Claiming Period* 1 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