APPLICATION FORM

QUEENSLAND STATE NOMINATION APPLICATION FORM

SKILLED NOMINATED VISA
Residential address:
IMPORTANT INFORMATION:

Before you submit your application, please ensure you

complete all required information as listed below. Failure
to provide all of the relevant information will delay the
processing of your application. Please complete the form
and upload it electronically through the Business and
Skilled Migration Queensland document portal.

Postal address (if different from above):

VISA APPLICATION
Please tick the relevant visa stream for this application.
(Tick ONE box only)
Skilled Nominated (Permanent) visa (subclass 190)
Skilled Regional (Provisional) visa (subclass 489)
EOI number:
Telephone (please include country and area code):

Date of EOI lodgement:

Mobile (please include country code):

Occupation and ANZSCO:

Email:

Current visa (if applicable):

Country of birth:

APPLICANT INFORMATION
Country migrating from:
Title of applicant: Mr Mrs Ms Dr
Family name(s):
Country of passport:

Given name(s):
Intended residential suburb in Queensland:

Gender: Male Female

Intended postcode in Queensland:
Date of birth (dd/mm/yyyy):
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A business unit of Trade & Investment Queensland

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SPOUSE INFORMATION MIGRATION AGENT INFORMATION (continued)

Title of spouse: Mr Mrs Ms Dr Mobile (please include country code):

Family name(s):
Email:

Given name(s):
Postal address:

Gender: Male Female

Date of birth (dd/mm/yyyy):

QUEENSLAND GOVERNMENT AGENCY

DEPENDANTS’ INFORMATION NOMINATION DECLARATION
Number of dependants (other than spouse): (Declaration to Business & Skilled Migration Queensland
(BSMQ) for a Queensland Government Agency nomination)
Adult Children
I,
For all children: family name(s), given name(s),
(name in print), for the purpose of applying for nomination
date of birth (dd/mm/yyyy), gender (M/F).
by BSMQ a Queensland Government Agency for the
purposes of the Migration Act 1990 (Cth) and the Migration
Regulations 1994 (Cth) (Business & Skilled Migration
Queensland) for the Skilled Sponsored visa (subclass 190)
and the Skilled Regional (provisional) visa (subclass 489),
I acknowledge and confirm that:
1. my nominated occupation is on the relevant
MIGRATION AGENT INFORMATION Queensland Skilled Occupation list as at the date
of this signed declaration and I have the required
Title: Mr Mrs Ms Dr qualifications, registration, licences and skills
Family name(s): assessment required for this occupation.
2. the nomination from BSMQ is provided on the basis
of the details provided in my nomination application,
Given name(s): including this Nomination Declaration.
3. BSMQ may nominate an applicant for a visa but the final
decision on the grant of a visa rests with the Australian
Company name: Government’s Department of Home Affairs (HA).
4. many Australian Government social security benefits
are NOT available to skilled migrants until they have
MARA Registration # (if applicable): been a permanent resident for two years.
5. BSMQ has no responsibility for finding employment or
providing financial or settlement assistance to skilled
Telephone (please include country and area code): migrants (or their dependants).
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A business unit of Trade & Investment Queensland

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APPLICATION FORM

6. whilst BSMQ takes every care when providing APPLICANT DECLARATION

information to applicants, BSMQ and its employees
are not liable for any inaccuracies or omissions in the I,
information provided to the applicant regarding their
eligibility for, or the application process for, the Skilled (name in print), declare that I have read and understand
Nominated Visa. the Nomination Declaration above and, if necessary, I have
7. the nomination is provided on the following conditions: arranged for a translation and explanation has been given
to me, and the above is true and correct at the time of
(a) I must continue to meet my visa conditions during
signing this declaration.
the period of my visa.
(b) I must work and reside in Queensland for a period Signature of applicant:
of at least two years from visa grant.
(c) The information contained in my nomination
application is complete and accurate and I must Date of signature (dd/mm/yyyy):
immediately notify BSMQ of any changes to or
inaccuracies in such information.
(d) I have undertaken research into Queensland and
the intended settlement region and am aware of MIGRATION AGENT DECLARATION
relevant living costs and services available.
I,
(e) I have sufficient funds to settle in Queensland to
support myself and my family during any period (name in print) acting on behalf of,
of unemployment.
(f) I must advise BSMQ when my visa is approved
and if I am on the 489 visa, I understand that I and (name in print), declare that I have informed the applicant
all dependants on this visa must work, study and of the conditions listed above, and if necessary I have
reside in a regional area of Queensland. arranged for translation and explanation to be given to
(g) I must advise BSMQ of my residential address the applicant in the applicant’s native language, and I
and contact details when living in permanent believe that the applicant understands and accepts these
accommodation and must continue to notify BSMQ conditions.
of subsequent changes to my residential address
Signature of agent:
and contact details during the period of my visa.
(h) I must notify BSMQ when I commence employment.
(i) I understand that BSMQ may contact me in relation
Date of signature (dd/mm/yyyy):
to my nomination at any stage during the period of
my visa.
(j) I must provide any information requested by BSMQ
in relation to my nomination during the period of Migration Agents Registration Number (MARN)
my visa. (if applicable):
(k) I must notify BSMQ of any change to my
circumstances affecting my ability to meet these
conditions.
8. if I fail to meet the conditions of the nomination,
BSMQ may withdraw the nomination and notify the
HA of such withdrawal.
9. if refused by the HA, it is the policy of BSMQ that it
will not appeal against this decision and will not
participate in the Administrative Appeals Tribunal
(AAT) appeal process.
TIQ3650 July 2018

A business unit of Trade & Investment Queensland

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APPLICATION FORM

MARKETING SURVEY PRIVACY STATEMENT

As part of our continuous quality improvement, we would BSMQ collects information from your application to
like your feedback on Queensland’s state nomination determine your eligibility for Queensland Nomination.
program. This information will only be accessed by authorised
employees within the agency. Some information may
Where did you first hear about BSMQ? be given to other Queensland or Australian Government
BSMQ website BSMQ social media agencies for the purpose of assessing your application.
Your information will not be disclosed to any other parties
Social
 media Migration
 agent without your consent unless authorised or required by law.
Australian
 event International
 event
SUBMIT YOUR APPLICATION FORM
Other
 website (please specify below):
Please complete the form and upload it electronically
through the Business and Skilled Migration Queensland
document portal.
Other
 (please specify below):
A link has been provided to you in your Queensland
Nomination: Invitation to lodge an application email.
Emails with attachments will no longer be accepted unless
requested by your case officer.

Please specify or provide further information in relation

to where you first heard about us. E.g. name of the event,
social channel, migration agent etc.

Which BSMQ website pages do you find the most useful?

Do you have any comments for improvements to the

BSMQ website?

Any other general comments:

TIQ3650 July 2018

A business unit of Trade & Investment Queensland

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