Form 1

Application forSkilled - Nominated (subclass 190) visa

APPLICANT DETAILS

EOI Number (if any)
Title: / Last Name: / First Name:
Date of birth: / Age: / Country of Birth: / Citizenship: / No. of Dependents:
Passport No.: / Australian Visa Held (if any)
Visa No.:
Expiry Date:
Address: / Tel No (including country code): / Email:

EDUCATION (list from most recent)

Qualification/s / Course / Date Completed / Name of Institution

ASSESSMENT RESULT

Nominated Occupation
ANZCO Code
Assessing Authority (eg ACS, CPA)
Outcome / Positive
Other

ENGLISH TEST RESULT

ListeningReading Writing Speaking Overall

Form 1(cont’d)

EMPLOYMENT HISTORY (list from most recent)

Occupation / Employer / Date Commenced

OTHER INFORMATION

Migration Agent Details (if any)
Name:
MARA Registration No:
Address:
Tel:
Email:

NSW Promotions

Did you meet with a NSW Government representative at a recent Expo or promotional event? Yes No

If yes please advise where and when

Payment

Enclosed is a bank cheque/money orderfor $300 (offshore) or $330 (incl. GST for onshore applicants). I understand that thispayment is non-refundable

Declaration

I declare that the above information is true and accurate and that I am confident I meet all the Commonwealth/NSW criteria for this visa. If granted a Skilled Nominated visa by DIAC, I agree to advise NSW Trade & Investment of my address on arrival in Australia (if not already living in NSW) and within 28 days of any change in home or business address during the term of my visa and respond to NSW Trade & Investment surveys or requests for updated information on employment and settlement in NSW.

______

Applicant’s SignatureDate

For Office Use Only:T&I Reference No. ______

Recommended for State Nomination Not recommended

Anomalies:

Prepared by:Approved by:

______

Form 1 (cont’d)

Skilled Nominated Visa Subclass 190

Request for NSW Government Nomination

New South Wales Nomination (OFFICE USE ONLY)

NSW Trade and Investment offers to nominate

[Name of applicant]

who is applying for general skilled migration under the following occupation

[Occupation]
[ANZSCO Code]

under the Skilled Nominated (Provisional) visa program.

[Signature of authorising officer]
[Name of authorising officer]
[Date]

The offer of nomination is valid till (Date)

The grant of a visa by the Department of Immigration and Citizenship is subject to their assessment of identity, health, character and other legal requirements.

Applications should be posted to:Agency Stamp or Seal:

Manager, Skilled Migration
NSW Trade & Investment
GPO Box 5477
Level 49 MLC Centre
19 Martin Place
SYDNEY NSW 2000
Australia /

1