Payment invoice/receipt no. ______
Application for Western Australian State Nomination
Business Innovation and Investment (Provisional) visa (subclass 188)
– Significant Investor Extension Stream
Attached is my completed State Nomination application form, including (X):
Copy of passport bio-data page (and evidence of visa expiry date)
Evidence of complying investment and maturity date
Completed Form 1414
Applicant declaration
I declare that
· All of the information contained in my application is correct; and
· I have assessed myself against the Department of Home Affairs 188 Business Innovation SIV Extension Stream criteria and believe I meet all the requirements.
Name of applicant: ______
Signature of applicant: ______
Dated (dd/mm/yyyy): ______
Migration agent declaration (if applicable)
As the appointed migration agent for the above named applicant I declare that
· to the best of my knowledge the information contained in the application is correct;
· I have assessed the applicant against the Department of Home Affairs 188 Business Innovation SIV Extension Stream criteria and believe he/she meets all the requirements; and
· the applicant has read and understands the content of this application.
Name of migration agent: ______
Signature of migration agent:: ______
Dated (dd/mm/yyyy): ______
Please note: The Business Migration Centre reserves the right to request applicants, agents or representatives of applicants for State nomination to formally attest to the accuracy of the information contained in this application or its attachments.
Please send your application to:Business Migration Centre
Small Business Development Corporation
GPO Box C111
Perth Western Australia 6001 / Telephone: (+618) 6552 3300
Facsimile: (+618) 6552 3399
Email:
WESTERN AUSTRALIAN GOVERNMENT
STATE NOMINATION APPLICATION FORM
188 Significant Investor visa – Extension Stream
Applicant Details:
Family Name:
Given Names:
Gender: M / F Date of birth (dd/mm/yyyy): ____ Age: _
Were you the primary applicant for your provisional visa? Yes No
If no, please provide the full name of the primary visa holder:
Family Name: Given Name:
Applicant’s Address:
Postcode:
Telephone: Mobile:
Email address:
Current Australian visa held (subclass):
Date your current visa was granted: ______
Expiry date of your current visa: ______
Passport number: Country of issue:
Date of issue of passport (dd/mm/yyyy):
Have you applied for nomination from any other Australian State or Territory government? Yes No
If yes, name of State or Territory government:
Migration Agent Details:
Are you using the services of a migration agent? Yes No
If yes, please provide migration agent details:
Migration agent name:
Business Name: ______
Postal Address:
Postcode:
Telephone: Mobile: Office:
Email address:
Statement of Assets and Liabilities
Name: Statement date (dd/mm/yyyy):
Note: Currency must be in Australian dollars.
Please include all your assets held in Western Australia.
Please mark your assets or liabilities that are NOT in Western Australia with a ‘X’.
.
ASSETS / AUD $ / LIABILITIES / AUD $Family home / Home mortgage
Investment property / Investment loan
Household contents / Personal loan
Motor vehicle / Other loans
Net assets in business / Other(s) (please list)
Superannuation
Cash in the bank
Term deposits
Shares or other managed investments
Other(s) (please list)
TOTAL ASSETS / $ / TOTAL LIABILITIES / $
NET ASSETS
(Business and personal assets held in Western Australia / $
Business Innovation and Investment (Provisional) visa (subclass 188)
– Significant Investor Extension Stream
State nomination applicants must demonstrate they meet the Department of Home Affairs criteria for the SIV188 Extension.
Extend your stay: the Significant Investor stream
You can apply to extend your stay for an extra two years under a Significant Investor Extension stream. You can apply for this extension stream twice, giving you a maximum of eight years on this provisional visa.
To be eligible for this extension stream:
· you must already hold a visa in the Significant Investor stream, and either:
o have had it for at least three years, or
o have not held more than one visa in the Significant Investor Extension stream
· you must have a current nomination from a state or territory government agency
· you must have a genuine intention to live in the nominating state or territory
· you must have continuously maintained your complying investment or complying significant investment in accordance with complying investment framework in place at the time you applied for your original subclass 188 visa.
Please confirm that you meet the following requirements:
1. Are you the holder of a Business Innovation and Investment (Provisional) visa (subclass 188) Significant Investor Stream?
Yes No
2. Have you held this visa for at least three years?
Yes No
3. Have you held more than one visa in the Significant Investor Extension Stream?
Yes No
4. Do you hold a current nomination from a State/Territory Government agency?
Yes No
5. If yes, from which State/Territory Government agency?
______
6. Please advise in which Australian State you currently reside.
______
7. Have you continuously maintained your complying investment in accordance with the complying investment framework in place at the time you applied for your original subclass 188 visa.
Yes No
8. Please provide details of your current complying investments.
9. Please demonstrate your commitment tomaintain your complying investment in Western Australia upon maturity of your investment.
10. Please advise the reasons why you are seeking an extension.
Please complete all questions and attach supporting documents where required. All documents submitted with your State Nomination application will be retained by the Business Migration Centre. Copies will be accepted, do not send original documents.
Before submitting this application form, please ensure you have completed all sections; decisions may be made on the information provided, without seeking further clarification.
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188 Business Innovation SIV – Extension – May 2017/1