Department of Immigration and Citizenship

Student (Temporary) Visa

SFS

Your details
Give the following details exactly as they appear in your passport. Family name Given names Sex Date of birth Relationship status Place of birth Town/City Country Singaraja INDONESIA I Putu Agus Sri Kresna Male 20 August 1982 Never Married

Details of the passport that you use for travel purposes Passport number Country of passport Nationality of passport holder Passport date of issue Passport date of expiry V018467 INDONESIA INDONESIA 25 August 2010 25 August 2015

Passport place of issue/issuing authority Singaraja It is strongly recommended that the passport be valid for at least 6 months. If you have an Australian visa grant number, please enter the visa grant number Grant number If you have a current Australian visa label in your current or previous passport, please enter the visa number Visa number 7001391505S

Details of your confirmation of enrolment

Before you can apply you must have a Confirmation of Enrolment from an Australian education provider to each course that you intend to study. Please provide the Confirmation of Enrolment code for each course. The code is located in the top right corner of your Confirmation of Enrolment. CoE code 46DE0841

Sponsorship details
As previously stated, this form can only be used where the visa application charge is required.
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Student (Temporary) Visa

If you believe you are in one of the following categories please do not continue this application form, as you will be charged the full application fee. - Sponsored by the Australian Government, for example, AusAID, Department of Defence. - Holder of a scholarship approved by the Commonwealth, such as: - International Postgraduate Research Scholarship Scheme (IPRSS); - Commonwealth Scholarship and Fellowship Plan (CSFP); - Holder of a completed Acceptance Advice of Secondary Exchange Student (AASES) form. - Applying to renew your Student visa because your education provider has defaulted on its agreement to provide your course of study. How are your studies in Australia to be funded? none of the above Is your principal course a: Full-award course, other than Postgraduate Research or Doctorate

Residential address details

Give details of the Australian residential address that you are currently living at. Address Suburb/Town State or Territory Postcode Country Your contact telephone numbers Home phone Mobile/Cell 0421852213 803/77 Bouverie St Carlton Victoria 3053 AUSTRALIA

Give details of the residential address in your home country. Address Suburb/Town State or Province outside Australia Bali Postcode Country Authorisation Do you want to authorise another person to act and/or receive communication about this application on your behalf? This includes authorising the Department to send that person any communication, documents or notifications relating to the application that would otherwise have been sent to you. No 82217 INDONESIA Jalan Ngurah Rai 171 Negara

Contact details
Give details of your postal address in Australia. If your postal address is different to your residential address please amend the details here. Family name I Putu Agus

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Given names Address Suburb/Town Australian State or Territory Postcode Country Communicating with you

Sri Kresna 803/77 Bouverie St Carlton Victoria 3053 AUSTRALIA

We can communicate about your application more quickly using e-mail and/or fax. Do you agree to this Department communicating with you via e-mail and/or fax? Yes If yes, enter e-mail address E-mail address Communicating with this Department In the course of deciding this application, we may need you to attend an Australian Government office overseas for an interview. If this occurs, which office would you prefer to go to? Melbourne Regional Office address_of_my_email@yahoo.com

Assistance with this form

Under Australian law, anyone who uses knowledge of migration procedures to offer immigration assistance to a person wishing to obtain a visa to enter or remain in Australia must be registered, unless they are exempt by law from registration. Did you receive assistance from any person in completing this form? No

Health declarations
You are required to answer the following questions for yourself and any other person included in the application. In the last 5 years, have you, or any other person included in this application, visited, or lived, outside INDONESIA for more than 3 consecutive months (other than Australia)? No Do you, or any other person included in this application, intend to enter a hospital or a health care facility (including nursing homes) while in Australia? No Do you, or any other person included in this application, intend to work as, or study to be, or train to be, a doctor, dentist, nurse or paramedic during your stay in Australia? No Do you, or any other person included in this application, intend to work, or be a trainee, at a child care centre (including preschools and creches) while in Australia? No Have you, or any other person included in this application: - ever had, or currently have, tuberculosis?
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- been in close contact with a family member that has active tuberculosis? - ever had a chest x-ray which showed an abnormality? No During your proposed visit to Australia, do you, or any other person included in this application, expect to incur medical costs, or require treatment or medical follow up for: blood disorder cancer heart disease hepatitis B or C liver disease HIV infection, including AIDS kidney disease, including dialysis No mental illness pregnancy No No No No No No No No

respiratory disease that has required hospital admission or oxygen therapy No other? No

Do you, or any other person included in this application, require assistance with mobility or care due to a medical condition? No Visa applicants are encouraged to be immunised against infectious diseases before travelling to Australia. Visa applicants who are unable to arrange their immunisation before departure from their home country are encouraged to seek advice on arrival in Australia. The Australian state and territory health authorities assist people to obtain general medical help and advice, including immunisation. Parents are strongly encouraged to have their children immunised against hepatitis B, diphtheria, tetanus, pertussis (whooping cough), poliomyelitis, haemophilus influenzae type-b (Hib), pneumococcal and meningococcal infections, mumps, measles, rubella and varicella (chickenpox). Babies between the ages of 2 and 8 months of age (only) are also encouraged to be immunised against rotavirus. Parents should bring any immunisation records for their children with them to Australia. Rubella vaccinations are strongly encouraged for women of child-bearing age.

Character declarations
If you wish to study in Australia, you must be of good character. The following questions ask details of your character. If your circumstances change before you travel you should inform the Australian Government office overseas. If you are receiving assistance in completing this form, you must ensure you personally answer these questions, and that the answers are faithfully transcribed to this form. For your reference, a copy of these questions can also be found in form 157A Application for a student (temporary) visa. Have you, or any person included in this application to apply for this visa, ever: been convicted of a crime or offence in any country (including any conviction which is now removed from official records)?
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No been charged with any offence that is currently awaiting legal action? No been acquitted of any criminal offence or other offence on the grounds of mental illness, insanity or unsoundness of mind? No been removed or deported from any country (including Australia)? No left any country to avoid being removed or deported? No been excluded from or asked to leave any country (including Australia)? No committed, or been involved in the commission of war crimes or crimes against humanity or human rights? No been involved in any activities that would represent a risk to Australian national security? No had any outstanding debts to the Australian Government or any public authority in Australia? No been involved in any activity, or been convicted of any offence, relating to the illegal movement of people to any country (including Australia)? No - served in a military force or state-sponsored or private militia, or - undergone any military or paramilitary training, or - been trained in weapons or explosives use (however described), other than in the course of compulsory national military service? No

Declaration
Do you have access to sufficient funds to support you and your family unit members for the TOTAL period of your stay in Australia (including proposed tuition costs for you and any school aged family members, living costs and cost of fares, regardless of whether your dependants intend to accompany you to Australia)? Yes I certify that the information provided on or with this form is correct. Yes Do you acknowledge that you must immediately advise this Department if you become aware that any information provided in this form is incorrect or if there is a change in your circumstances at any time? Yes

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If granted a student visa, do you acknowledge that you are required to abide by the conditions of this temporary visa as outlined in the information sheet Applying for a student visa and on this Department's web site, and understand that if you cannot obtain a further visa that you must depart Australia on or before the cease date of the student visa. Yes Do you hold health insurance with an approved Overseas Student Health Cover (OSHC) provider for the proposed duration of your Student visa? Yes Do you acknowledge that you understand that: - if the 8534 visa condition is imposed on your visa, it will be indicated by the condition code "8534" and by the short description "No Further Stay"? (This can be confirmed on your grant letter or through the Online visa enquiry facility.) - Do you acknowledge that this means that the 8534 condition has been imposed on your visa and that you will not, while in Australia, be entitled to the grant of any other visa*, apart from a further student visa providing permission to work, the application for which was made on form 157P or 157P(Internet)? - Do you understand that the effect of the 8534 visa condition is that it will not be possible for you to apply to remain in Australia beyond your authorised period of stay? - Do you agree to having this condition included on any visa issued to you as the result of this application if this Department decides to impose it as a condition of grant of a visa? - if the 8535 visa condition is imposed on your visa, it will be indicated by the condition code "8535" and by the short description "No further Stay"? (This can be confirmed on your grant letter or through the Online visa enquiry facility.) - Do you acknowledge that this means that the 8535 condition has been imposed on your visa and that you will not, while in Australia, be entitled to the grant of any other visa*, apart from: - a further student visa providing permission to work, the application for which was made on form 157P or 157P(Internet); or - a further student visa, providing your sponsor consents to the grant of that further student visa? - the effect of the 8535 visa condition is that it will not be possible for you to remain in Australia beyond your authorised period of stay*, unless you are applying for a further student visa with the consent of your sponsor, and that you will be required to depart Australia on or before the date notified on your visa label or on your grant letter if you do not have a label in your passport? Yes I will respect Australian values as listed at the beginning of this application, during my stay in Australia and will obey the laws of Australia. Yes

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