First Name *
Family Name *
Visa Type * 12-Month Working Holiday Visa6-Month Tourist Visa3-Month Tourist Visa
Gender * Please selectMaleFemale
Date of Birth *
Town / City of Birth *
State / Province of Birth *
Country of Birth *
Your Current Residential Address *
Current Residential State / Province *
Current Residential Postcode *
Current Residential Town / City *
Current Residential Country *
National identity card number, if applicable
Passport Number *
Passport Country *
Passport Nationality *
Passport Date of Issue *
Passport Date of Expiry *
Passport Place of Issuing Authority *
Please list all your citizenship(s) currently held *
Phone Number *
Email Address *
Marital status * Please selectMarriedDe FactoSame-sex coupleEngaged to be marriedDivorcedSeparatedWidowedNever married
Planned Arrival Date in Australia *
What is your current occupation? *
Type of employment you seek during your stay *
What is your Highest Education? * Please selectHigher DegreeDegreeDiplomaTraining or Technical CertificateCollege DegreeSenior High School CertificateJunior High School Certificate
Institution at which you are enrolled or have graduated from (USA citizens only)
Evidence of Education (USA citizens only) Please selectConfirmation of enrolment into post secondary educationLetter of defermentCertificate of achievement / GraduationAcademic transcriptAcademic record
Qualification Status (USA citizens only) Please selectAccepted and deferredEnrolled and deferredCurrently enrolledGraduated
Education provider type (USA citizens only) Please selectHigh schoolUniversityTertiary collegeTechnical education institutionOther training institution
Education provider address (USA citizens only)
Do you have a return or onward ticket or the funds for a fare to depart Australia? * Please selectYesNo
Have you previously been to Australia and applied for a visa? If yes, give details & list your visa grant number(s) *
Have you ever had an Australia visa refused or cancelled? If yes, give details *
Do you currently hold an Australian visa? If yes, give details *
In the last 5 years, have you visited, or lived, outside your country of passport for more than 3 consecutive months? If yes, give details and dates *
Do you intend to enter a hospital or a health care facility (including nursing homes) while in Australia? If yes, give details *
Do you intend to work as, or study to be, a doctor, dentist, nurse or paramedic during your stay in Australia? If yes, give details *
Do you intend to work, or be a trainee, at a child care centre (including preschools and creches) while in Australia? If yes, give details *
Do you intend to be in a classroom situation for more than 3 months (eg. as either a student, teacher, lecturer, or observer)? If yes, give details *
Have you ever had, or currently have, tuberculosis, been in close contact with a family member that has active tuberculosis, ever had a chest x-ray which showed an abnormality? If yes, give details *
During your proposed visit to Australia, do you expect to incur medical costs, require treatment or medical follow up? (i.e. for blood disorder, cancer, heart disease, pregnancy, etc.) If yes, give details *
Do you require assistance with mobility or care due to a medical condition? If yes, give details *
Have you undertaken a health examination for an Australian visa in the last 12 months? If yes, give details *
Do you hold health insurance to cover your stay in Australia? * Please selectYesNo
Have you been convicted of a crime or offence in any country (including any conviction which is now removed from official records)? If yes, give details *
Have you been charged with any offence that is currently awaiting legal action? If yes, give details *
Have you been acquitted of any criminal offence or other offence on the grounds of mental illness, insanity or unsoundness of mind? If yes, give details *
Have you been removed or deported from any country (including Australia)? If yes, give details *
Have you left any country to avoid being removed or deported? If yes, give details *
Have you been refused a visa for Australia or another country? If yes, give details *
Have you been excluded from or asked to leave any country (including Australia)? If yes, give details *
Have you committed, or been involved in the commission of war crimes or crimes against humanity or human rights abuses? If yes, give details *
Have you been involved in any activities that would represent a risk to Australian national security? If yes, give details *
Have you had any outstanding debts to the Australian Government or any public authority in Australia? If yes, give details *
Have you been involved in any activity, or been convicted of any offence, relating to the illegal movement of people to any country (including Australia)? If yes, give details *
Have you served in a military force or state sponsored/private militia, undergone any military/paramilitary training, or been trained in weapons/explosives use (however described) other than in the course of compulsory national military service? If yes, give details *
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IN BECOMING AN ULTIMATE AGENT
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TERMS & CONDITIONS OF ENTRY
This Competition is open to all Ultimate Travel customers. Posts must have been published from 01 Jan 2019 onwards, be original content captured or produced by the traveller and must be posted to a personal Instagram account. Qualifying entries must be deemed by Ultimate Travel to reflect the style of Ultimate’s brand and reflect experiences accessible by Ultimate customers. Posts with no association to Ultimate will not qualify. The winning post will be decided at the discretion of Ultimate Adventure Travel Pty Ltd. If you qualify for a prize, your acceptance of the prize consents Ultimate to a worldwide license to use the image within its marketing material and promotional activities. Entries must include the relevant Ultimate Travel hashtags at the time of posting. These must be clearly displayed and not hidden after bulk text or hashtags. Winners must be following Ultimate Travel on Instagram. Ultimate Travel reserve the right to withdraw and end this competition at any time.
THANK YOU FOR YOUR ENTRY!
YOU'RE NOW IN THE RUNNING TO WIN A SPOT ON OUR 10-DAY ULTIMATE BALI TOUR FOR YOU & A MATE!
THE WINNER WILL BE NOTIFIED ON 4TH MARCH 2019.
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