1417-1

1417 (Design date 07/13) - © COMMONWEALTH OF AUSTRALIA, 2013

Proposal for refugee and special humanitarian entrants by Approved Proposing Organisation

Form

1417

About this formImportant – Please read this information carefully before you complete your proposal. Once you have completed your proposal we strongly advise that you keep a copy for your records.

Who should use this form?This form should be used by Approved Proposing Organisations1 (proposers) seeking to propose visa applicants under the Community Proposal Pilot.

Proposals may be submitted by proposers that have signed a Deed of Agreement with the Department of Immigration and Citizenship (the department).

If you are eligible to propose, you will also need form 842 Application for an Offshore Humanitarian visa to be completed by the visa applicant and submitted together with this form.

All forms are available from the department’s website www.immi.gov.au/allforms/

What is required of an Approved Proposing Organisation?As the Approved Proposing Organisation you will:• ensure payments of the Visa Application Charge (VAC) for

the Refugee and Humanitarian visa are lodged;

• arrange and fund medical assessments that are required for the visa application process;

• arrange and fund airfares to Australia; and• provide services and assistance to humanitarian entrants2

who have arrived in Australia.

‘Information and orientation assistance’ includes assisting the entrant to access:• registration with Centrelink and Medicare;• health services (eg. doctor, dentist and pharmacy);• employment services (eg. Job Services Australia);• education and training services (eg. Adult Migrant English

Program, children’s schooling);• translating and interpreting services;• banking services;• childcare services; and• transport.

As the Approved Proposing Organisation, you may authorise a community organisation (referred to as the Supporting Community Organisation) to fulfil some or all of these requirements including provision of services to the humanitarian entrants. If you are authorising a Supporting Community Organisation to act on your behalf you must complete Part C – Details of Supporting Community Organisation.

Failure to perform your obligations as specified in the Deed of Agreement may adversely affect any future proposals you submit under the Community Proposal Pilot.

Lodgement of formsA valid application under the Community Proposal Pilot comprises a completed form 842 Application for an Offshore Humanitarian visa completed by the visa applicant(s), this form (form 1417) completed by the proposer, and the payment of the first instalment of the VAC. These forms must be lodged by post or courier at the department’s Melbourne Offshore Humanitarian Processing Centre (OHPC). Please refer to the department’s website www.immi.gov.au/fees-charges for payment details.

Before a visa has been grantedThe application will be assessed by the OHPC and transferred to the relevant overseas mission for further processing. Following assessment of the application, the overseas mission will contact the visa applicant(s), and the proposer, advising the applicants to undertake required health assessments, character and security checks.

If the application is assessed as meeting the criteria for the grant of a visa, the overseas mission will contact the visa applicant(s), and the proposer, advising that the final instalment of the VAC must be paid. Details of the amount of the outstanding VAC will also be provided at this time.

After a visa has been grantedIf the visa applicant(s) you are proposing are granted a humanitarian visa, please encourage them to attend the Australian Cultural Orientation Program (AUSCO) to which they will be invited. AUSCO is delivered overseas before people begin their journey to Australia and provides practical advice on living in Australia and giving participants the opportunity to ask questions about travel to and life in Australia.

Integrity of applicationThe department is committed to maintaining the integrity of the visa and citizenship programs. Please be aware that if you or the person you are proposing provide us with fraudulent documents or claims, this may result in processing delays and possibly the application being refused.

Immigration assistanceA person gives immigration assistance to you if he or she uses, or claims to use, his or her knowledge or experience in migration procedure to assist you with your visa application, request for ministerial intervention, cancellation review application, sponsorship or nomination.

1 The Approved Proposing Organisation is an organisation that has entered into a Deed of Agreement with the department.2 An applicant under the Community Proposal Pilot who is granted a Refugee and Special Humanitarian visa and travels to Australia, becomes a ‘humanitarian entrant’ on arrival.


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

Form 956 is available from the department’s website www.immi.gov.au/allforms/

Options for receiving written communicationsIf you do not appoint a migration agent/exempt person you may still authorise another person, in writing, to receive written communications on your behalf. This person is called the authorised recipient.

Authorised recipient information

All written communication about your application will be sent directly to you or your authorised recipient.

The department will communicate with the most recently appointed authorised recipient as you may only appoint one authorised recipient at any time for a particular application.

You will be taken to have received any documents sent to that person as if they had been sent to you.

To appoint an authorised recipient you should complete:

• Part F – Options for receiving written communications; and

• form 956A Appointment or withdrawal of an authorised recipient.

Note: In order for you to receive written communications on behalf of the visa applicants you are proposing you must complete Part F – Options for receiving written communications. The main applicant will need to complete Question 17 and Question 46 on the attached form 842 Application for an Offshore Humanitarian visa.

Note: Migration agents/exempt persons do not need to complete form 956A.

Form 956A is available from the department’s website www.immi.gov.au/allforms/

Consent to communicate electronicallyThe department may use a range of means to communicate with you. However, electronic means such as fax or e-mail will only be used if you indicate your agreement to receiving communication in this way.

To process your application the department may need to communicate with you about sensitive information, for example, health, police checks, financial viability and personal relationships. Electronic communications, unless adequately encrypted, are not secure and may be viewed by others or interfered with.

If you agree to the department communicating with you by electronic means, the details you provide will only be used by the department for the purpose for which you have provided them, unless there is a legal obligation or necessity to use them for another purpose, or you have consented to use for another purpose. They will not be added to any mailing list.

The Australian Government accepts no responsibility for the security or integrity of any information sent to the department over the internet or by other electronic means.

If you authorise another person to receive documents on your behalf and they wish to be contacted electronically, their signature is required on form 956 or 956A to indicate their consent to this form of communication.

Note: Electronic communication is the fastest means of communication available and the department prefers to communicate electronically because this results in faster processing.

In Australia a person may only lawfully give immigration assistance if he or she is a registered migration agent or is exempt from being registered. Only registered migration agents may receive a fee or reward for providing immigration assistance.

If an unregistered person in Australia, who is not exempt from registration, gives you immigration assistance they are committing a criminal offence and may be prosecuted.

Migration agents in Australia

Migration agents in Australia must be registered with the Office of the Migration Agents Registration Authority (Office of the MARA) unless they are exempt from registration.

Migration agents outside Australia

Migration agents who operate outside Australia do not have to be registered. The department may give some overseas agents an ID number. This number does not mean that they are registered.

Note: Some Australian registered migration agents operate overseas.

Migration agent information

A migration agent is someone who can:

• advise you on the visa that may best suit you;

• tell you the documents you need to submit with your application;

• help you fill in the application and submit it; and

• communicate with the department on your behalf.

If you appoint a migration agent, the department will assume that your migration agent will be your authorised recipient, unless you indicate otherwise.

Your migration agent will be the person with whom the department will discuss your application and from whom it will seek further information when required.

You are not required to use a migration agent. However, if you use a migration agent, the department encourages you to use a registered migration agent. Registered agents are bound by the Migration Agents Code of Conduct, which requires them to act professionally in their clients’ lawful best interests.

Information on migration agents, including a list of registered migration agents, is available on the Office of the MARA website www.mara.gov.au

You can also access information about migration agents on the department’s website www.immi.gov.au

Exempt persons

The following people do not have to be a registered migration agent in order to provide immigration assistance, but they must not charge a fee for their service:

• a close family member (spouse, de facto partner, child, parent, brother or sister);

• a member of parliament or their staff;

• an official whose duties include providing immigration assistance (eg. a Legal Aid provider);

• a member of a diplomatic mission, consular post or international organisation.

Appointing a migration agent/exempt person

To appoint a migration agent/exempt person you should complete Part F – Options for receiving written communications.


About the information you giveThe department is authorised to collect information provided on this form under Part 2 of the Migration Act 1958 ‘Control of Arrival and Presence of Non-citizens’. The information provided will be used for assessing the eligibility of persons you have proposed for a Refugee and Humanitarian (Class XB) visa, or may be used to assist in establishing the extent of the visa applicant’s connection with Australia.

Information provided might also be disclosed to other agencies authorised to receive information in relation to foreign affairs, adoption, border control, business skills, citizenship, education, health, law enforcement, taxation, pensions and benefits, service provision to refugees and eligible humanitarian entrants and their proposers, review of decisions and registration of migration agents.

The collection, access, storage, use and disclosure by the department of the information you provide in this form is governed by the Privacy Act 1988. The information form 993i Safeguarding your personal information, available from the departments website www.immi.gov.au/allforms/pdf/993i.pdf gives details about the agencies to which your personal information might be disclosed.

The acknowledgement in Part H of this form enables the department to share the information on this form with parties mentioned above.

Application process

Step 1 – Complete this form

Carefully read and fully complete this form.

Step 2 – Applicants complete and sign application form

The visa applicant(s) you are proposing should fully complete form 842 Application for an Offshore Humanitarian visa, in accordance with the instructions on that form and send it back to you.

Step 3 – Lodge the completed application

Lodge this form (form 1417) (including payment of the first instalment of VAC) and the completed and signed form 842 Application for an Offshore Humanitarian visa at the address specified below.

By Post:

Victoria Offshore Humanitarian Processing Centre GPO Box 241 Melbourne VIC 3001 AUSTRALIA

By Courier (no hand deliveries):

Offshore Humanitarian Processing Centre Department of Immigration and Citizenship 2 Lonsdale Street Melbourne VIC 3000 AUSTRALIA

For further information, please see the information sheet Lodging Certain Humanitarian Applications in Australia available from www.immi.gov.au/visas/humanitarian/offshore/lodging-humanitarian-applications.htm

Note: If you do not lodge the application in accordance with the instructions above, the visa application may be invalid. The department cannot process invalid applications.

Step 4 – Receipt of application

The office processing the visa application will acknowledge receipt of the application accompanying your proposal in writing.

Processing applications can take several months, or longer. If you want information regarding the person you have proposed, you should contact that person directly.

For information on the making and processing of visa applications, see information form 1025i Visa applications.

Step 5 – Health assessment

All applicants for permanent visas, including the main applicant, spouse and any dependants must be assessed against the health criteria. The overseas mission will contact you with the details.

Step 6 – Payment of the final instalment of the VAC and plan for settlement assistance

If all legal requirements are met for grant of the visa the department will send you a letter requesting the payment of the final instalment of the VAC and your plan for settlement assistance.

Step 7 – After a visa has been granted

After the visa has been granted you are required to pay for airfares for the applicant(s).

How to complete this form• Please use a pen, and write neatly in English using BLOCK

LETTERS.

• Tick where applicable.

• Answer all questions truthfully and completely.

• Where there is insufficient space for your answer please continue on a separate page. Clearly mark the separate page with the question number it relates to.

• Sign the form at Part H.

• Lodge this completed proposal, along with application form 842 to the office of the department as specified in Step 3.

• Please take careful note of where and how the application must be delivered to the department, as invalid applications cannot be processed.

For information on how to make a valid application, see information form 1025i Visa applications.

www.immi.gov.auTelephone 131 881 during business hours in Australia to speak to an operator (recorded information available outside these hours). If you are outside Australia, please contact your nearest Australian mission.

Home page

General enquiry line

Please keep these information pages for your reference

www.immi.gov.au/visas/humanitarian/offshore/lodging-humanitarian-applications.htm

This page is intentionally blank


Proposal for refugee and special humanitarian entrants by Approved Proposing Organisation

Form

1417

Part A – Details of the persons you wish to propose for entry to Australia

3Tick where applicable

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

How many people are included in your proposal?1

Give details of the main applicant

How was the main applicant referred to you (give full details)

Precise relationship to the main applicant


2

11

Family name

Family name

Family name

Given names

Given names

Given names

3 Are you aware if the main applicant you are proposing is known by any other names? (such as name at birth, alias, previous married name)

No

Yes Give details

Family name

Given names

5

6

9

7

Sex

Sex

Sex

Male

Male

Male

Female

Female

Female

Date of birth

Date of birth

Date of birth

Date of arrival in current country of residence

DAY MONTH YEAR

DAY MONTH YEAR

DAY MONTH YEAR

DAY MONTH YEAR

Place of birth

Town/city

Country

8

4

Current country of residence

Citizenship (if stateless, write the previous country of citizenship)

10 Relationship status

Relationship status

Relationship status

Married legally

Married legally

Married legally

Married religiously

Married religiously

Married religiously

Married by tradition/custom



De facto

De facto

De facto

Engaged

Engaged

Engaged

Widowed

Widowed

Widowed

Separated

Separated

Separated

Divorced

Divorced

Divorced

Never married or been in a de facto

relationship


relationship


relationship

12

13

Full residential address of the main applicant (not post office box) Please include any United Nations High Commissioner for Refugees () Registration number

Give details of all other dependent family members of the main applicant who are included in this proposal

POSTCODE

1.

2.


Give details

No

Yes

Does the applicant have immediate family in Australia?14




Family name

Family name

Family name

Family name

Family name

Family name

Family name

Family name

Family name

Family name

Given names

Given names

Given names

Given names

Given names

Given names

Given names

Given names

Given names

Given names

Sex

Sex

Sex

Male

Male

Male

Female

Female

Female

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

DAY MONTH YEAR

DAY MONTH YEAR

DAY MONTH YEAR

DAY MONTH YEAR

DAY MONTH YEAR

DAY MONTH YEAR

DAY MONTH YEAR

DAY MONTH YEAR

DAY MONTH YEAR

DAY MONTH YEAR

Relationship status

Relationship status

Relationship status

Married legally

Married legally

Married legally

Married religiously

Married religiously

Married religiously




De facto

De facto

De facto

Engaged

Engaged

Engaged

Widowed

Widowed

Widowed

Separated

Separated

Separated

Divorced

Divorced

Divorced


relationship


relationship


relationship

3.

1.

2.

3.

4.

5.

6.

7.

4.

5.

If insufficient space, attach additional details

If insufficient space, attach additional details


21 Contact telephone numbers of person authorised to sign this form on behalf of the Approved Proposing Organisation

Note: If the contact details of the person authorised to sign this form change before this application is finalised, you must notify the office of the department where the application is being processed.

Office hours ( ) ( )

COUNTRY CODE AREA CODE NUMBER

After hours ( ) ( )

Mobile

22 Does the person authorised to sign this form agree to the department communicating with them by fax, e-mail or other electronic means?

Give details

No

Yes

Fax number

E-mail address

( ) ( )


Part B – Proposer’s details

Name of the Approved Proposing Organisation

Position held by this person in the above organisation

15

20

Australian Business Number (ABN)16

Details of the person authorised to sign this form on behalf of the Approved Proposing Organisation

19

Family name

Given names

17

18

Full street address of Approved Proposing Organisation (not post office box)

POSTCODE

POSTCODE

Postal address (If the same as street address, write ‘AS ABOVE’)

Part C – Details of Supporting Community Organisation

Name of Supporting Community Organisation24

Australian Business Number (ABN)25

Details of the contact person in the Supporting Community Organisation

28

Family name

Given names

26

27

Full street address of Supporting Community Organisation (not post office box)

POSTCODE

POSTCODE

Postal address (If the same as street address, write ‘AS ABOVE’)

(AREA CODE )Office hours telephone

E-mail address

Give details of the Supporting Community Organisation’s experience in providing settlement assistance to humanitarian entrants

29

Go to Part DNo

Yes

Is there a Supporting Community Organisation?23


Give the names and/or roles of people who will be assisting with the plan for settlement assistance and outline the tasks they have been allocated

Note: It is important that volunteers understand what is required of them and have the appropriate checks completed as specified in the Deed of Agreement.

31

Give details of the plan for settlement assistance you have for settling the entrants, for example, accommodation, arrangements made for youths, useful programs or networks to assist entrants in education and employment and to integrate socially

Part D – Settlement assistance

30

Please give details of the person who assisted you

No

Yes

32 Did you receive assistance in completing this form?

Part E – Assistance with this form

Go to Part F

Family name

Given names

Title: Mr Mrs Miss Ms Other

POSTCODE

Address

Telephone number or daytime contact

( ) ( )


Office hours

Mobile

33 Is the person an agent registered with the Office of the Migration Agents Registration Authority (Office of the MARA)?

No

Yes Go to Part F

No

Yes

Go to Part F

No

34 Is the person/agent in Australia?

35 Did you pay the person/agent and/or give a gift for this assistance?

Part F – Options for receiving written communications

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

Myself

You should complete form 956A Appointment or withdrawal of an authorised recipient

Authorised recipient

Migration agent

Exempt person

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

OR

OR

OR

Yes


37

Part G – Payment details

Give details below

Bank cheque

Credit card

MasterCard

American Express

Visa

Diners Club

JCB

Payment by (tick one box) Australian Dollars

AUD

Credit card number

:

: : : :

MONTH

:

: : : : : : : : : : : : : :

YEAR

Expiry date

Cardholder’s name

Address

POSTCODE

Signature of cardholder

Credit card information will be used for charge paying purposes only.

Telephone number

( ) ( )


How will the visa application charge be paid?

Payment is accepted by bank cheque or credit card only. If paying by bank cheque please make payable to the Department of Immigration and Citizenship.

Please make payable to: Department of Immigration and Citizenship

38

• is responsible for ensuring the payment of medical assessment fees, airfares, and Visa Application Charges for the entrants proposed at Part A;

• is responsible for performing its obligations as specified in the Deed of Agreement for the applicant(s) proposed at Part A.

I declare that the details provided on this form are correct.

I give permission for the information in this form to be shared with relevant Commonwealth and state agencies and service providers engaged by the Australian Government to assist in the settlement of humanitarian entrants.

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

Signature of authorised representative of Approved Proposing Organisation

DateDAY MONTH YEAR

We strongly advise that you keep a copy of your application and all attachments for your records.

I acknowledge that the organisation I represent:

Part H – Acknowledgement

This acknowledgement must be completed by the person authorised to sign on behalf of the Approved Proposing Organisation nominated at Part B.

Full name (block letters)

1417-1

Documents