OFFICIAL: Sensitive
Personal Privacy
Department of Home Affairs Record of
Application for a Visitor Short Stay Visa Responses
Terms and Conditions
View Terms and Conditions View Privacy statement
I have read and agree to the terms and conditions
Yes
Application context
Current location
Is the applicant currently outside Australia?
Yes
Give the current location of the applicant and their legal status at this location.
Current location: BANGLADESH
Legal status: Citizen
Purpose of stay
Select the stream the applicant is applying for:
Tourist stream (tourism/visit family or friends)
Note: Once the application has been lodged, the stream cannot be changed. For more information on
each stream, click on the help icon above.
List all reasons for visiting Tourism
Australia:
Give details of any significant dates on which the applicant needs to be in Australia:
Please provide the detailed information regarding the important
dates on which the applicant is required to be in Australia,
specifically on 17 October
Group processing
Is this application being lodged as part of a group of applications?
No
Special category of entry
Is the applicant travelling as a representative of a foreign government, travelling on a United Nations
Laissez-Passer or a member of an exempt group?
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Application for a Visitor Short Stay Visa
No
Applicant
Information: Entering names incorrectly may result in denial of permission to board an aircraft to
Australia, or result in delays in border processing on arrival to Australia, even if the applicant has
been granted a visa.
Passport details
Enter the following details as they appear in the applicant's personal passport.
Family name: FARJANA WADUD
Given names: NIRJANA
Sex: Female
Date of birth: 05 Jul 2000
Passport number: A18781085
Country of passport: BANGLADESH - BGD
Nationality of passport holder: BANGLADESH - BGD
Date of issue: 21 May 2025
Date of expiry: 20 May 2035
Place of issue / issuing DHAKA
authority:
It is strongly recommended that the passport be valid for at least six months.
National identity card
Does this applicant have a national identity card?
Yes
National identity card
Enter details exactly as shown on the national identity card.
Family name: NIRJANA
Given names: FARJANA WADUD
Identification number: 8715340553
Country of issue: BANGLADESH
Note: If the National identity card does not have a Date of issue or a Date of expiry, do not enter a
date. Leave the field/s blank.
Date of issue:
Date of expiry:
Pacific-Australia Card
The Pacific-Australia Card is issued through an invitation process to Pacific leaders. If the applicant
does not hold a Pacific-Australia Card, select 'No' for this question.
Is the applicant a Pacific-Australia Card holder?
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Application for a Visitor Short Stay Visa
No
Place of birth
Town / City: AKUA MAROL BARI, KOTWALI,
State / Province: MYMENSINGH SADAR
Country of birth: BANGLADESH
Relationship status
Relationship status: Engaged
Other names / spellings
Is this applicant currently, or have they ever been known by any other names?
No
Citizenship
Is this applicant a citizen of the selected country of passport (BANGLADESH)?
Yes
Is this applicant a citizen of any other country?
No
Previous travel to Australia
Has this applicant previously travelled to Australia?
No
Has this applicant previously applied for a visa to Australia?
No
Grant number
Does this applicant have an Australian visa grant number?
No
Other passports or documents for travel
Does this applicant have any other passports or documents for travel?
Yes
Does the applicant intend to travel on a United Nations Laissez-Passer?
No
Give details of any other non United Nations passports or documents for travel that might have been
previously used to travel to Australia.
Other passport or document for travel
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Application for a Visitor Short Stay Visa
Type of document: Passport
Enter details as shown on the passport.
Name: FARJANA WADUD, Nirjana
Sex: Female
Date of birth: 05 Jul 2000
Passport number: A18781085
Country of issue: BANGLADESH - BGD
Nationality of passport holder: BANGLADESH - BGD
Date of issue: 21 May 2025
Date of expiry: 20 May 2035
Place of issue / issuing DHAKA
authority:
Other identity documents
Does this applicant have other identity documents?
No
Health examination
Has this applicant undertaken a health examination for an Australian visa in the last 12 months?
No
Critical data confirmation
All information provided is important to the processing of this application.
If the information included on this page is incorrect, it may lead to denial of permission to board an
aircraft to Australia, even if a visa has been granted.
Confirm that the following information is correct and that it is in the correct fields.
Family name: FARJANA WADUD
Given names: NIRJANA
Sex: Female
Date of birth: 05 Jul 2000
Country of birth: BANGLADESH
Passport number: A18781085
Country of passport: BANGLADESH - BGD
Is the above information Yes
correct?
Travelling companions
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Application for a Visitor Short Stay Visa
Each person travelling to Australia must submit a separate visitor visa application. This includes
children and other family members. Listing a person's name on this page does NOT mean that the
person has applied for a visa.
Are there any other persons travelling with the applicant to Australia?
No
Contact details
Country of residence
Usual country of residence: BANGLADESH
Department office
The applicant may be required to attend an Australian Government Office for an interview. Which is
the closest office to the applicant’s current location?
Office: Bangladesh, Dhaka
Residential address
Note that a street address is required. A post office address cannot be accepted as a residential
address.
Country: BANGLADESH
Address: AKUA MAROL BARI,
KOTWALI
Suburb / Town: MYMENSINGH SADAR
State or Province: MYMENSINGH
Postal code: 2200
Contact telephone numbers
Enter numbers only with no spaces.
Home phone: 01789052124
Business phone: 01777262626
Mobile / Cell phone: 01312499503
Postal address
Is the postal address the same as the residential address?
No
Country: BANGLADESH
Address: HOUSE 935/936
ROAD-15 BLOCK I
Suburb / Town: BASHUNDHARA
State or Province: DHAKA
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Application for a Visitor Short Stay Visa
Postal code: 1229
Email address
Email address: sultanasabira57@[Link]
Authorised recipient
Does the applicant authorise another person to receive written correspondence on their behalf?
This authorises the department to send the authorised person all written correspondence that would
otherwise be sent directly to the applicant.
No
This person is referred to as the 'authorised recipient'.
Electronic communication
The Department prefers to communicate electronically as this provides a faster method of
communication.
All correspondence, including notification of the outcome of the application will be sent to:
Email address: sultanasabira57@[Link]
Note: The holder of this email address may receive a verification email from the Department if the
address has not already been verified. If the address holder receives a verification email, they should
click on the link to verify their address before this application is submitted.
Non-accompanying members of the family unit
Does the applicant have any members of their family unit not travelling to Australia who are not
Australian citizens or Australian permanent residents?
No
Entry to Australia
Proposed period of stay
Does the applicant intend to enter Australia on more than one occasion?
Yes
How long does the applicant plan to stay in Australia?
Note: If the applicant intends to enter Australia more than once, select the longest period they plan to
stay in Australia on a single visit.
Length of stay in Australia: Up to 3 months
Planned arrival date: 17 Oct 2025
Planned final departure date: 17 Nov 2025
Note: If granted, the stay period may be less than the period requested. The applicant should check
the Grant Notification Letter to confirm their period of stay in Australia.
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Application for a Visitor Short Stay Visa
Does the applicant know the dates of entry for each occasion after first entry to Australia?
Yes
Give details of the additional entry.
Date from: 17 Oct 2025
Date to: 17 Nov 2025
Give reason: This itinerary covers Australia's highlights within five weeks,
balancing major cities, natural wonders, and leisure. It ensures
visits to Sydney, Melbourne, Cairns, Brisbane, Adelaide, Perth,
and Hobart, offering culture, adventure, and relaxation in one
complete journey.
Study while in Australia
Will the applicant undertake a course of study in Australia?
No
Relatives, friends or contacts in Australia
Will the applicant visit any relatives, friends or contacts while in Australia?
Yes
Contact in Australia
Relationship to applicant
Relationship to the applicant: Sister
Contact's details
Family name: BRISHTY
Given names: WASIMA FARIHA
Sex: Female
Date of birth: 12 Jun 1995
Residential address
Note that a street address is required. A post office address cannot be accepted as a residential
address.
Country: AUSTRALIA
Address: 25 A ROOKWOOD RD
YAGOONA
Suburb / Town: YAGOONA NSW
State / Territory: New South Wales
Postcode: 2199
Contact telephone numbers
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Application for a Visitor Short Stay Visa
Enter numbers only with no spaces.
Home phone:
Business phone:
Mobile / Cell phone: 0404123980
Electronic communication
Email address: [Link]@[Link]
Australian residency status
Australian residency status: Other
Visa applicant's current overseas employment
Current employment details
Employment status: Student
Student course details
Give details of the course the applicant is undertaking.
Course name: M.B.B.S STUDENT
Institution name: UNITED MEDICAL COLLAGE
Date from: 16 Jan 2019
Date to: 01 Jun 2025
Financial support
Funding details
Give details of how the applicant's stay in Australia will be funded:
Supported by other person
Type of support: All costs
What funds will the applicant My sister will bear all of expense in staying Australia and I
have available to support their have also enough Bank balance and my husband will also give
stay in Australia? me enough financial support for this purpose. I will Attach bank
statement of my husband and me.
Relationship to applicant
Give details of the person that will provide support to the applicant.
Relationship to the applicant: Sister
Family name: BRISHTY
Given names: WASIMA FARIHA
Country: AUSTRALIA
Address: 25 A ROOKWOOD
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YAGOONA
Suburb / Town: YAGOONA NSW
State / Territory: New South Wales
Postcode: 2199
Health declarations
In the last five years, has any applicant visited, or lived, outside their country of passport, for more
than 3 consecutive months? Do not include time spent in Australia.
No
Does any applicant intend to enter a hospital or a health care facility (including nursing homes) while
in Australia?
No
Does any applicant intend to work as, or study or train to be, a health care worker or work within a
health care facility while in Australia?
No
Does any applicant intend to work, study or train within aged care or disability care while in Australia?
No
Has any applicant:
• 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?
No
During their proposed visit to Australia, does any applicant expect to incur medical costs, or require
treatment or medical follow up for:
• blood disorder
• cancer
• heart disease
• hepatitis B or C and/or liver disease
• HIV infection, including AIDS
• kidney disease, including dialysis
• mental illness
• pregnancy
• respiratory disease that has required hospital admission or oxygen therapy
• other?
No
Does any applicant require ongoing medical care or need special equipment, assistive technology or
assistance from others for daily living?
No
Character declarations
If the applicant answers ‘Yes’ to any of the character declarations they must give all relevant details.
For combined applications, state which applicant the declaration applies to.
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Application for a Visitor Short Stay Visa
If the matter relates to a criminal conviction, provide:
• the date and nature of the offence
• full details of the sentence
• dates of any period of imprisonment or other detention.
Has any applicant ever been charged with any offence that is currently awaiting legal action?
No
Has any applicant ever been convicted of an offence in any country (including any conviction which is
now removed from official records)?
No
Has any applicant ever been the subject of a domestic violence or family violence order, or any other
order, of a tribunal or court or other similar authority, for the personal protection of another person?
No
Has any applicant ever been the subject of an arrest warrant or Interpol notice?
No
Has any applicant ever been found guilty of a sexually based offence involving a child (including
where no conviction was recorded)?
No
Has any applicant ever been named on a sex offender register?
No
Has any applicant ever been acquitted of any offence on the grounds of unsoundness of mind or
insanity?
No
Has any applicant ever been found by a court not fit to plead?
No
Has any applicant ever been directly or indirectly involved in, or associated with, activities which
would represent a risk to national security in Australia or any other country?
No
Has any applicant ever been charged with, or indicted for: genocide, war crimes, crimes against
humanity, torture, slavery, or any other crime that is otherwise of a serious international concern?
No
Has any applicant ever been associated with a person, group or organisation that has been or is
involved in criminal conduct?
No
Has any applicant ever been associated with an organisation engaged in violence or engaged in
acts of violence (including war, insurgency, freedom fighting, terrorism, protest) either overseas or in
Australia?
No
Has any applicant ever served in a military force, police force, state sponsored / private militia or
intelligence agency (including secret police)?
No
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Application for a Visitor Short Stay Visa
Has any applicant ever undergone any military/paramilitary training, been trained in weapons/
explosives or in the manufacture of chemical/biological products?
No
Has any applicant ever been involved in people smuggling or people trafficking offences?
No
Has any applicant ever been removed, deported or excluded from any country (including Australia)?
No
Has any applicant ever overstayed a visa in any country (including Australia)?
No
Has any applicant ever had any outstanding debts to the Australian Government or any public
authority in Australia?
No
Visa history
Has the applicant held or does the applicant currently hold a visa to Australia or any other country?
No
Has the applicant ever been in Australia or any other country and not complied with visa conditions or
departed outside their authorised period of stay?
No
Has the applicant ever had a visa for Australia or any other country refused or cancelled?
No
Declarations
Warning:
Giving false or misleading information is a serious offence.
The applicants declare that they:
Have read and understood the information provided to them in this application.
Yes
Have provided complete and correct information in every detail on this form, and on any attachments
to it.
Yes
Understand that if any fraudulent documents or false or misleading information has been provided
with this application, or if any of the applicants fail to satisfy the Minister of their identity, the
application may be refused and the applicant(s), and any member of their family unit, may become
unable to be granted a visa for a specified period of time.
Yes
Understand that if documents are found to be fraudulent or information to be incorrect after the grant
of a visa, the visa may subsequently be cancelled.
Yes
Will inform the Department in writing immediately as they become aware of a change in
circumstances (including change of address) or if there is any change relating to information they
have provided in or with this application, while it is being considered.
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Application for a Visitor Short Stay Visa
Yes
Have read the information contained in the Privacy Notice(Form 1442i).
Yes
Understand that the department may collect, use and disclose the applicant's personal information
(including biometric information and other sensitive information) as outlined in the Privacy
Notice(Form 1442i).
Yes
Understand that if a no further stay 8503 condition is imposed on this visa, it will limit the ability to
remain in Australia beyond the authorised period of stay of the visa.
Yes
Agree not to undertake study or training for more than three months.
Yes
Agree to leave Australia on or before the expiry of the period of stay of the visa.
Yes
Give consent to the collection of their fingerprints and facial image if required.
Yes
Understand that, if required to provide their fingerprints and facial image, the applicant's fingerprints
and facial image and biographical information held by the Department may be given to Australian law
enforcement agencies to help identify the applicant and determine eligibility for grant of the visa being
applied for, and for law enforcement purposes.
Yes
Give consent to Australian law enforcement agencies disclosing the applicant's biometric,
biographical and criminal record information to the Department to help identify the applicant, to
determine eligibility for grant of a visa and for law enforcement purposes.
Yes
Understand that the Visitor visa does not permit them to work in Australia.
Yes
Give consent to the Department using the applicant's biometric, biographical and criminal record
information obtained for the purposes of the Migration Act 1958 or the Citizenship Act 2007.
Yes
As an applicant:
I understand that if my visa ceases to be in effect and I do not hold another visa to remain in Australia
at that time, I will be an unlawful non-citizen under the Migration Act 1958. As such, I will be expected
to depart from Australia, and be subject to removal under the Migration Act 1958.
Yes
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