Local Contact's Name:
Relation with the Contact:
Contact's Address
Contact's Phone Number
Contact's Email:
Have you ever lost a passport or had one stolen?
Certified Health Exam:
Enter HAP ID:
Health Insurance By:
Policy Number:
Health Insurance - From:
Health Insurance - To:
"Has the applicant, or any person included in this application, held or currently hold a visa to Australia or any other country?
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"Has the applicant, or any person included in this application, ever been in Australia or any other country and not complied with visa conditions or departed outside their authorized period of stay?
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"Has the applicant, or any person included in this application, ever had an application for entry or further stay in Australia or any other country refused, or had a visa cancelled?
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"In the last five years, has any applicant visited, or lived, outside their country of passport, for more than 3 consecutive months? Do not include time spent in Australia?
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"Does any applicant intend to work as, or study to be a doctor, dentist, nurse or paramedic during their stay in Australia?
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"Does any applicant intend to work or be a trainee at a child care centre (including preschools and creches) while in Australia?
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"Ever had, or currently have, tuberculosis?
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"Been in close contact with a family member that has active tuberculosis?
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"Ever had a chest x-ray which showed an abnormality?
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"Does any applicant require assistance with mobility or care due to a medical condition?
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"Has any applicant ever been charged with any offence that is currently awaiting legal action?
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"Has any applicant ever been convicted of an offence in any country (including any conviction which is now removed from official records)?
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"Has any applicant ever been the subject of an arrest warrant or Interpol notice?
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"Has any applicant ever been found guilty of a sexually based offence involving a child (including where no conviction was recorded)?
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"Has any applicant ever been named on a sex offender register?
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"Has any applicant ever been acquitted of any offence on the grounds of unsoundness of mind or insanity?
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"Has any applicant ever been found by a court not fit to plead?
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"Has any applicant ever been directly or indirectly involved in, or associated with, activities which would represent a risk to national security in Australia or any other country?
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"Has any applicant ever 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?
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"Has any applicant ever been associated with a person, group or organisation that has been or is involved in criminal conduct?
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"Has any applicant ever been associated with an organisation engaged in violence or engaged in acts of violence (including war, insurgency, freedom fighting, terrorism, and protest) either overseas or in Australia?
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"Has any applicant ever served in a military force, police force, state sponsored / private militia or intelligence agency (including secret police)?
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"Has any applicant ever undergone any military/paramilitary training, been trained in weapons/ explosives or in the manufacture of chemical/biological products?
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"Has any applicant ever been involved in people smuggling or people trafficking offences?
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"Has any applicant ever been removed, deported or excluded from any country (including Australia)?
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"Has any applicant ever overstayed a visa in any country (including Australia)?
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"Has any applicant ever had any outstanding debts to the Australian Government or any public authority in Australia?