg. school certificate, electrician
certificate, BA, PhD)
Other applicants
A2
A3
A4
A5
A6
A7
If you need more space, please attach a separate page with the details
English language codes
1 = Very well (eg. can speak English with little hesitation and few errors in most situations)
2 = Well (eg. can speak English well enough to deal with basic social and work situations)
3 = Not well (eg. can speak only a little English)
4 = Not at all
842 (Design date 07/16) - Page 30
Part J Health
40 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
If you answered Yes to any of the questions at Question 41, provide all
details below. If the matters relate to a criminal conviction, please give
the nature of the offence, full details of sentence and dates of any period
of imprisonment or other detention.
No
Yes
Part K Character
41 Has any person included in this application ever:
been charged with any offence that is
currently awaiting legal action?
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
If you need more space, please attach a separate page with the details
No
Go to Part M
Yes
Title:
Mrs
Mr
Miss
Ms
Myself
OR
Other
Proposer
Family name
OR
Given names
Authorised
recipient
Organisation
Address
OR
Migration agent
OR
Postcode
Exempt person
Office hours
Area code
) (
Number
)
Mobile/cell
43 Is the person an agent registered with the Office of the Migration Agents
Registration Authority (Office of the MARA)?
No
Yes
Go to Part M
Go to Part M
Yes
45 Did you pay the person/agent and/or give a gift for this assistance?
No
Yes
Signature
of main
applicant
Signature of
dependent
applicant
Name
Signature of
dependent
applicant
Name
Signature of
dependent
applicant
Name
Signature of
dependent
applicant
Name
Signature of
dependent
applicant
Name
Signature of
dependent
applicant
Name
Signature of
dependent
applicant
Name
Signature
or mark of
applicant
Day
Month
Year
Month
Year
Date
Signature
or mark of
partner
(if applicable)
Day
Date
Signatures of persons aged 16 years or over who are included in this
application (if applicable)
Signature
or mark
Day
Month
Year
Month
Year
Month
Year
Month
Year
Month
Year
Month
Year
Date
Signature
or mark
Day
Date
Signature
or mark
Day
Date
Signature
or mark
Day
Date
Signature
or mark
Day
Date
Signature
or mark
Day
Date
Part P Declaration
49 This declaration must be signed by you (the main applicant) and ALL
persons aged 18 or over included in this application.
I declare that:
the information I have supplied on and with this form is complete,
correct and up-to-date in every detail.
I did not marry or enter a de facto relationship to become eligible for
entry to Australia.
I understand that if I have given false or misleading information, my
application may be refused, or, if a visa has been granted, the visa
may be cancelled and I could be removed from Australia.
I understand that if I am granted a visa, any person not included in
this application will not have automatic right of entry to Australia by
way of this application.
I undertake to inform the Australian Government of any material
changes to my circumstances while my application is being
considered, or before I am immigration cleared.
(Note: Your visa may be cancelled and you could be removed if you
do not advise of changes in circumstances).
I authorise the Australian Government to make any enquiries
necessary to determine my eligibility for entry to Australia, and to use
any information supplied in this application for that purpose.
I understand that unless my qualifications have already been
recognised by an Australian assessing authority before my departure,
they may not be recognised after my arrival.
I understand that it is my personal responsibility to assess my own
employment prospects in Australia and acknowledge that labour
market conditions there can vary significantly from time to time and
between regions.
I understand that grant of a visa provides no guarantee of
employment once in Australia.
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 information collected in the visa process may be
disclosed to other agencies and contracted service providers for the
purposes of evaluating my settlement needs and providing
settlement support.
For applicants applying in the Community Proposal Pilot:
I understand that my Approved Proposing Organisation will be
lodging this application on my behalf; and
I understand that the information that I provide in this form may be
shared with my Approved Proposing Organisation and that my
Approved Proposing Organisation may also share this information
with any Supporting Community Organisations it works with in order
to provide services to help me settle in Australia.
Signature
or mark of
applicant
Day
Month
Year
Month
Year
Date
Signature
or mark of
partner
(if applicable)
Day
Date
Signatures of persons aged 18 years or over who are included in this
application (if applicable)
Signature
or mark
Day
Month
Year
Month
Year
Month
Year
Month
Year
Month
Year
Month
Year
Date
Signature
or mark
Day
Date
Signature
or mark
Day
Date
Signature
or mark
Day
Date
Signature
or mark
Day
Date
Signature
or mark
Day
Date
Important: If your circumstances change after you lodge this application (eg. you change your address, marry or become engaged to be married, or have
a baby), you must notify the office where you lodge this application. If your application is supported by a proposal form 681 Refugee and special
humanitarian proposal or form 1417 Proposal for refugee and special humanitarian entrants by Approved Proposing Organisations and your proposers
circumstances change after you have lodged this application, you should also notify the office where you lodge this application.
COMMONWEALTH OF AUSTRALIA, 2016
Question
Document
Q21
OR
A statement explaining why you have no
travel/identity documents
Q23
Q27
Q33
Q34
Document
Eight (8) recent passport size photographs of
each person included in your application,
with the full name of the person written
on the back of each photograph
Q2 & 3
Q4
Q8
Q9
Q10
Q17
Q18
Attached?
Attached?