Application for a

Crew/Seaman (Temporary) visa

Please use a pen, and write neatly in English using BLOCK LETTERS.
Tick where applicable

10 Details from the passport that you will use to enter Australia
Passport number

Note: A separate application is required for each person

applying for a Maritime Crew visa. Partners and dependent
children must complete individual application forms.

Country of passport
DAY

YEAR

Date of expiry

Application details

Issuing authority/

1 Are you applying as: (tick one box only)

Place of issue as
shown in your

a crew member (or under offer of

employment as a crew member) on
a non-military ship

passport

Go to Question 3

Note: You must have a valid current passport to enter Australia.

Leave your passport details blank if you do not have

the passport or still under processing.

the partner of a crew member

the dependant child of a crew member

2 Does your partner or parent currently hold, or have

they applied for, a Maritime Crew visa?
No

MONTH

Date of issue

11 Are you a citizen of the country of passport

given above? No

You are not eligible to apply

Yes

Yes

3 What is your first intended arrival date in

12 Do you hold any citizenship other than the nationality

DAY

MONTH

YEAR

provided with the passport details above?

Australia after you lodge this application

(if known)?

No
Yes

What other countries are you a citizen of?

Your details
4

Your full name as shown in your passport or travel document

13

If you are applying as a partner or dependent child of a crew

Family name

member, please provide the following details of that crew member

Given names

Crew members full name as shown in

their passport or travel document

5 Other names you have you been known by

Family name

(including name at birth, previous married names, aliases)

Given names

Sex

Male

Female
DAY

6 Sex

Male

Female
DAY

MONTH

MONTH

YEAR

Date of birth
Crew members passport details

YEAR

7 Date of birth

Passport number
Country of passport

8 Place of birth
Town/city

DAY

MONTH

YEAR

Date of issue

Country

Date of expiry

9 Relationship status

Issuing authority/

Married

Separated

Engaged

Divorced

De facto

Never married or
been in a de facto
relationship

Place of issue as
shown in passport

Widowed
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1273 (Design date 03/14) - Page

14 Residential address in your country of usual residence

Please describe the nature of the business

Note: A post office box address is not acceptable as a

residential address. Failure to give your residential
address will result in your application being invalid.

Sea crew job title

(eg. Administration, Catering, Deck, Engine, Entertainment, Officer)

POSTAL CODE

Occupation

15 Address for correspondence about this application

(If the same as your residential address, write AS ABOVE)
Note: You must ensure these details are correct so that
we can advise you of the outcome of your application.

Character declaration
19 Have you ever:

been convicted of a crime or offence in any

country resulting in you being sentenced to

POSTAL CODE

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

imprisonment for 12 months or more?

been sentenced to 2 or more terms

16 Your telephone numbers

COUNTRY CODE

AREA CODE

of imprisonment where the total of

NUMBER

Office hours

After hours

those terms is 2 years or more?

been removed or deported from
any country (including Australia)?
been excluded from or asked to leave

Mobile/cell

any country (including Australia)?

17 Do you agree to the department communicating

committed, or been involved in the

with you by fax or email?

commission of war crimes or crimes

No

against humanity or human rights?

Yes

been involved in any activities

that would represent a risk to
Australian national security?

Give details
COUNTRY CODE AREA CODE

Fax number

) (

NUMBER
)

had any outstanding debts to the

Australian Government or any
public authority in Australia?

Email address

Employment details
18 Crew should provide details of the vessel operator,
shipping company or manning agency with which they
are employed or under offer of employment.
Partner/Dependent children should provide their
current employers details or write NIL in the Name of
employer question if they are not employed.

been involved in any activity, or been

convicted of any offence, relating to
the illegal movement of people to
any country (including Australia)?
served in a private militia, and
trained in weapons/explosives use
other than in the course of
compulsory national military service?

If you answered Yes to any of the above questions, provide all the

Name of employer
(For partner/dependants who are not employed, write NIL)

relevant details. If insufficient space, attach an additional statement.

Employers address

POSTAL CODE
COUNTRY CODE AREA CODE

Fax
number

1273 (Design date 03/14) - Page 2

) (

NUMBER
)

COMMONWEALTH OF AUSTRALIA, 2016

Assistance with this form

20 Did you receive assistance in completing this form?
No

Go to Question 24

Yes

Please give details of the person who assisted you

Title: Mr

Mrs

Miss

Ms

Options for receiving

written communications
24 All written communications about this application should be sent to:
(Tick one box only)
Myself

Other

OR

Family name

Authorised
recipient

Given names

You should complete form 956A Appointment

or withdrawal of an authorised recipient

OR

Address

Migration agent
OR
POSTAL CODE

Exempt person

Your migration agent/exempt person should

complete form 956 Advice by a migration
agent/exempt person of providing
immigration assistance

Telephone number or daytime contact

AREA CODE

COUNTRY CODE

Office hours

) (

NUMBER

Declaration

WARNING: Giving false or misleading information is a serious offence.

Mobile/cell

25 I declare that:
21 Is the person an agent registered with the Office of the
Migration Agents Registration Authority (Office of the MARA)?

No
Yes

I understand the department may request labor

certificate from me to be able to work in Australia Port.

Go to Question 24
.

22 Is the person/agent in Australia?

No

the information supplied on or with this form is correct.

Note: Any information in this application, including

employment details, may be checked. Any false
information could result in the refusal of your visa.

Go to Question 24

Yes

23 Did you pay the person/agent and/or give a gift for

this assistance? No

Signature of
applicant

Yes

DAY

MONTH

YEAR

Date

We strongly advise that you keep a copy of your

application and all attachments for your records.

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