DEPENDENCY QUESTIONNAIRE 
 

 Please provide detailed answers and supporting evidence of any claims. 
 Attach further pages if there is insufficient room for your answers. 
 

 
1. Please give reasons why you consider yourself to be financially dependent upon another
person.
Who pays for your basic needs of shelter, food and clothing? Provide the names of all people who
support you financially. How long have you been dependent on another person? Provide details
and evidence of how much and how often payments are made by other persons on your behalf.
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2. Are you engaged, married, living in a de-facto relationship?

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3. Are you studying?
If so, please provide the name of the school/ college/ university and details of whether the course is
part-time or full-time, its duration and expected date of completion.
Provide evidence from the institution of your enrolment.
If you are receiving a scholarship or other studies assistance from any source, provide details and
evidence of the monetary amount and duration of that assistance.
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Other Family Visa Branch 
Post: Locked Bag 7 NORTHBRIDGE WA  6865 • Email: perthcofs@homeaffairs.gov.au •  www.homeaffairs.gov.au 
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4. Are you working?
If so, are you working part-time or full-time? Provide evidence of your current employment (if any)
and evidence of your earnings from that employment.
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5. Are you are incapacitated for work due to total or partial loss of bodily or mental functions?
If so, provide medical evidence to support this claim.
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6. Do you receive any form of pension or allowance from the Government or any other
organisation (including superannuation, investments, trust accounts etc)?
If so, provide details and evidence of the amounts, frequency and duration of any payments.
If you have retired from work and are not receiving a pension, provide evidence to support any
claims that you are ineligible for a pension.
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7. Do you receive income from any other source?

If so, when did you commence receiving this income? Provide details and evidence of the amounts,
frequency and duration of any payments.
If receiving financial support from any other person(s), please provide their full name and their
relationship to you. Please also supply evidence of any financial assistance from these people.
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Name:

Signature: Date: