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: VIETNAM
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: Other
Give details of any significant dates on which the applicant needs to be in Australia:
1. August 2st, 2025
2. October 8th, 2025
Group processing

Is this application being lodged as part of a group of applications?

No

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This form submitted by : hkanhkhoa1311@[Link]
Role(s) : Self-registered user
Submitted on : 20/05/2025 20:58

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Special category of entry

Is the applicant travelling as a representative of a foreign government, or travelling on a United

Nations Laissez-Passer?
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: Hoang
Given names: Kim Anh Khoa
Sex: Male
Date of birth: 12 Jan 2002
Passport number: C7456844
Country of passport: VIET NAM - VNM
Nationality of passport holder: VIET NAM - VNM
Date of issue: 27 May 2019
Date of expiry: 27 May 2029
Place of issue / issuing Immigration Department
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: Hoang
Given names: Kim Anh Khoa
Identification number: 051202012267
Country of issue: VIETNAM
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: 09 May 2021
Date of expiry: 12 Jan 2027

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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?
No
Place of birth

Town / City: Quang Ngai

State / Province: Quang Ngai
Country of birth: VIETNAM
Relationship status

Relationship status: Never Married

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 (VIET NAM)?

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?
No

Other identity documents

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Does this applicant have other identity documents?

Yes

Other identity documents

Enter details exactly as shown on the identity document.

Family name: Hoang

Given names: Kim Anh Khoa
Type of document: Birth certificate
Identification number: TP/HT-1999-A.2-04
Country of issue: VIETNAM
Other identity documents
Enter details exactly as shown on the identity document.

Family name: Hoang

Given names: Kim Anh Khoa
Type of document: Drivers licence
Identification number: 510218003457
Country of issue: VIETNAM
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: Hoang

Given names: Kim Anh Khoa
Sex: Male
Date of birth: 12 Jan 2002
Country of birth: VIETNAM
Passport number: C7456844
Country of passport: VIET NAM - VNM

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Is the above information Yes

correct?
Travelling companions
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: VIETNAM

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: Vietnam, Ho Chi Minh City

Residential address
Note that a street address is required. A post office address cannot be accepted as a residential
address.
Country: VIETNAM
Address: 190 Chu Van An
Ward 26
Suburb / Town: Binh Thanh District
State or Province: HO CHI MINH (SAI GON)
Postal code: 72300
Contact telephone numbers
Enter numbers only with no spaces.
Home phone: 0916006601
Business phone:
Mobile / Cell phone: 0916006601
Postal address

Is the postal address the same as the residential address?

Yes

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Email address

Email address: hkanhkhoa1311@[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: hkanhkhoa1311@[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 6 months
Planned arrival date: 02 Aug 2025
Planned final departure date: 11 Aug 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.
Does the applicant know the dates of entry for each occasion after first entry to Australia?

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Yes
Give details of the additional entry.
Date from: 08 Oct 2025
Date to: 16 Oct 2025
Give reason: Girlfriend's birthday and tourism
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: Friend

Contact's details

Family name: Phan

Given names: Le Truc Vy
Sex: Female
Date of birth: 11 Oct 2005
Residential address
Note that a street address is required. A post office address cannot be accepted as a residential
address.
Country: AUSTRALIA
Address: 108-128 Leicester Streeet
Suburb / Town: Carlton
State / Territory: Victoria
Postcode: 3053
Contact telephone numbers
Enter numbers only with no spaces.
Home phone:
Business phone:
Mobile / Cell phone: 0451757095

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Electronic communication

Email address: victoriaphanle@[Link]

Australian residency status

Australian residency status: Australian Temporary Resident (Student)

Visa applicant's current overseas employment

Current employment details

Employment status: Employed

Occupation grouping: Community and Personal Service Workers
Organisation: Babylons Joint Stock Company
Start date with current 26 Apr 2024
employer:
Organisation address
Note that a street address is required. A post office address cannot be accepted as an organisation
address.
Country: VIETNAM
Address: Room 16.34, Block G3, Vinhomes Greenbay
Luong The Vinh Street, Me Tri Ward
Suburb / Town: Nam Tu Liem District
State or Province: HA NOI
Postal code: 12000
Contact telephone numbers
Enter numbers only with no spaces.
Business phone:
Mobile / Cell phone: 0913904626
Electronic communication

Email address: [Link]@[Link]

Financial support

Funding details

Give details of how the applicant's stay in Australia will be funded:

Self funded

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What funds will the applicant Bank statement and bank account saving statement
have available to support their
stay in Australia?
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.
If the matter relates to a criminal conviction, provide:
• the date and nature of the offence

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• 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
Has any applicant ever undergone any military/paramilitary training, been trained in weapons/
explosives or in the manufacture of chemical/biological products?
No

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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?
Yes
Give details: 1. USA Visa
Passport: B9227125
Control number: 20141920330007
Date: 10/07/2015 - 08/07/2016
2. USA Visa
Passport: B9227125
Control number: 20172216070008
Date: 15/08/2017 - 13/08/2018
3. USA Visa
Passport: C7456844
Control number: 20191913460001
Date: 12/07/2019 - 09/07/2020
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

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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.
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:

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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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Supporting evidence

Applicant 1 - Kim Anh Khoa Hoang (12 Jan 2002)

Evidence type Document type Description Date received Filename
Evidence of the financial status and Bank Statement - Personal Bank, Credit card 20/05/2025 Bank Statement_Hoang Kim Anh
funding for visit and Saving account [Link]
Family register and composition Other (specify) Birth Certificate 20/05/2025 Birth Certificate_Hoang Kim Anh
form (if applicable) [Link]
Invitation from family, friends or Other (specify) Accommodation of 20/05/2025 Confirmation Of
organisations Girlfriend Accomodation_Phan Le Truc
[Link]
Evidence of the financial status and Other (specify) Credit Card 20/05/2025 Credit Card Statement_Hoang
funding for visit Statement Kim Anh [Link]
Family register and composition Other (specify) Details of Relatives 20/05/2025 Details of Relatives [Link]
form (if applicable) Form
Evidence of planned tourism Itinerary Flight Information 20/05/2025 Flight Information_Hoang Kim
activities in Australia Anh [Link]
Invitation from family, friends or Other (specify) IMMI Grant 20/05/2025 IMMI Grant [Link]
organisations Notification of
Girlfriend
Invitation from family, friends or Other (specify) Invitation from 20/05/2025 Invitation for Hoang Kim Anh
organisations girlfriend [Link]
Evidence of current employment or Other (specify) Labor Contract 20/05/2025 Labor Contract_Hoang Kim Anh
self-employment [Link]
National Identity Document (other National ID Card Translated and 20/05/2025 National ID_Back_Hoang Kim
than Passport) nortarized Anh [Link]
National Identity Document (other National ID Card Translated and 20/05/2025 National ID_Front_Hoang Kim
than Passport) nortarized Anh [Link]
Family register and composition Family Book/Household Booklet/ Translated and 20/05/2025 Nortarized Family Book_Hoang
form (if applicable) Family Composition Evidence nortarized Kim Anh [Link]
National Identity Document (other National ID Card Translated and 20/05/2025 Notarized National ID_Hoang
than Passport) nortarized Kim Anh [Link]
Travel Document Other (specify) Expired Passport 20/05/2025 Old Passport_Hoang Kim Anh
[Link]
Evidence of the financial status and Other (specify) Saving Account 20/05/2025 Orignal Document_Confirmation
funding for visit Statement Of Saving_Hoang Kim Anh
[Link]
Travel Document Passport 20/05/2025 Passport_Hoang Kim Anh
[Link]
Invitation from family, friends or Other (specify) Passport of Girlfriend 20/05/2025 Passport_Phan Le Truc [Link]
organisations
National Identity Document (other National ID Card 20/05/2025 Picture_Back_Hoang Kim Anh
than Passport) [Link]
National Identity Document (other National ID Card 20/05/2025 Picture_Front_Hoang Kim Anh
than Passport) [Link]
Invitation from family, friends or Other (specify) Our Proof of 20/05/2025 Proof of Relationship_Hoang Kim
organisations Relationship Anh Khoa & Phan Le Truc [Link]
Evidence of current employment or Evidence of Leave Together with labor 20/05/2025 Request for Leave Approval_Trip
self-employment contract to [Link]
Invitation from family, friends or Other (specify) Student Confirmation 20/05/2025 Student Confirmation_Phan Le
organisations of Girlfriend Truc [Link]
Invitation from family, friends or Other (specify) Student ID of 20/05/2025 Student ID_Phan Le Truc [Link]
organisations Girlfriend

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Evidence of the applicant's previous Entry/exit stamped pages of the Passport no 20/05/2025 USA Visa with Immigration
travel expired passport B9227125 Stamp_Hoang Kim Anh [Link]
Evidence of the applicant's previous Visa documentation USA Visa_August 20/05/2025 USA Visa_Aug2018_Hoang Kim
travel 2018 Anh [Link]
Evidence of the applicant's previous Visa documentation USA Visa_July 2016 20/05/2025 USA Visa_Jul2016_Hoang Kim
travel Anh [Link]
Evidence of the applicant's previous Visa documentation USA Visa_July 2020 20/05/2025 USA Visa_Jul2020_Hoang Kim
travel Anh [Link]

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