Please use a pen, and write neatly in English using BLOCK LETTERS. Tick where applicable 3
1 Indicate if you are applying outside Australia or in Australia: Outside Australia Go to Question 2
In Australia Go to Question 5 Applicants outside Australia
2 When do you wish to visit Australia?
DAY MONTH YEAR DAY
Date from to
3 How long do you wish to stay in Australia? Up to 3 months
Up to 6 months
Up to 12 months
Note: The stay period granted may be less than the period requested. You should check the terms of any visa granted.
4 Do you intend to enter Australia on more than one occasion? No Go to Question 7
Yes Give details
6 Provide detailed reasons for requesting this further stay
MONTH
YEAR
Go to Question 7
Applicants in Australia
5 Specify the date you wish to extend your stay to
DAY MONTH YEAR