Nomination of Student Dependants: About This Form
Nomination of Student Dependants: About This Form
Nomination of Student Dependants: About This Form
919
evidence of payment of the Overseas Student Health Cover premium in favour of each nominated family unit member. Where stated, original documents must be provided. Where copies of original documents are required, the copies must be certified copies. In Australia, a certified copy is one certified by a Justice of the Peace or a Commissioner for Declarations or a person before whom a statutory declaration may be made under the Statutory Declarations Act 1959.
Charges
Your dependant(s)s completed student visa application form, together with the correct Visa Application Charge and this nomination, can be lodged at an Australian mission overseas. The Visa Application Charge is not refundable. Fees may be subject to adjustment at any time. Visa Application Charges may be subject to adjustment on 1 July each year. This may increase the cost of a visa. You can check the Visa Application Charge with your nearest office of the Department of Immigration and Citizenship (the department) in Australia, or from form 990i Charges, which is available from the departments website www.immi.gov.au/allforms/
How to nominate
Complete this form and send it, along with the documents you are required to provide, to your dependant(s) overseas. Your dependant(s) should complete form 157A Application for a student visa and lodge it, together with this form 919 Nomination of student dependants and the documents you have provided, at an Australian mission overseas.
Integrity of nomination
The department is committed to maintaining the integrity of the visa and citizenship programs. Please be aware that if you provide us with fraudulent documents or claims, this may result in processing delays and possibly your nomination being refused.
In addition, the relevant registered education provider(s) may be told whether or not your visa has been granted. The collection, access, storage, use and disclosure by the department of the information you provide in this form is governed by the Privacy Act 1988 and, in particular, by the 11 Information Privacy Principles. The information form 993i Safeguarding your personal information gives details of agencies to which your personal information might be disclosed. This form is available from the departments website www.immi.gov.au/allforms/ or from any office of the department or Australian mission overseas. The department is authorised under the Migration Act 1958, in certain circumstances, to collect a range of personal identifiers including a facial image, fingerprints and a signature from noncitizens, including from visa applicants. The department requires personal identifiers to assist in assessing your identity. The department is authorised to disclose your personal identifiers and information relating to your name and other relevant biographical data to a number of agencies including law enforcement and health agencies and to other agencies who may need to check your identity with this department. Where the department obtains personal identifiers they will become part of your official record with the department. The department is involved in international information exchanges with a number of countries, including the United Kingdom, the United States of America, Canada and New Zealand. These international information exchanges may involve the sharing of personal identifiers, including facial images and fingerprint data, collected by immigration agencies such as this department. If, as a result of this sharing between countries, there is a match with your personal identifiers, the department will disclose your biographical data, copies of travel and other identity documents or information from such documents, your immigration status and immigration history (which may include any immigration abuse and offences) and any criminal history information relevant to immigration purposes. The purpose of such disclosure would be to help confirm your identity and determine if you have presented to the department and the other agency under the same identity and with similar claims. For more detailed information you should read information form 1243i Your personal identifying information, which is available from the departments website www.immi.gov.au/allforms/ or from any office of the department or Australian mission overseas.
Home page www.immi.gov.au General Telephone 131 881 during business hours enquiry line in Australia to speak to an operator (recorded
information available outside these hours). If you are outside Australia, please contact your nearest Australian mission.
Form
919
Please use a pen, and write neatly in English using BLOCK LETTERS. Tick where applicable
Your details
1
Your family name in English Family name Given names
10 Relationship status
Married Engaged De facto Separated Divorced Widowed Never married or been in a de facto relationship
2 3 4
Male
DAY
Female
MONTH YEAR
Citizenship/Nationality
Address for correspondence (If the same as your residential address, write AS ABOVE)
POSTCODE
Country of issue
Do you agree to the department communicating with you by fax, e-mail or other electronic means? No Yes Fax number E-mail address Note: If this application is refused, you will be notified by mail Give details
(AREA CODE )
DAY
MONTH
YEAR
Date of issue
2. Name in English Ethnic script Relationship to you Date of birth (DAY/MONTH/YEAR) Place of birth Citizenship/ Nationality Is evidence of your relationship attached? 3. Name in English Ethnic script Relationship to you Date of birth (DAY/MONTH/YEAR) Place of birth Citizenship/ Nationality No Yes
Course duration
DAY
MONTH
YEAR
DAY
MONTH
YEAR
to
17 Do you have:
adequate means to support yourself and your dependants? No Yes You may be asked to provide supporting documents
Is evidence of your relationship attached? 4. Name in English Ethnic script Relationship to you Date of birth (DAY/MONTH/YEAR) Place of birth Citizenship/ Nationality Is evidence of your relationship attached? 5. Name in English Ethnic script Relationship to you Date of birth (DAY/MONTH/YEAR) Place of birth Citizenship/ Nationality Is evidence of your relationship attached?
No
Yes
obtained health cover for your dependants? No Yes Please provide evidence
enrolled any school aged dependants (that is, children who are unmarried and who have turned 5 years of age, but have not yet turned 18 years of age) who are included in this nomination, in a school in Australia? No Yes Please provide evidence of enrolment, including details of any school fees
No
Yes
(Members of your family unit may include your partner and any dependent children of you or your partner who are unmarried and have not turned 18.)
1. Name in English Ethnic script Relationship to you Date of birth (DAY/MONTH/YEAR) Place of birth Citizenship/ Nationality Is evidence of your relationship attached?
919 (Design date 04/12) - Page 4
No
Yes
No
Yes
COMMONWEALTH OF AUSTRALIA, 2012
Declaration
WARNING: Giving false or misleading information is a serious offence.
25 I declare that the information supplied on and with this nomination form
is complete, true and correct in every particular.
POSTCODE
Ethnic script
Your signature
DAY
MONTH
YEAR
Date
POSTCODE
We strongly advise that you keep a copy of this nomination and all attachments for your records.
) (
POSTCODE
24 Did you pay the person/agent and/or give a gift for this assistance?
No Yes