1、1419 CHS (Design date 12/14) - Page 5 COMMONWEALTH OF AUSTRALIA, 2014 Form 1419 CHS CHINESE SIMPLIFIED Application for a Visitor visa Tourist stream 访问者签证申请表旅游者细类 3 Tick where applicable Please use a pen, and write neatly in English using BLOCK LETTERS. 3 在适合的选项打勾 请使用钢笔，用英语的大写字母工整填写。 Up to 3 months
2、不超过三个月 Up to 6 months 不超过六个月 How long do you wish to stay in Australia? 你想在澳大利亚逗留多长时间？ 3 Up to 12 months 不超过十二个月 Note: The stay period granted may be less than the period requested. You should check the terms of any visa granted. 注：获得批准的居留期可能短于所要求的居留期。你应该核 对签证中批准的期限。 PHOTOGRAPH Please attach a recen
3、t passport size photograph of yourself. 照片 请附上你本人近 期的护照尺寸的 照片。 Outside Australia 澳大利亚境外 In Australia 在澳大利亚境内 Indicate if you are applying outside Australia or in Australia: 标明你是在澳大利亚境外还是在境内申请： 1 Go to Question 2 请转到问题 2 Go to Question 5 请转到问题 5 When do you wish to visit Australia? 你打算在什么时候访问澳大利亚？ 2
4、DAY 日 MONTH 月 YEAR 年 Applicants outside Australia 澳大利亚境外的申请人 Give details 请详述 No 否 Yes 是 Do you intend to enter Australia on more than one occasion? 你打算多次进入澳大利亚吗? 4 Go to Question 7 请转到问题 7 Go to Question 7 请转到问题 7 Specify the date you wish to extend your stay to 请具体说明你希望延长 逗留至哪一天 5 Applicants in Au
5、stralia 澳大利亚境内的申请人 Provide detailed reasons for requesting this further stay 请提供要求继续逗留的详细理由。 6 Date 日期 to 至 from 自 DAY 日 MONTH 月 YEAR 年1419 CHS (Design date 12/14) - Page 6 COMMONWEALTH OF AUSTRALIA, 2014 10 Are you or have you been known by any other name? (including name at birth, previous married
6、 names, aliases) 你目前或以前是否有其他名字？ (包括出生时的名字、婚前的名字和别名） Give details 请详述 No 否 Yes 是 Note: If this visa application is approved, your current visa may cease. 注：如果此签证申请获得批准，你现有的签证可能 会中止。 Yes 是 Do you currently hold an Australian visa? 你目前是否持有澳大利亚的签证？ 11 12 Have you applied for a Parent (subclass 103) visa
7、? 你是否曾申请父母（103细类）签证？ Please provide your queue date 请提供你的排队日期 是 Yes List countries 列出这些国家 Are you a citizen of any other country? 你是任何其他国家的公民吗？ 14 13 Do you currently hold, or have you applied for, an APEC Business Travel Card (ABTC)? 你目前是否持有或已申请APEC商务旅行卡（ABTC）？ Note: If this visa application is app
8、roved, the Australian visa associated with your ABTC will cease. 注：如果本签证申请获得批准，跟你的ABTC有关的 澳大利亚签证就会中止。 8 Place of birth 出生地 市/镇 Town/city State/province 州/省 Country 国家 9 Relationship status 婚姻状况 Married 已婚 De facto 事实婚姻 Engaged 已订婚 Divorced 离婚 Separated 分居 Widowed 鳏居或 寡居 Never married or been in a de
9、 facto relationship 从未结婚或同居 Date of birth 出生日期 护照号码 Passport number 护照颁发国 Country of passport Nationality of passport holder 护照持有人的 国籍 Date of issue 颁发日期 Date of expiry 失效日期 Place of issue/ issuing authority 签发地点/ 签发机关 Part A Your details A 部份 你的细节 Give the following details exactly as they appear i
10、n your passport Make sure your passport is valid for the period of stay you are applying for. 请提供以下详细资料，这些资料必须跟你的护照完全相同。 请确保你的护照在你申请逗留的期间仍然有效。 7 姓 Family name Given names 名 Sex 性别 Male 男 Female 女 是 Yes Yes 是 No 否 No 否 No 否 No 否 DAY 日 MONTH 月 YEAR 年 DAY 日 MONTH 月 YEAR 年 DAY 日 MONTH 月 YEAR 年 Give deta
11、ils 请详述 Do you have other current passports? 你目前还有其他护照吗？ 15 Passport number 护照号码 Country of passport 颁发护照的国家 是 Yes No 否1419 CHS (Design date 12/14) - Page 7 COMMONWEALTH OF AUSTRALIA, 2014 Type of document 文件类型 Identity number 身份编号 Country of issue 颁发国家 23 Do you agree to the department communicatin
12、g with you by email and/or fax? This may include receiving notification of the outcome of this application. Note: We can communicate about this application more quickly using email and/or fax. 你是否同意移民部通过电子邮件和/或传真跟你沟通？ 这可能包括本申请结果的通知书。 注：通过电子邮件和/或传真，我们可以更快地进行有关这项 申请的沟通。 Fax number 传真号码 Email address 电
13、子邮箱 ( ) ( ) COUNTRY CODE AREA CODE NUMBER 20 POSTCODE 邮政编码 Your current residential address Note: A street address is required as a post office box address cannot be accepted. 你目前的住址 注：要求提供街道住址；邮政信箱不能被接受。 21 Address for correspondence (If the same as your residential address, write AS ABOVE) 通讯地址 (如
14、果与住址相同，请写“同上”） Country Country 国家 国家 22 Contact telephone numbers 联系电话 Home 家庭电话 ( ) ( ) COUNTRY CODE AREA CODE NUMBER 国家代码 地区代码 号码 Office 办公电话 ( ) ( ) Mobile/cell 手机 POSTCODE 邮政编码 Do you hold an identity card or identity number issued to you by your government (eg. National identity card) (if appli
15、cable)? Note: If you are the holder of multiple identity numbers because you are a citizen of more than one country, you need to enter the identity number on the card from the country that you live in. 你是否有政府颁发给你的身份证或身份编号（例如全国通用 身份证）(若有的话)？ 注意：如果你拥有多重国籍，所以有多个身份编号，那么必 须填写目前所居住国家的身份编号。 16 Family name
16、姓 Given names 名 Give details 请详述 No 否 Yes 是 Give details 请详述 No 否 Yes 是 国家代码 地区代码 号码 19 What is the purpose of your stay in your current location and what is your visa status? 您住在目前所在的地方的目的是什么，持有什么签证？ 17 In what country are you currently located? 您目前在哪个国家？ Give details 请详述 18 What is your legal stat
17、us in your current location? 您在目前所在的地方有何种法律地位？ Citizen 公民 Visitor 访问者 Work visa 工作签证 Other 其他 Permanent resident 永久居民 Student 学生 No legal status 没有法律地位1419 CHS (Design date 12/14) - Page 8 COMMONWEALTH OF AUSTRALIA, 2014 Are you travelling to, or are you currently in, Australia with any family membe
18、rs? 你是否有任何家庭成员跟你一起到澳大利亚，或者目前跟你一起在澳大利亚？ 24 Full name Relationship to you Name of sponsor (if applicable) 请提供每个家庭成员的详细资料。 所有的申请务必同时递交。 Give details of each family member Make sure all the applications are lodged at the same time. Part B Family travelling to Australia with you B 部分 - 跟你一起到澳大利亚的家人 Do yo
19、u have a partner, any children, or fianc who will NOT be travelling, or has NOT travelled, to Australia with you? 你是否有伴侣、子女或未婚伴侣不会跟你一起去澳大利亚，或者没有跟你一起来到澳大利亚？ 25 Full name Date of birth Relationship to you Their address while you are in AustraliaDAY MONTH YEAR / / / / / Part C Family NOT travelling to
20、Australia with you C 部分 - 不跟你一起到澳大利亚的家人 If insufficient space, give details at Part O 如果没有足够的空间，请把详细资料填在O部分。 If insufficient space, give details at Part O 如果没有足够的空间，请把详细资料填在O部分。 是 Yes Give details 请详述 No 否 Yes 是 No 否 全名 与你的关系 担保人姓名（如果有的话） 全名 与你的关系 当你在澳大利亚的时候，他们的住址 出生日期 日 月 年1419 CHS (Design date 12/
21、14) - Page 9 COMMONWEALTH OF AUSTRALIA, 2014 Do you have any relatives in Australia? 27 Full name Date of birth Relationship to you Address Citizen or permanent resident of AustraliaDAY MONTH YEAR 日 月 年/ / / / / Full name Date of birth Relationship to you Address Citizen or permanent resident of Aus
22、traliaDAY MONTH YEAR 日 月 年/ / / / / If insufficient space, give details at Part O If insufficient space, give details at Part O 如果没有足够的空间，请把详细资料填在O部分。 如果没有足够的空间，请把详细资料填在O部分。 Do you have any friends or contacts in Australia? 28 No 否 Yes 是 Give details 请详述 No 否 Yes 是 你在澳大利亚是否有任何亲戚? 你在澳大利亚是否有任何朋友或联系人？
23、Give details 请详述 No 否 Yes 是 No 否 Yes 是 No 否 Yes 是 No 否 Yes 是 No 否 Yes 是 No 否 Yes 是 No 否 Yes 是 No 否 Yes 是 Is it likely you will be travelling from Australia to any other country (eg. New Zealand, Singapore, Papua New Guinea) and back to Australia? 你是否有可能从澳大利亚旅行到其他国家（例如新西兰、新加坡、巴布亚新几内亚)，然后再回到澳大利亚？ 26 A
24、ttach itinerary details 请附上行程的细节 Part D Details of your visit to Australia D 部份 - 你访澳的细节 是 Yes No 否 全名 与你的关系 地址 出生日期 澳大利亚公民 或永久居民 全名 与你的关系 地址 出生日期 澳大利亚公民 或永久居民1419 CHS (Design date 12/14) - Page 10 COMMONWEALTH OF AUSTRALIA, 2014 30 Do you intend to do a course of study while in Australia? 你在澳大利亚期间是
25、否打算学习某门课程？ Name of the course 课程名称 Name of the institution 教育机构 名称 How long will the course last? 该课程必须学多长时间？ In the last 5 years, have you visited or lived outside your country of passport for more than 3 consecutive months? Do not include time spent in Australia. 近5年来，你是否在为你颁发护照的国家之外访问或居住连续 3个月以上？
26、 不包括在澳大利亚境内的时间。 31 Country(s) Country(s) Country(s) 国家 国家 国家 1. 2. 3. Part E Health details E 部分 - 关于健康的细节 If insufficient space, give details at Part O 如果没有足够的空间，请把详细资料填在O部分。 32 Do you intend to enter a hospital or health care facility (including nursing homes) while in Australia? 你在澳大利亚期间打算住院或者进入某
27、个医疗保健机构 (包括疗养院）吗？ Give details 请详述 No 否 Yes 是 Give details 请详述 No 否 Yes 是 Give details 请详述 No 否 Yes 是 Why do you want to visit Australia? Include details of any dates that are of special significance to your visit. 你为什么要访问澳大利亚？ 请具体说明对于你访问澳大利亚一事特别重要的日期。 29 If insufficient space, give details at Part
28、O 如果没有足够的空间，请把详细资料填在O部分。 Date Date Date 日期 日期 日期 to to to 至 至 至 from from from 从 从 从 DAY DAY DAY 日 日 日 MONTH MONTH MONTH 月 月 月 YEAR YEAR YEAR 年 年 年1419 CHS (Design date 12/14) - Page 11 COMMONWEALTH OF AUSTRALIA, 2014 35 36 Do you require assistance with mobility or care due to a medical condition?
29、你是否因为行动不便而需要协助，或者由于医疗方面的原因 而需要护理？ 37 Have you undertaken a health examination for an Australian visa in the last 12 months? 最近12个月以来，你是否为了申请澳大利亚签证而做过任何 健康检查？ Note: If you are applying for a long stay Visitor visa or are 75 years or over, you will be asked to undergo a health assessment and may be as
30、ked to show that you have medical insurance to cover your intended stay in Australia. Please contact your nearest office of the department for further advice before lodging your application. If additional medical consultations are required, a decision on your visa application will be delayed. 注：如果你申
31、请长期居留访问者签证，或者年龄达到或超 过75岁，你将会被要求接受健康评估，而且可能必须表明 你打算在澳大利亚逗留的期间有医疗保险。在递交申请前， 请就近跟移民部办事处联系，以寻求进一步的建议。如果 需要额外的医疗咨询，那么你的签证申请就有可能被拖延。 kidney disease, including dialysis; mental illness; pregnancy; respiratory disease that has required hospital admission or oxygen therapy other? 肾病，包括透析； 精神疾病； 怀孕； 需要住院治疗或吸氧
32、疗法的 呼吸道疾病； 其他情况。 During your proposed visit to Australia, do you expect to incur medical costs, or require treatment or medical follow up for: 在你打算访问澳大利亚期间，你是否预期会由于下列任何一 种疾病而产生医疗费用，或者需要治疗或医疗随访？ blood disorder; cancer; heart disease; hepatitis B or C and/or liver disease; HIV infection, including AID
33、S; 血液疾病； 癌症； 心脏病； 乙型肝炎、丙型肝炎或 其他肝病； HIV病毒感染，包括艾 滋病； Give details 请详述 No 否 Yes 是 Give details 请详述 No 否 Yes 是 Give details (including HAP ID if available) 请详述(包括 HAP ID 即“健康评估统一编号”， 如果有的话） No 否 Yes 是 33 Do you intend to work as, or study to be, a doctor, dentist, nurse or paramedic during your stay in
34、Australia? 你在澳大利亚逗留期间是否打算当医生、牙医、护士或护理 人员，或者从事以这些职业为目标的学习？ 34 Have you: 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? 你是否有下列情况： 患有或曾经患过肺结核病？ 跟患有活动性肺结核的家庭成员有过密切接触？ 你的胸部X光片曾显示异常？ Gi
35、ve details 请详述 No 否 Yes 是 Give details 请详述 No 否 Yes 是1419 CHS (Design date 12/14) - Page 12 COMMONWEALTH OF AUSTRALIA, 2014 Part F Character details 38 Have you ever: 你是否曾经： F 部分 - 关于品格的细节 been directly or indirectly involved in, or associated with, activities which would represent a risk to nationa
36、l security in Australia or any other country? 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? 直接或间接参与可能给澳大利亚的 国家安全带来风险的活动，或与这 样的活动有关联？ 因为种族灭绝罪、战争罪、反人类罪、 酷刑、奴役或在国际上受到严重关注 的任何其
37、他罪行而被指控或起诉？ 否 是 No Yes 否 是 No Yes been charged with any offence that is currently awaiting legal action? been convicted of an offence in any country (including any conviction which is now removed from official records)? been the subject of an arrest warrant or Interpol notice? been found guilty of a
38、 sexually based offence involving a child (including where no conviction was recorded)? been named on a sex offender register? been acquitted of any offence on the grounds of unsoundness of mind or insanity? 被指控犯法、现正等候法律诉讼？ 在任何国家被判为犯法（包括现已从 官方犯罪记录上删除的任何案底)？ 成为逮捕令或国际刑警通缉的目标？ 被认定涉及儿童的性犯罪（包括没 有留案底者）？ 留
39、有性犯罪的案底？ 因为精神不健全或精神错乱，虽然 犯法但被无罪开释？ 否 是 No Yes 否 是 No Yes 否 是 No Yes 否 是 No Yes 否 是 No Yes 否 是 No Yes been found by a court not fit to plead? 被法院认为不适合辩护？ 否 是 No Yes served in a military force, police force, state sponsored/private militia or intelligence agency (including secret police)? undergone an
40、y military/paramilitary training, been trained in weapons/explosives or in the manufacture of chemical/biological products? 曾在军队、警察部队、国家支持的 或私人的民兵、或情报机构中服役？ 接受过任何军事/准军事训练，或接 受过使用武器/爆炸物或制造化学/ 生物产品的培训？ been associated with a person, group or organisation that has been/is involved in criminal conduct?
41、与涉及犯罪行为的个人、团体或组 织有关联？ 否 是 No Yes 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? 与从事暴力行为的组织有关，或与暴 力行为有关（包括战争、叛乱、自由 斗殴、恐怖活动、抗议），无论是在 海外还是在澳大利亚？ 否 是 No Yes been re
42、moved, deported or excluded from any country (including Australia)? 被任何国家驱逐、驱逐或遣返（包括 澳大利亚）？ overstayed a visa in any country (including Australia)? 在任何国家（包括澳大利亚）签证 逾期？ had any outstanding debts to the Australian Government or any public authority in Australia? 拖欠澳大利亚政府或澳大利亚任何 公共机构债务而仍未归还？ been invol
43、ved in people smuggling or people trafficking offences? 参与人口走私或人口贩运的犯法行为？ 否 是 No Yes 否 是 No Yes 否 是 No Yes 否 是 No Yes 否 是 No Yes 否 是 No Yes1419 CHS (Design date 12/14) - Page 13 COMMONWEALTH OF AUSTRALIA, 2014 G 部分 - 就业状况 Part G Employment status What is your employment status? 你的就业状况如何？ 39 Telephon
44、e number 电话号码 Employed/ self-employed 被他人雇用/ 自我雇用 Give details 请提供细节 Employer/business name 雇主/企业名称 邮政编码 POSTCODE 地址 Address Position you hold 你的职务 How long have you been employed by this employer/business? 你受雇于该雇主/ 企业多久了？ 已退休 Retired 退休的年度 Year of retirement 学生 Student 请提供详细资料 Give details Your cur
45、rent course 你目前学习的课程 教育机构名称 Name of educational institution How long have you been studying at this institution? 你已经在该机构学习多 久了？ 其他 Other 请提供详细资料 Give details Unemployed 失业 Explain why you are unemployed and give details of your last employment (if applicable) 解释你为什么失业，并提供你最后一份工 作的细节（如果有的话） ( ) ( ) C
46、OUNTRY CODE 国家代码 AREA CODE 地区代码 NUMBER 号码 If you answered Yes to any of the questions at Question 38, give ALL relevant details below. 如果你在第38个问题的任何一点回答“是”，那么请在下面提供所有的相关细节。 If insufficient space, give details at Part O 如果没有足够的空间，请把详细资料填在O部分。1419 CHS (Design date 12/14) - Page 14 COMMONWEALTH OF AUST
47、RALIA, 2014 Part H Funding for stay H 部分 - 逗留的资金来源 All visitors to Australia must be able to demonstrate they have adequate funds to cover all costs associated with their visit. Providing evidence of funds will help expedite the processing of a visitor visa application. Examples may include personal
48、 bank statements showing a financial history, pay slips, audited accounts, taxation records or details of funds that visitors will be taking with them or funds that are available to them. Relevant factors may also include the number of persons your are supporting, the type of activities planned and
49、the length of stay sought. 凡是到澳大利亚的访问者，都必须能够证明他们有足够的资金来支付跟他们的访问有关的全部费用。提供资金证明，有助于加快办理 访问者签证申请。例如，资金可以包括显示财务历史的个人银行对账单、工资单、经过审计的账目、税收记录，或者访问者将要随身 携带的资金或者他们能够获得的资金的细节。有关的因素可能还包括有多少人是由你支持的、你打算进行哪种类型的活动以及希望逗 留多长时间。 40 Give details of how you will maintain yourself financially while you are in Australia 请详细说明你在澳大利亚期间如何解决自己的财务问题。 Is your
