This form contains 130 fields organized into 49 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Address for Correspondence
Correspondence Address Line 1 Text
Enter the first line of the address for correspondence.
Correspondence Address Line 2 Text
Enter the second line of the address for correspondence.
Correspondence Suburb/Town Text
Enter the suburb or town for the correspondence address.
Correspondence Postcode Text
Enter the postcode for the correspondence address.
Agent/Practitioner Details
Mr Checkbox
Check this box if the agent or practitioner's title is Mr.
Mrs Checkbox
Check this box if the agent or practitioner's title is Mrs.
Miss Checkbox
Check this box if the agent or practitioner's title is Miss.
Ms Checkbox
Check this box if the agent or practitioner's title is Ms.
Other Title Text
Please enter the title of the agent or practitioner if it is not Mr, Mrs, Miss, or Ms.
Agent/Practitioner Family Name Text
Please enter the family name of the registered migration agent, legal practitioner, or exempt person.
Agent/Practitioner Given Names Text
Please enter the given names of the registered migration agent, legal practitioner, or exempt person.
Exempt Person's Date of Birth Date
Please enter the date of birth for the exempt person.
Max length: 11 characters
Agent/Practitioner Identification Number
Migration Agent Registration Number (MARN) Text
Please provide your 7-digit Migration Agent Registration Number (MARN).
Max length: 7 characters
Legal Practitioner Number (LPN) Text
Please provide your 7-digit Legal Practitioner Number (LPN).
Max length: 5 characters
Agent/Practitioner Telephone Numbers
Office Phone Country Code Text
Enter the country code for the agent's or practitioner's office telephone number.
Office Phone Area Code Text
Enter the area code for the agent's or practitioner's office telephone number.
Office Phone Number Text
Enter the agent's or practitioner's main office telephone number.
Mobile/Cell Phone Number Text
Enter the agent's or practitioner's mobile or cell phone number.
Alternative Contact Person Details
No Checkbox
Check this box if there is no other registered migration agent or legal practitioner from your organisation who the Department may discuss this case with.
Yes Checkbox
Check this box if there is another registered migration agent or legal practitioner from your organisation who the Department may discuss this case with.
Alternative Contact Person's Family Name Text
Please provide the family name of the alternative contact person.
Alternative Contact Person's Given Names Text
Please provide the given names of the alternative contact person.
Alternative Contact Person Identification Number
Alternative Contact MARN Text
Please enter the Migration Agent Registration Number (MARN) for the alternative contact person.
Max length: 7 characters
Alternative Contact LPN Text
Please enter the Legal Practitioner Number (LPN) for the alternative contact person.
Max length: 5 characters
Alternative Contact Person Telephone Numbers
Alternative Contact Office Hours Country Code Text
Enter the country code for the alternative contact person's office hours telephone number.
Alternative Contact Office Hours Area Code Text
Enter the area code for the alternative contact person's office hours telephone number.
Alternative Contact Office Hours Number Text
Enter the main telephone number for the alternative contact person's office hours.
Alternative Contact Mobile/Cell Number Text
Enter the mobile or cell phone number for the alternative contact person.
Application Process
Application process Checkbox
Check this box if you are providing assistance with an application process.
Type of Application Text
Provide the type of application.
Date Lodged Date
Provide the date the application was lodged.
Max length: 11 characters
Application process - Not yet lodged Checkbox
Check this box if the application process has not yet been lodged.
Appointment as Authorised Recipient
No Checkbox
Check this box if the person named at Question 18 was NOT appointed as the client's authorised recipient.
Yes Checkbox
Check this box if the person named at Question 18 WAS appointed as the client's authorised recipient.
Authorised Recipient Status
Authorised Recipient Status No Checkbox
Check this box if you have not been authorised to receive written communication on behalf of your client(s) in relation to the matter indicated in Question 15, and then proceed to Part C.
Authorised Recipient Status Yes Checkbox
Check this box if you have been authorised to receive written communication on behalf of your client(s) in relation to the matter indicated in Question 15.
Business or Residential Address
Business or Residential Address Line 1 Text
Please provide the first line of the business or residential address.
Business or Residential Address Line 2 Text
Please provide the second line of the business or residential address.
Business or Residential Address Line 3 Text
Please provide the third line of the business or residential address.
Business or Residential Postcode Text
Please provide the postcode for the business or residential address.
Cancellation Process
Cancellation process Checkbox
Check this box if you are providing assistance with a cancellation process.
Cancellation Process Subclass of Visa Text
Please enter the subclass of the visa relevant to the cancellation process.
Cancellation Process Date Visa Granted Date
Please enter the date the visa was granted.
Max length: 11 characters
Capacity of Assistance
Registered migration agent Checkbox
Check this box if you are providing assistance in the capacity of a registered migration agent.
Legal practitioner Checkbox
Check this box if you are providing assistance in the capacity of a legal practitioner.
Exempt person Checkbox
Check this box if you are providing assistance in the capacity of an exempt person.
Client 1 Business or Residential Address
Client 1 Business or Residential Address Line 1 Text
Enter the first line of the client's business or residential address.
Client 1 Business or Residential Address Line 2 Text
Enter the second line of the client's business or residential address.
Client 1 Postcode Text
Enter the postcode for the client's business or residential address.
Client 1 Date of Birth
Client 1 Date of Birth Date
Enter the full date of birth for Client 1.
Max length: 11 characters
Client 1 Department of Home Affairs Client ID Number
Client 1 Department of Home Affairs Client ID Number Text
Provide the client's ID number from the Department of Home Affairs, if known.
Client 1 Full Name
Client 1 Family Name Text
Provide the family name for Client 1.
Client 1 Given Names Text
Provide the given names for Client 1.
Client 1 Mobile/Cell Number
Client 1 Mobile/Cell Number Text
Provide the mobile or cell phone number for Client 1.
Client 1 Office Telephone Number
Client 1 Office Telephone Country Code Text
Please enter the country code for Client 1's office telephone number.
Client 1 Office Telephone Area Code Text
Please enter the area code for Client 1's office telephone number.
Client 1 Office Telephone Number Text
Please enter the main number for Client 1's office telephone number.
Client 1 Organisation Name
Client 1 Organisation Name Text
Provide the name of the Client 1 organisation, if applicable.
Client's Business or Residential Address
Address Line 1 Text
Enter the first line of the client's business or residential address.
Address Line 2 Text
Enter the second line of the client's business or residential address.
Address Line 3 Text
Enter the third line of the client's business or residential address, typically including suburb, city, or state.
Postcode Text
Enter the postcode for the client's business or residential address.
Client's Date of Birth
Client's Birth Day Text
Enter the day of the client's birth.
Max length: 11 characters
Client's Full Name
Client's Family Name Text
Enter the client's family name.
Client's Given Names Text
Enter the client's given names.
Client's Mobile Phone
Client's Mobile/cell Text
Enter the client's mobile or cell phone number.
Client's Office Phone
Client's Office Phone Country Code Text
Enter the country code for the client's office phone number.
Client's Office Phone Area Code Text
Enter the area code for the client's office phone number.
Client's Office Phone Number Text
Enter the main part of the client's office phone number.
Client's Organisation Name
Client's Organisation Name Text
Provide the full legal name of the client's organisation, if applicable.
Declaration by Client
Appointment of registered migration agent / legal practitioner / exempt person Checkbox
Check this box if you have appointed a registered migration agent, legal practitioner, or exempt person named in Part A of this form to provide assistance with matters as indicated on this form.
Appointment of authorised recipient Checkbox
Check this box if you have appointed the person named at Question 2 of this form to receive all documents relating to the matter indicated at Question 15 on your behalf.
Ending appointment Checkbox
Check this box if the registered migration agent, legal practitioner, or exempt person named in Part B is no longer acting on your behalf.
Withdrawal of authorised recipient appointment Checkbox
Check this box if the registered migration agent, legal practitioner, or exempt person listed at Question 18 on this form is no longer authorised to receive documents on your behalf.
Client Declaration Date Date
Provide the date the client is making this declaration.
Max length: 11 characters
Declaration by Registered Migration Agent/Legal Practitioner/Exempt Person
Appointment of Registered Migration Agent/Legal Practitioner/Exempt Person Checkbox
Check this box if you are declaring that you have been appointed by the client named in Part A of this form as a registered migration agent, legal practitioner, or exempt person, and will act on their behalf as permitted by law.
Appointment of Authorised Recipient Checkbox
Check this box if you have been appointed as an authorised recipient by the persons named in Part A and agree to receive all relevant documents, including by electronic means if indicated in Question 7.
Ending Appointment of Registered Migration Agent/Legal Practitioner/Exempt Person Checkbox
Check this box if you are declaring that you are no longer acting on behalf of the client named in Part B and have advised the client accordingly.
Withdrawal of Authorised Recipient Appointment Checkbox
Check this box if you understand that you are no longer acting as an authorised recipient in this matter.
Declaration Date Day Text
Enter the day of the declaration date.
Max length: 11 characters
Department of Home Affairs Identification Numbers
Request ID Number (RID) Text
Enter the Department of Home Affairs Request ID number (RID).
Transaction Reference Number (TRN) Text
Enter the Department of Home Affairs Transaction Reference Number (TRN).
Electronic Communication Details
No Checkbox
Check this box if the client does not agree to the Department communicating with them by email or other electronic means.
Yes Checkbox
Check this box if the client agrees to the Department communicating with them by email or other electronic means and intends to provide further details.
Email Address Text
Enter the client's email address for electronic communication with the Department.
Email Communication Consent
No Checkbox
Check this box if you do not agree to the Department communicating with you by email or other electronic means.
Yes Checkbox
Check this box if you agree to the Department communicating with you by email or other electronic means.
Email Address for Communication Text
Provide the email address you agree to for communication with the Department.
Ending Appointment as Authorised Recipient
No Checkbox
Check this box if the client is not ending their appointment as an authorised recipient.
Yes Checkbox
Check this box if the client is ending their appointment as an authorised recipient.
Fifth Other Client Name
Fifth Other Client Family Name Text
Provide the family name for the fifth other client.
Fifth Other Client Given Names Text
Provide the given names for the fifth other client.
First Other Client Name
First Other Client Family Name Text
Enter the family name for the first other client.
First Other Client Given Names Text
Enter the given names for the first other client.
Fourth Other Client Name
Fourth Other Client Family Name Text
Please provide the family name for the fourth other client.
Fourth Other Client Given Names Text
Please provide the given names for the fourth other client.
General
cc.resadd str Text
cc.resadd sub Text
Identification Numbers
Request ID Number Text
Enter the Department of Home Affairs Request ID number.
Transaction Reference Number Text
Enter the Department of Home Affairs Transaction Reference Number.
Legal Practitioner Number
Legal Practitioner Number (LPN) Digit Text
Please provide the final digit of the Legal Practitioner Number.
Max length: 5 characters
Migration Agent Registration Number
MARN Text
Provide the Migration Agent Registration Number (MARN).
Max length: 7 characters
Notification Type
New appointment Checkbox
Check this box if you are notifying the Department about a new appointment to provide immigration assistance.
Appointment has ended Checkbox
Check this box if you are notifying the Department that your appointment to provide immigration assistance has ended.
Organisation Name
Organisation Name Text
Provide the name of your organisation.
Person Receiving Immigration Assistance
Visa applicant Checkbox
Check this box if the person receiving immigration assistance is a visa applicant.
Sponsor or sponsor applicant Checkbox
Check this box if the person receiving immigration assistance is a sponsor or sponsor applicant.
Nominator or nominator applicant Checkbox
Check this box if the person receiving immigration assistance is a nominator or nominator applicant.
Proposer or proposer applicant Checkbox
Check this box if the person receiving immigration assistance is a proposer or proposer applicant.
Visa holder for cancellation Checkbox
Check this box if the person receiving immigration assistance is a visa holder whose visa is being considered for cancellation or has been cancelled.
Person requesting ministerial intervention Checkbox
Check this box if the person receiving immigration assistance is a person requesting ministerial intervention.
Reason for Exemption
Close Family Member Checkbox
Check this box if you are an exempt person because you are a close family member (spouse, child, parent, brother, or sister).
Sponsor Checkbox
Check this box if you are an exempt person because you are a sponsor.
Nominator Checkbox
Check this box if you are an exempt person because you are a nominator.
Member of Diplomatic Mission or International Organisation Checkbox
Check this box if you are an exempt person because you are a member of a diplomatic mission, consular post, or international organisation.
Member of Parliament or Staff Checkbox
Check this box if you are an exempt person because you are a member of parliament or their staff.
Public Service Act Official or State/Territory Public Service Member Checkbox
Check this box if you are an exempt person because you are an official appointed or engaged under the Public Service Act 1999, or a member of state/territory public services giving immigration assistance as part of their duties.
Registered Person's Mobile Phone
Registered Person's Mobile Phone Number Text
Provide the registered person's mobile or cell phone number.
Registered Person's Name and Organisation
Registered Person's Family Name Text
Provide the family name of the registered person.
Registered Person's Given Names Text
Provide the given names of the registered person.
Registered Person's Organisation Name Text
Provide the name of the registered person's organization, if applicable.
Registered Person's Office Phone
Registered Person's Office Phone Country Code Text
Enter the country code for the registered person's office phone number.
Registered Person's Office Phone Area Code Text
Enter the area code for the registered person's office phone number.
Registered Person's Office Phone Number Text
Enter the main phone number for the registered person's office phone.
Second Other Client Name
Second Other Client Family Name Text
Enter the family name of the second other client.
Second Other Client Given Names Text
Enter the given names of the second other client.
Specific Matter Details
Specific matter Checkbox
Check this box if you are providing assistance for a specific matter, such as sponsorship monitoring, sanction activity by the Department, or only one stage of a two-stage visa, or ministerial intervention.
Specific Matter Details Text
Provide comprehensive details regarding the specific matter, such as sponsorship monitoring, sanction activity by the Department, or information related to a single stage of a two-stage visa or ministerial intervention.
Third Other Client Name
Third Other Client Family Name Text
Enter the family name of the third other client.
Third Other Client Given Names Text
Enter the given names of the third other client.