Anda di halaman 1dari 5

Department of Immigration and Citizenship

Maritime Crew (Subclass ZM 988) Visa

Record of Responses

Applicant details (sea crew member)


Give the following details as they appear in your passport. Family name Given names Sex Date of birth Relationship status Place of birth Town/City Country of birth Country of residence Select your country of usual residence from the list provided. You will be asked later in this application to provide your full residential address in this country. Country of residence Passport details Provide details of the passport that you will use to enter Australia. Enter these details exactly as they appear in your passport. Passport number Country of passport Passport nationality Passport date of issue Passport date of expiry E1069385 BANGLADESH BANGLADESH 14 FEB 2010 13 FEB 2015 BANGLADESH HOBIGONG BANGLADESH RAHMAN SHAH HAMIDUR Male 22 DEC 1971 Married

Passport place of issue / issuing authority DHAKA / GOVT OF BANGLADESH You must have a valid passport and visa to enter Australia. You must notify the department if you wish to enter Australia on a different passport to the one specified in this application so your visa can be linked to your passport. If you have an Australian visa grant number, please enter the visa grant number Grant number If you have a current Australian visa label in your current or previous passport, please enter the visa number Visa number
Generated: October 6, 2011, 1:55:46 AM (EST) Page 1 of 5

TRN :EGNY1AKJFV

Maritime Crew (Subclass ZM 988) Visa

Are you a citizen of the country of passport? Yes Are you known by any other names? (This includes names before marriage) No Do you hold any citizenship other than the nationality provided with the passport details above? No Are you currently in Australia? No What is your first intended arrival date in Australia after you lodge this application (if known)?

Critical data confirmation


All the information provided in this application is important to the decision to grant a visa. if the information included on this page is incorrect, it may lead to: the application being refused, or cancellation or cessation of the visa, or denial of permission to travel to, enter or remain in Australia even if the visa has been granted. Please confirm that the following information is correct and that it is in the correct fields. If you are unsure of what is required for each field, press the 'Previous' button at the bottom of this page. This will return you to the previous screen where you can select the next to the fields for which you require help. Is the following information correct? Family name Given names Sex Date of birth Country of birth Passport number Country of passport Yes Yes Yes Yes Yes Yes Yes

Applicant residential address details


Give details of the current residential address Address HOUSE - 285, ROAD - 19/C, NEW D.O.H.S. MOHAKHALI Suburb/Town
Generated: October 6, 2011, 1:55:46 AM (EST)

DHAKA
Page 2 of 5

TRN :EGNY1AKJFV

Maritime Crew (Subclass ZM 988) Visa

State or Province Postcode Country BANGLADESH

Postal address (if different from above) Address Suburb/Town Australian State or Territory OR State or Province outside Australia Postcode Country Contact telephone numbers Home phone Work phone Mobile/Cell +880 1731670949 +880 2 9862789

Consent to communicate electronically In order to process your application quickly, the Department prefers to communicate with you using e-mail. If you do not wish to communicate via e-mail, a letter will be sent to the above contact address which will take longer to receive advice about your application. Do you agree to this Department communicating with you via e-mail? Yes If yes, enter e-mail address E-mail address sas070535@gmail.com

Applicant character declarations


Have you ever: been convicted of any crime or offence in any country resulting in you being sentenced to imprisonment for 12 months or more? OR been sentenced to 2 or more terms of imprisonment where the total of those terms is 2 years or more? No If Yes, please give details

been removed or deported from any country (including Australia)? No If Yes, please give details

Generated: October 6, 2011, 1:55:46 AM (EST)

Page 3 of 5

TRN :EGNY1AKJFV

Maritime Crew (Subclass ZM 988) Visa

been excluded from or asked to leave any country (including Australia)? No If Yes, please give details

committed, or been involved in the commission of war crimes or crimes against humanity or human rights? No If Yes, please give details

been involved in any activities that would represent a risk to Australian national security? No If Yes, please give details

had any outstanding debts to the Australian Government or any public authority in Australia? No If Yes, please give details

been involved in any activity, or been convicted of any offence, relating to the illegal movement of people to any country (including Australia)? No If Yes, please give details

served in a private militia, and trained in weapons/explosives use other than in the course of compulsory national military service? No If Yes, please give details

Applicant employment details


Crew should provide details of the vessel operator, shipping company or manning agency with which they are employed or under offer of employment. Employer Name Address A.P. MOLLER SINGAPORE PTE. LTD 3 HARBOURFRONT PLACE, #13-01, HARBOURFRONT TOWER 2 Suburb/Town State or Province Postcode Country Telephone number 099254 SINGAPORE +65 6318 3601 SINGAPORE

Occupation
Generated: October 6, 2011, 1:55:46 AM (EST)

MARINER
Page 4 of 5

TRN :EGNY1AKJFV

Maritime Crew (Subclass ZM 988) Visa

Sea-crew job title

CAPTAIN / MASTER

Please describe the nature or type of business SHIPPING OPERATOR

Applicant declaration
Note: Any information in this application, including employment details, may be checked. Any false information could result in: the application being refused, or cancellation or cessation of the visa, or denial of permission to travel to, enter or remain in Australia even if the visa has been granted. I certify that the information supplied on or with this form is correct. Yes We strongly advise that you keep a copy of your application and all attachments for your records.

Generated: October 6, 2011, 1:55:46 AM (EST)

Page 5 of 5

TRN :EGNY1AKJFV