VISA APPLICATION FORM
FAMILY NAME : PETER
GIVEN NAMES : CYRIL
SEX (GENDER) : MALE ✓ FEMALE
✓
DATE OF BIRTH : 15/12/2000
COUNTRY OF BIRTH : INDIA
PASSPORT NUMBER : Z6142938
COUNTRY OF PASSPORT :
INDIA
AADHAR NO : 7635 4905 5725
RESIDENTIAL ADDRESS : B-108, HILL CREST II, RAHEJA VIHAR POWAI,
ANDHERI EAST, MUMBAI,
MAHARASHTRA, INDIA, PIN 400072
APPLICANT MOBILE/TEL. NO +91 9820515200
:
CYRILPETER015@[Link]
EMAIL ADDRESS :
MARITAL STATUS : SINGLE ✓ MARRIED SEPARATED
DIVORCE WIDOWED
ARE MEMBERS OF THE NO
FAMILY UNIT
ACCOMPANYING WITH
STUDENT? :
STUDENT’S MAIN
LANGUAGE : MALAYALAM
CURRENT LOCATION INDIA
(COUNTRY) :
LEGAL STATUS (VISA) : CITIZEN OF INDIA
KNOWN BY OTHER NAMES /
SPELLING :
HEALTH EXAMINATION - 35727411
STUDENT (HAP ID) :
HEALTH EXAMINATION -
SPOUSE (HAP ID) :
HEALTH EXAMINATION -
CHILD (HAP ID) :
HEALTH INSURANCE
HEALTH COVER (OSHC) :
NAME OF HEALTH INSURER OSHC BY ALLIANZ CARE
PROVIDER :
INSURANCE POLICY
NUMBER :
DATE FROM : 29/01/2024
DATE TO : 15/03/2026
ENGLISH TEST DETAIL
NAME OF ENGLISH TEST : IELTS ✓ PTE TOEFL
DATE OF TEST : 27/11/2023
TEST REFERENCE NUMBER : 23IA532622PETC008A
COUNTRY WHERE TEST INDIA
WAS UNDERTAKEN :
OVERALL TEST SCORE : 8.0
MARRIED STUDENT FAMILY UNIT
ARE THERE ANY ACCOMPANYING /NON-ACCOMPANYING MEMBERS OF THE FAMILY UNIT INCLUDED IN THIS
APPLICATION?
NAME CURRENT DATE OF RELATIONSHIP PASSPORT AADHAR NO. ACCOMPANYING?
COUNTRY OF BIRTH WITH NO. ( YES / NO )
RESIDENCE (DD/MM/YY) STUDENT
OTHER FAMILY MEMBERS
DOES THE APPLICANT HAVE ANY PARENTS AND SIBLINGS IN OR OUTSIDE AUSTRALIA?
FIRST NAME LAST NAME CURRENT DATE OF RELATIONSHIP OCCUPATION
COUNTRY OF BIRTH WITH STUDENT
RESIDENCE (DD/MM/YY)
PETER CHERIAN INDIA 19/07/1969 FATHER SERVICE
CHRISTINA PETER INDIA 01/04/1976 MOTHER SERVICE
CYANNE PETER INDIA 13/07/2009 SISTER STUDYING
EDUCATION HISTORY
DETAIL OF ALL EDUCATION QUALIFICATION OBTAINED FROM CLASS 10TH
ONWARDS IN INDIA OR ABROAD.
QUALIFICATION: COURSE NAME: INSTITUTION NAME: COUNTRY OF DATE FROM: DATE TO:
INSTITUTION:
CLASS 10TH ICSC BOMBAY SCOTTISH INDIA 06/05/2016
SCHOOL
CLASS 12TH CBSC R N PODAR HIGH INDIA 26/05/2018
SCHOOL SANTACRUZ
MUMBAI MR
DIPLOMA
BACHELOR [Link] VELLORE INSTITUTE INDIA 01/05/2018 30/05/2022
DEGREE OF TECHNOLOGY
MASTER
DEGREE
EMPLOYMENT HISTORY
GIVE DETAILS OF THE APPLICANT’S EMPLOYMENT AND UNEMPLOYMENT HISTORY SINCE LEAVING
SCHOOL/COLLEGE/UNIVERSITY
EMPLOYMENT INCLUDES ALL PAID EMPLOYMENT, SELF EMPLOYMENT, FAMILY BUSINESS EMPLOYMENT,
WORK EXPERIENCE, INTERNSHIPS, UNPAID EMPLOYMENT AND VOLUNTEER WORK.
UNEMPLOYMENT INCLUDES ALL GAPS IN EMPLOYMENT SINCE LEAVING SCHOOL/COLLEGE/UNIVERSITY.
SR. DATE DATE ORGANISATION ORGANISATION ADDRESS POSITION CONTACT MOBILE / TEL
NO. FROM TO NAME PERSON FROM NO. OF
(DD/M (DD/M ORGANISATION CONTACT
M/YY) M/YY) PERSON
1. 01/07/20 3/09/202 QUANTEL AI QYANTEL AI, INC, RESEARC SUDEEP AMIN +1 (732) 754-6493
21 1 H AND
SUITE 2337, 5 PENNE APPLICAT
PLAZA, ION
DEVELOP
MENT
NEW YORK, NY 10001
INTERN
2. 01/08/20 PRESEN HSBC 2, AIRPORT RD, SOFTWAR SAYLI +91 77559 24092
22 T TECHNOLOGY E MADHUKAR
INDIA
JAYPRAKASH ENGINEE PATIL
NAGAR, R
YERAWADA, PUNE,
MAHARASHTRA
411006
3.
4.
COUNTRIES VISITED (INTERNATIONAL TRAVELS)
HAVE ANY OF THE APPLICANTS VISITED ANY COUNTRIES IN THE PAST 10 YEARS? INCLUDE:
• WORK OR STUDY OUTSIDE YOUR USUAL COUNTRY OF RESIDENCE
• HOLIDAY/LEISURE TRIPS
• BUSINESS
• MILITARY DEPLOYMENT
• VISITS BACK TO YOUR USUAL COUNTRY OF RESIDENCE IF LIVING AWAY
S. NO. NAME OF THE COUNTRY : DATE DATE TO: PURPOSE OF VISIT:
APPLICANT FROM: (DD/MM/YY)
(DD/MM/YY)
1 CYRIL PETER SINGAPORE 13/08/2016 19/08/2016 TOURIST
VISA HISTORY
HAS THE APPLICANT, OR ANY OTHER PERSON NAME :
INCLUDED IN THIS APPLICATION PREVIOUSLY TYPE OF VISA :
APPLIED FOR ANY TYPE OF AUSTRALIAN DATE :
VISA? DECISION :
HAS THE APPLICANT, OR ANY OTHER PERSON COUNTRY NAME:
INCLUDED IN THIS APPLICATION CURRENTLY VISA TYPE:
HOLD ANY VALID VISA TO TRAVEL (ANY VALIDITY:
COUNTRY)? PROVIDE DETAIL WITH PROOF PASSPORT NO:
HAS THE APPLICANT, OR ANY OTHER PERSON COUNTRY NAME:
INCLUDED IN THIS APPLICATION EVER HAD REFUSAL TYPE:
ANY PREVIOUS VISA REFUSAL / VISA DATE OF REFUSAL:
CANCELLED /DEPORTED FROM ANY COUNTRY?
PROVIDE DETAIL WITH PROOF
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.
COUNTRY COUNTRY
NAME : NAME :
DATE DATE FROM
FROM : :
DATE TO : DATE TO :
DOES ANY APPLICANT INTEND TO WORK AS, OR STUDY TO BE A DOCTOR,
DENTIST, NURSE OR PARAMEDIC DURING THEIR STAY IN AUSTRALIA?
GIVE DETAIL : NO
DOES ANY APPLICANT INTEND TO WORK OR BE A TRAINEE AT A CHILD CARE
CENTRE (INCLUDING PRESCHOOLS AND CRÈCHES) WHILE IN AUSTRALIA?
GIVE DETAIL : NO
HAS ANY APPLICANT EVER HAD TUBERCULOSIS, 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, ANY OTHER MAJOR SURGERY OR HEALTH
ISSUES ?
GIVE DETAIL : NO
CHARACTER DECLARATIONS
HAS ANY APPLICANTS EVER BEEN CHARGED WITH ANY OFFENCE/ CRIMINAL
CONVICTION/ IMPRISONMENT/ARREST WARRANT/ DRUNK & DRIVE (INCLUDING
ANY CONVICTION WHICH IS NOW REMOVED FROM OFFICIAL RECORDS)?
GIVE DETAIL : NO
DETAILS OF FUNDS
APPLICANTS FOR A STUDENT VISA NEED TO HAVE ENOUGH MONEY THAT IS
GENUINELY AVAILABLE TO PAY FOR COURSE FEES, TRAVEL AND LIVING
COSTS FOR THE STUDENT AND THEIR ACCOMPANYING FAMILY MEMBERS
WHILE IN AUSTRALIA.
TYPE OF NAME OF BANK ACCOUNT NO. FUNDS SPONSOR RELATION ANNUAL
FUNDS AVAILABLE NAME WITH INCOME
APPLICANT
LOAN IDFC FIRST BANK 0002074634 RS. 3626856 BANK
VISA FEE PAYMENT DETAIL
I HEREBY AUTHORISE “KAAISER SERVICES PVT. LTD” TO PAY MY ONE TIME AUSTRALIAN STUDENT
VISA APPLICATION FEE OF USING THE FOLLOWING CREDIT CARD / PAY PAL DETAIL
AUD 620 + SURCHARGE IN FAVOUR OF “DEPARTMENT OF IMMIGRATION AND BORDER
PROTECTION”
FULL NAME ON CREDIT PETER CHERIAN
CARD :
CREDIT CARD NUMBER : 4375519569770009
EXPIRY DATE (MM/YY) : 06/30
CVV NUMBER : 778
OR
PAY PAL USER ID :
PASSWORD :
APPLICANT SIGNATURE: ______________________________
