Claiming Period* 1 July 2021 to 30 June 20221 July 2020 to 30 June 20211 July 2019 to 30 June 20201 July 2018 to 30 June 20191 July 2017 to 30 June 20181 July 2016 to 30 June 2017
Do you have a current or expired Medicare card?* NoYes
Title* ---DrMrMrsMissMs
Family Name*
First Name*
Gender* ---MaleFemale
Date of Birth*
Contact Number*
Email Address*
Residential Address*
Postal Address*
Is the postal address a tax agent’s address? NoYes
Your country of residence before coming to Australia ---AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia HerzegovinaBotswanaBrazilBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepChadChileChinaColombiaComorosCongoCongo {Democratic Rep}Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIreland {Republic}IsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar, {Burma}NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe
How long did you live in this country before coming to Australia?*
Do you hold current or expired health or medical insurance in Belgium, Italy, the Netherlands, Norway or Slovenia (for example European Health Insurance card, Tessera Sanitaria or AIRE registration)?* NoYes
Are you from Finland, Malta or Norway?* NoYes
Have you lodged an application for permanent residency (other than a parent visa) with the Department of Home Affairs, this includes applications for Spouse Combined visas (subclass 820/801) and (subclass 309/100)?* NoYes
Is the application for permanent residency that is being considered by the Department of Home Affairs, still ongoing?* YesNo
Provide a current letter or email from the Department of Home Affairs that confirms your application has been approved, withdrawn or refused.*
Have you lodged an appeal against that decision?* NoYes
Have you lodged more than one Permanent residency application?* NoYes
Have you lodged an application for permanent residency with the Department of Home Affairs under parent category (Aged parent or Contributory parent)?* NoYes
Are you leaving Australia permanently before end of the current financial year?* NoYes
Date of Submission*
I agree to the Terms and Conditons