Form
Consent to grant an Australian visa
to a child under the age of 18 years 122
Department of Home Affairs
9
Important – Please read this information carefully before you
complete this consent form. Once you have completed this Transaction Reference Number
consent form we strongly advise that you keep a copy for your This Transaction Reference Number is required if this consent
records. relates to an electronic visa application.
Transaction
Who should use this form? Reference EGP3FMRWP9
Where children under 18 years of age intend to travel to Number
Australia, their non-accompanying parent(s) or person(s) with
parental responsibility (anyone who can lawfully determine
where the child/children is/are to live) may be required to sign a
consent form to give permission for the child/children to be
granted an Australian visa for the purpose of travel to stay
temporarily or permanently in Australia. If one parent, or
person(s) with parental responsibility, has lawfully been made
solely responsible for making decisions as to where the child/
children is/are to live, then only that parent or person needs to
sign the consent form and provide the required documentation.
How to complete this form
This form must be completed in English. The completed and
signed form (Parts A and B) and any additional documentation
should be sent to the relevant processing office (where you
lodged your visa application), or uploaded via Immi Account
(for electronic applications).
You must attach to this form:
• a certified copy of the child’s/children’s birth certificate(s),
(if it is not already lodged with the application);
• a certified copy of the personal details page of the
non-accompanying parent’s, or person(s) with parental
responsibility’s passport, driver’s licence, National Identity
Card (ID card) or birth certificate; and
• a certified copy of any relevant evidence making you
solely responsible for making decisions about where the
child/children is/are to live (if applicable). This may include
legal documents, travel or court orders.
Note: One of the official identity documents provided by the
parent(s) must include a signature.
To attach this form and the required documentation to
your electronic visa application, please use Immi
Account. For instructions on how to do this see
[Link]
immiaccount
Note: This form is not for the use of Resident Return visa
(RRV), Electronic Travel Authority (ETA) or eVisitor applicants
who are under 18 years of age.
Important information about privacy
The Privacy Act 1988 contains 13 Australian Privacy
Principles which regulate the way that the Department collects
and handles personal information. Information about how the
Department collects, uses and discloses personal information
for its key functions can be found in form 1442i Privacy
notice. More information about the Department’s general
information handling practices (including form 1442i) can be
found in the Department’s Privacy policy at
[Link]
accountability/our-commitments/privacy
© COMMONWEALTH OF AUSTRALIA, 1229 (Design date 11/23) -
2023 Page 1
Global You can contact our Global Service Centre (GSC)
Service Centre Monday to Friday 9 am to 5 pm your local
time.
The GSC is closed on Australian National Public
Holidays.
In Australia Phone: 131 881
Outside Australia Phone: +61 2 6196 0196
Please keep this information page for your reference
Form
Consent to grant an Australian visa
to a child under the age of 18 years 122
Department of Home Affairs
9
This page is intentionally blank
© COMMONWEALTH OF AUSTRALIA, 1229 (Design date 11/23) -
2023 Page 3
Form
Consent to grant an Australian visa
to a child under the age of 18 years 122
Department of Home Affairs
9
Please open this form using Adobe Acrobat Reader.
Transaction
Either type (in English) in the fields provided or print Reference
this form and complete it (in English) using a pen and Number
BLOCK LETTERS.
Tick where applicable ✓
Part A – Child’s/Children’s details
1 Give details of each child for whom you give permission to
be granted an Australian visa
Provide details as shown in passport
A. Family name ANUNIKE
Given names JESSE IKEMSINACHI
Day Month Year
Date of
birth 30-Mar-2016
Country NIGERIA
of
passpor B01576295
t
Passpor
t
numb
er
B. Family Country of passport
Passport number
name
ANUNIKE
Given Day Month Year
17-Mar-2018
names
NIGERIA
Date of B01676911
birth
C. Family passport
Passport number
name
ANUNIKE
Given Day Month Year
06-Dec-2019
names
JORDAN EBUBEMSINACHI
Date of
birth
NIGERIA
Country
of B01576297
D. Family name
Given Date of birth
names
ALEXIS CHIGOZIRIM
© COMMONWEALTH OF AUSTRALIA, 1229 (Design date 11/23) -
2023 Page 3
Child’s/Children’s full names
Country
of
passpor Day Month Year
t EGP3FMRWP9
Passport
number
If insufficient space, attach additional details
A. Family name ANUNIKE Given names JESSE IKEMSINACHI Form
Consent to grant an Australian visa
B. Family name ANUNIKE Given names JORDAN EBUBEMSINACHI
to a child under the age of 18 years 122
C. Family name ANUNIKE Given names ALEXIS CHIGOZIRIM
Department of Home Affairs
D. Family name Given names 9
Part B – Details of Parent(s)/Person with parental responsibility
4 Parent/Person with parental responsibility 2 (if parental
2 Parent/Person with parental responsibility 1 responsibility is shared)
Family name DOMINIC-ANUNIKE Family name ANUNIKE
Given names EVELYN NWANI Given names KELVIN CHIMA
Address 3 STROM STREET WRIGHTS Address 3 OJEMUYIWA STREET
OGBA
ACT Postcode 2611 IKEJA Postcode 000
Country code Area code Country code Area code Number
Telephone Number
( +61 ) ( ) 0423740380 Telephone ( +234 ) ( ) 9024570951
Mobile
Mobile ✔
phone
phone
© COMMONWEALTH OF AUSTRALIA, 1229 (Design date 11/23) -
2023 Page 5
Child’s/Children’s full names
0423740380
9024570951
Relationship to child/children Father ✔ Relationship to child/children Father
Mother Other Passport Mother Other Passport
or ID card or driver’s licence number
B00943532 or ID card or driver’s licence number
B00497813
3 Purpose of travel to Australia
5 Purpose of travel to Australia
Temporary visit✔ Permanent residence Both
Temporary visit✔ Permanent residence Both
Documents to provide with this form (if required)
Documents to provide with this form
A certified copy of the child’s/children’s birth
A certified copy of the child’s/children’s birth
certificate(s), (if it is not already lodged with the
certificate(s), (if it is not already lodged with the
application).
application).
A certified copy of the personal details page
A certified copy of the personal details page
of the non-accompanying parent’s, or person(s)
of the non-accompanying parent’s, or person(s)
with parental
with parental
responsibility’s passport, driver’s licence, National
responsibility’s passport, driver’s licence, National
Identity Card (ID card) or birth certificate (including
Identity Card (ID card) or birth certificate (including one
one showing parent signature).
showing parent signature).
If applicable – a certified copy of any relevant evidence
If applicable – a certified copy of any relevant evidence
making you solely responsible for making decisions about
making you solely responsible for making decisions about
where the child/ children is/are to live. This may include
where the child/ children is/are to live. This may include
legal documents, travel or court orders.
legal documents, travel or court orders.
Parent/Person with parental responsibility 2 – Declaration
Parent/Person with parental responsibility 1 – Declaration
WARNING: Giving false or misleading information or
WARNING: Giving false or misleading information or documents
documents is a serious offence.
is a serious offence.
I declare that:
I declare that:
• the information supplied on this form is complete,
• the information supplied on this form is complete,
correct and up-to-date;
correct and up-to-date;
• I have provided all documents as required;
• I have provided all documents as required;
• I have read the information contained in form 1442i Privacy
• I have read the information contained in form 1442i Privacy
notice;
notice;
• I understand the Department may collect, use and disclose
• I understand the Department may collect, use and disclose
my personal information (including biometric information and
my personal information (including biometric information and
other sensitive information) as outlined in form 1442i Privacy
other sensitive information) as outlined in form 1442i Privacy
notice.
notice.
Signature ✍ Signature ✍
Day Month Year
Day Month Year
Date 31-Jul-2024
Date 31-Jul-2024
1229 (Design date 11/23) - Page 4 © COMMONWEALTH OF AUSTRALIA, 2023
