OFFICIAL: Sensitive
Personal Privacy
Department of Home Affairs
Application for a Visitor Short Stay Visa Not Yet Lodged
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: INDONESIA
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:
7-10 May 2025: visiting Melbourne
11-13 May 2025: visiting Sydney
14-16 May 2025: visiting Adelaide
17 May 2025: return trip from Melbourne to Jakarta
Group processing
Is this application being lodged as part of a group of applications?
No
Special category of entry
Personal Privacy
OFFICIAL: Sensitive
Generated: Mon, 17 Mar 2025 15:16:58, AEDT Reference Number: EGP6TVU7VF Page 1 of 12
OFFICIAL: Sensitive
Personal Privacy
Application for a Visitor Short Stay Visa
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: Fikri
Given names: Radja Ahmad Nur
Sex: Male
Date of birth: 17 Apr 2001
Passport number: C8841385
Country of passport: INDONESIA - IDN
Nationality of passport holder: INDONESIA - IDN
Date of issue: 06 Apr 2022
Date of expiry: 06 Apr 2027
Place of issue / issuing Karawang
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: Fikri
Given names: Radja Ahmad Nur
Identification number: 3201291704010001
Country of issue: INDONESIA
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: 18 Feb 2020
Date of expiry:
Pacific-Australia Card
Personal Privacy
OFFICIAL: Sensitive
Generated: Mon, 17 Mar 2025 15:16:58, AEDT Reference Number: EGP6TVU7VF Page 2 of 12
OFFICIAL: Sensitive
Personal Privacy
Application for a Visitor Short Stay Visa
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: Bogor
State / Province: Jawa Barat
Country of birth: INDONESIA
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 (INDONESIA)?
Yes
Is this applicant a citizen of any other country?
No
Previous travel to Australia
Has this applicant previously travelled to Australia?
Yes
Has this applicant previously applied for a visa to Australia?
Yes
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
Does this applicant have other identity documents?
No
Personal Privacy
OFFICIAL: Sensitive
Generated: Mon, 17 Mar 2025 15:16:58, AEDT Reference Number: EGP6TVU7VF Page 3 of 12
OFFICIAL: Sensitive
Personal Privacy
Application for a Visitor Short Stay Visa
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: Fikri
Given names: Radja Ahmad Nur
Sex: Male
Date of birth: 17 Apr 2001
Country of birth: INDONESIA
Passport number: C8841385
Country of passport: INDONESIA - IDN
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?
Yes
Travelling companion
Relationship to the applicant: Parent
Family name: Sahara
Given names: Sahara
Sex: Female
Date of birth: 13 May 1974
You can link applications for a family or other people travelling together by creating a group. This
helps the Department to process the applications at the same time. To add this application to a
group, select Prev until you reach the application context page (page 2 of this form) and update the
group details section.
Contact details
Personal Privacy
OFFICIAL: Sensitive
Generated: Mon, 17 Mar 2025 15:16:58, AEDT Reference Number: EGP6TVU7VF Page 4 of 12
OFFICIAL: Sensitive
Personal Privacy
Application for a Visitor Short Stay Visa
Country of residence
Usual country of residence: INDONESIA
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: Indonesia, Jakarta
Residential address
Note that a street address is required. A post office address cannot be accepted as a residential
address.
Country: INDONESIA
Address: Jalan Griya Indah no. 14, RT/RW 003/007
Ciomas Rahayu, Ciomas
Suburb / Town: Kabupaten Bogor
State or Province: JAWA BARAT
Postal code: 16610
Contact telephone numbers
Enter numbers only with no spaces.
Home phone:
Business phone:
Mobile / Cell phone: 089662405031
Postal address
Is the postal address the same as the residential address?
Yes
Email address
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.
Yes, another person
This person is referred to as the 'authorised recipient'.
Authorised recipient contact details
Personal Privacy
OFFICIAL: Sensitive
Generated: Mon, 17 Mar 2025 15:16:58, AEDT Reference Number: EGP6TVU7VF Page 5 of 12
OFFICIAL: Sensitive
Personal Privacy
Application for a Visitor Short Stay Visa
Family name: Sahara
Given names: Sahara
Postal address
Country: INDONESIA
Address: Jalan Griya Indah no. 14, RT/RW 003/007
Ciomas Rahayu, Ciomas
Suburb / Town: Kabupaten Bogor
State or Province: JAWA BARAT
Postal code: 16610
Contact telephone numbers
Enter numbers only with no spaces.
Business phone:
Mobile / Cell phone: 081315111303
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: [email protected]
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?
Yes
Non-accompanying member of the family unit
Relationship to the applicant: Parent
Family name: Djaenudin
Given names: Deden
Sex: Male
Date of birth: 12 Dec 1971
Country of birth: INDONESIA
Personal Privacy
OFFICIAL: Sensitive
Generated: Mon, 17 Mar 2025 15:16:58, AEDT Reference Number: EGP6TVU7VF Page 6 of 12
OFFICIAL: Sensitive
Personal Privacy
Application for a Visitor Short Stay Visa
Non-accompanying member of the family unit
Relationship to the applicant: Sister
Family name: Maharani
Given names: Dwi Fitri
Sex: Female
Date of birth: 06 Jul 2004
Country of birth: INDONESIA
Entry to Australia
Proposed period of stay
Does the applicant intend to enter Australia on more than one occasion?
No
How long does the applicant plan to stay in Australia?
Length of stay in Australia: Up to 3 months
Planned arrival date: 07 May 2025
Planned final departure date: 17 May 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.
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?
No
Visa applicant's current overseas employment
Current employment details
Employment status: Employed
Occupation grouping: Professionals
Organisation: International Trade Analysis and Policy Studies
Start date with current 07 Mar 2025
employer:
Organisation address
Note that a street address is required. A post office address cannot be accepted as an organisation
address.
Personal Privacy
OFFICIAL: Sensitive
Generated: Mon, 17 Mar 2025 15:16:58, AEDT Reference Number: EGP6TVU7VF Page 7 of 12
OFFICIAL: Sensitive
Personal Privacy
Application for a Visitor Short Stay Visa
Country: INDONESIA
Address: Jl. Agatis IPB Campus
Babakan, Darmaga
Suburb / Town: Kabupaten Bogor
State or Province: JAWA BARAT
Postal code: 16680
Contact telephone numbers
Enter numbers only with no spaces.
Business phone:
Mobile / Cell phone:
Electronic communication
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 mother will be funding the trip
have available to support their
stay in Australia?
Relationship to applicant
Give details of the person that will provide support to the applicant.
Relationship to the applicant: Parent
Family name: Sahara
Given names: Sahara
Country: INDONESIA
Address: Jalan Griya Indah no. 14, RT/RW 003/007
Ciomas Rahayu, Ciomas
Suburb / Town: Kabupaten Bogor
State or Province: JAWA BARAT
Postal code: 16610
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.
Personal Privacy
OFFICIAL: Sensitive
Generated: Mon, 17 Mar 2025 15:16:58, AEDT Reference Number: EGP6TVU7VF Page 8 of 12
OFFICIAL: Sensitive
Personal Privacy
Application for a Visitor Short Stay Visa
Yes
Visits to other countries
Give details of all applicants that have in the last 5 years visited, or lived, outside their country of
passport for more than 3 consecutive months. Do not include time spent in Australia.
Name: FIKRI, Radja Ahmad Nur (17 Apr 2001)
Country: KOREA, SOUTH
Date from: 19 Aug 2022
Date to: 23 Aug 2022
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.
Personal Privacy
OFFICIAL: Sensitive
Generated: Mon, 17 Mar 2025 15:16:58, AEDT Reference Number: EGP6TVU7VF Page 9 of 12
OFFICIAL: Sensitive
Personal Privacy
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
Personal Privacy
OFFICIAL: Sensitive
Generated: Mon, 17 Mar 2025 15:16:58, AEDT Reference Number: EGP6TVU7VF Page 10 of 12
OFFICIAL: Sensitive
Personal Privacy
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?
Yes
Give details: Held D-2 South Korean Visa valid from 19 August 2022 to 19
February 2023
Held Class TU Student S217 Sub Class 576 Australian Visa valid
from 17 October 2008 to 31 August 2012
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.
Personal Privacy
OFFICIAL: Sensitive
Generated: Mon, 17 Mar 2025 15:16:58, AEDT Reference Number: EGP6TVU7VF Page 11 of 12
OFFICIAL: Sensitive
Personal Privacy
Application for a Visitor Short Stay Visa
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:
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
Personal Privacy
OFFICIAL: Sensitive
Generated: Mon, 17 Mar 2025 15:16:58, AEDT Reference Number: EGP6TVU7VF Page 12 of 12
