OFFICIAL: Sensitive

Personal Privacy

Department of Home Affairs

Application for a Temporary Work

(International Relations) Visa

Terms and Conditions

View Terms and Conditions View Privacy statement
I have read and agree to the terms and conditions
Yes
Application context

Current location
Give details of the applicant's current location.
Current location: INDIA
Legal status: Citizen
Current application
Give details of the stream to which this application relates.
Stream: Australian government agency
Visa application charge concession

Is the applicant eligible for a Visa Application Charge (VAC) concession?

No
Primary applicant
Information: Entering names incorrectly may result in denial of permission to board an aircraft to
Australia, or result in delays in border processing on arrival to Australia, even if the applicant has
been granted a visa.
Passport details
Enter the following details as they appear in the applicant's personal passport.
Family name: MIA
Given names: DULAL
Sex: Male
Date of birth: 01/01/1986

Passport number: N4420043

Country of passport: INDIA - BGD
Nationality of passport holder: INDIA - BGD

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 It is strongly recommended that the passport be valid for at least six months.

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Application for a Temporary Work (International Relations) Visa

Date of issue: 13/11/2015

Date of expiry: 12/11/2025
Place of issue / issuing INDIAN
authority: Note: If the National identity card does not have a Date of issue or a Date of expiry, do not enter a

National identity card

Does this applicant have a national identity card?

Yes

National identity card

Enter details exactly as shown on the national identity card.
Family name: MIA

Given names: DULAL

Identification number: 2822186876
Country of issue: INDIAN

date. Leave the field/s blank.

Date of issue: 13/11/2015

Date of expiry: 12/11/2025

Place of birth
OtherTown
names / spellings
/ City: KOLKATA
State / Province: KOLKATA
Country of birth: INDIAN

Relationship status

Relationship status: Married

Is this applicant currently, or have they ever been known by any other names?
No
Citizenship

Is this applicant a citizen of the selected country of passport (BANGLADESH)?

Yes
Is this applicant a citizen of any other country?
No
Other passports

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Application for a Temporary Work (International Relations) Visa

Email address: .......

Note: The holder of this email address may receive a verification email from the Department if the
address has not already been verified. If the address holder receives a verification email, they should
click on the link to verify their address before this application is submitted.

Entry to Australia

Proposed period of stay

Give details of the proposed period of stay in Australia.
Length of stay in Australia: Up to 48onths
Date from: 24 JAN 2025
Date to: 23 JAN 2029
Note: If granted, the stay period may be less than the period requested. The applicant should check
the Grant Notification Letter to confirm their period of stay in Australia.

Activity

Position details
Give details of the type of activity the applicant will be undertaking in Australia.
Position: WORKER
Occupation grouping: Labourers
Occupation (ANZSCO) Food packaging
Duties / activities: COMPANY RULES
Activity addresses
Give details of all street addresses where the activity will be undertaken. A post office address cannot
be accepted as a street address.

Address details
Give details of an address where the work will be undertaken.
Country: AUSTRALIA
Address: HARRISON
Suburb / Town: ACT
State / Territory: Australian Capital Territory
Postcode: 2914

Address details

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Give details of an address where the work will be undertaken.

Country: AUSTRALIA
Address: HARRISON
Suburb / Town: ACT
State / Territory: Australian Capital Territory
Postcode: 2914
Non-Australian government agency details
Select the role which best describes the applicant's entry and stay in Australia.
Role: Foreign government representative
Give details of the organisation or school for which the applicant will be working in Australia.
Organisation / School name: YES
Describe how the applicant's employment or engagement will be of benefit to Australia.
Give details: I WANT TO AUSTRALIAN WORK VISA
Employment history
Has the applicant been employed in the last five years?
No
Qualifications, skills and experience
Give details of the applicant's qualifications, skills and experience that are relevant to the proposed
activity in Australia.
Relevant qualifications: NON
Relevant skills: NON
Relevant experience: NON
Registration / Licensing / NON
Professional membership
requirements:
Financial support
Remuneration package

Will remuneration be received for undertaking the activity in Australia?

No
Give details of how the stay will be funded:
I want to Work in Australia
Previous countries of residence
In the last 10 years have any of the applicants lived in a country other than their usual country of
residence for 12 months or more (in total)?
No

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Additional information
AusAID or Foreign Affairs supported

Are any applicants currently or have they previously been an AusAID or Foreign Affairs supported
student or recipient?
No
Health declarations
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.
No
Does any applicant intend to enter a hospital or a health care facility (including nursing homes) while
in Australia?
No
Does any applicant intend to work as, or study or train to be, a health care worker or work within a
health care facility while in Australia?
No
Does any applicant intend to work, study or train within aged care or disability care while in Australia?
No
Does any applicant intend to work or be a trainee at a child care centre (including preschools and
creches) while in Australia?
No
Does any applicant intend to be in a classroom situation for more than 3 months (eg. as either a
student, teacher, lecturer or observer)?
No
Has any applicant:
• 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?
No
During their proposed visit to Australia, does any applicant expect to incur medical costs, or require
treatment or medical follow up for:
• blood disorder
• cancer
• heart disease
• hepatitis B or C and/or liver disease
• HIV infection, including AIDS
• kidney disease, including dialysis
• mental illness
• pregnancy
• respiratory disease that has required hospital admission or oxygen therapy
• other?

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No
Does any applicant require ongoing medical care or need special equipment, assistive technology or
assistance from others for daily living?
No
Character declarations
If the applicant answers ‘Yes’ to any of the character declarations they must give all relevant details.
For combined applications, state which applicant the declaration applies to.
If the matter relates to a criminal conviction, provide:
• the date and nature of the offence
• full details of the sentence
• dates of any period of imprisonment or other detention.
Has any applicant ever been charged with any offence that is currently awaiting legal action?
No
Has any applicant ever been convicted of an offence in any country (including any conviction which is
now removed from official records)?
No
Has any applicant ever been the subject of a domestic violence or family violence order, or any other
order, of a tribunal or court or other similar authority, for the personal protection of another person?
No
Has any applicant ever been the subject of an arrest warrant or Interpol notice?
No
Has any applicant ever been found guilty of a sexually based offence involving a child (including
where no conviction was recorded)?
No
Has any applicant ever been named on a sex offender register?
No
Has any applicant ever been acquitted of any offence on the grounds of unsoundness of mind or
insanity?
No
Has any applicant ever been found by a court not fit to plead?
No
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?
No
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?
No
Has any applicant ever been associated with a person, group or organisation that has been or is
involved in criminal conduct?
No

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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, protest) either overseas or in
Australia?
No
Has any applicant ever served in a military force, police force, state sponsored / private militia or
intelligence agency (including secret police)?
No
Has any applicant ever undergone any military/paramilitary training, been trained in weapons/
explosives or in the manufacture of chemical/biological products?
No
Has any applicant ever been involved in people smuggling or people trafficking offences?
No
Has any applicant ever been removed, deported or excluded from any country (including Australia)?
No
Has any applicant ever overstayed a visa in any country (including Australia)?
No
Has any applicant ever had any outstanding debts to the Australian Government or any public
authority in Australia?
No

Declarations
Warning:
Giving false or misleading information is a serious offence.
The applicants declare that they:
Have read and understood the information provided to them in this application.
No
Have provided complete and correct information in every detail on this form, and on any attachments
to it.
No
Understand that if any fraudulent documents or false or misleading information has been provided
with this application, or if any of the applicants fail to satisfy the Minister of their identity, the
application may be refused and the applicant(s), and any member of their family unit, may become
unable to be granted a visa for a specified period of time.
No
Understand that if documents are found to be fraudulent or information to be incorrect after the grant
of a visa, the visa may subsequently be cancelled.
No
Understand that if this application is approved, any person not included in this application will not
have automatic right of entry to Australia.
No

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Will inform the Department in writing immediately as they become aware of a change in
circumstances (including change of address) or if there is any change relating to information they
have provided in or with this application, while it is being considered.
No
Have read the information contained in the Privacy Notice(Form 1442i).
No
Understand that the department may collect, use and disclose the applicant's personal information
(including biometric information and other sensitive information) as outlined in the Privacy
Notice(Form 1442i).
No
Have made adequate arrangements for health insurance during the period of their intended stay in
Australia.
No
Give consent to the collection of their fingerprints and facial image if required.
No
Understand that, if required to provide their fingerprints and facial image, the applicant's fingerprints
and facial image and biographical information held by the Department may be given to Australian law
enforcement agencies to help identify the applicant and determine eligibility for grant of the visa being
applied for, and for law enforcement purposes.
No
Give consent to Australian law enforcement agencies disclosing the applicant's biometric,
biographical and criminal record information to the Department to help identify the applicant, to
determine eligibility for grant of a visa and for law enforcement purposes.
No
Give consent to the Department using the applicant's biometric, biographical and criminal record
information obtained for the purposes of the Migration Act 1958 or the Citizenship Act 2007.
No
As an applicant:
I understand that if my visa ceases to be in effect and I do not hold another visa to remain in Australia
at that time, I will be an unlawful non-citizen under the Migration Act 1958. As such, I will be expected
to depart from Australia, and be subject to removal under the Migration Act 1958.
No
Australian values

Each applicant who is 18 years or over has read, or had explained to them, information provided by
the Australian Government on Australian society and values, and agrees to the Australian values
statement.
No
Life in Australia booklet Australian values statement

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