1440 (Design date 01/14) - Page 1 COMMONWEALTH OF AUSTRALIA, 2014

Payment details
Form
1440
Note: This form should only be used where there are limited payment options for visa applications outside Australia or for making top-up payments.
Application details
1 Number of people included in the application
2 Details of ALL people included in the application
Family name Given names
Date of birth Subsequent Temporary
Application Charge payable?
Day Month Year
Main applicant
No Yes
Additional applicant(s)
No Yes
No Yes
No Yes
No Yes
If more than 4 additional applicants, attach a separate sheet with details (including name, date of birth and whether the Subsequent Temporary Application
Charge is payable)
Visa Application Charges
3 IMPORTANT: You must refer to the Department of Immigration and Border Protections website at www.immi.gov.au/fees-charges to complete
this section. The website shows reference tables with the Visa Application Charges applicable to each visa.
Visa you are applying for

Country of application lodgement
Base Application Charge
Write the amount shown on the reference table for the visa you are applying for AUD (1)
+
Non-internet Application Charge (if applicable) AUD (2)
Additional Applicant Charge aged 18 years or over at the time the application was lodged
+
Write the amount shown on the
reference table for your visa subclass
Number of additional applicants
aged 18 years or over
AUD X (multiplied by)

=

AUD (3)
Additional Applicant Charge under 18 years of age at the time the application was lodged
+
Write the amount shown on the
reference table for your visa subclass
Number of additional applicants
under 18 years of age
AUD X (multiplied by)

=

AUD (4)
Subsequent Temporary Application Charge (if applicable)
+
Write the amount shown on the
reference table for your visa subclass Number of applicants
AUD X (multiplied by)

=

AUD (5)
=
Total
Total (1) + (2) + (3) + (4) + (5) AUD
You must pay the total amount or the application(s) will not be valid.
1440 (Design date 01/14) - Page 2 COMMONWEALTH OF AUSTRALIA, 2014
Payment details
4 How will you pay your application charge?
Note: A surcharge may apply to payments made by credit card.
Further information is available from
www.immi.gov.au/fees-charges/how-to-pay.htm
If applying in Australia, credit card or debit card with credit card facility
are the preferred methods of payment. Payments made by credit card or
debit card with credit card facility are processed quicker than other
payment methods.
Debit cards cannot be used for applications lodged by mail. If paying by
bank cheque or money order please make payable to the Department of
Immigration and Border Protection.
If applying outside Australia, please check with the Australian
Government ofce where you intend to lodge your application as to
what methods of payment and currencies they can accept and to whom
the payment should be made payable.
Credit card
Debit card with credit card facility
Pre-paid card with credit card facility
Give details below
Payment by (tick one box) Australian Dollars
MasterCard
American Express
Visa
Diners Club
JCB AUD
Credit card number
: : : : : : : : : : : : : : : : : :
Expiry date
Month
:
Year
:
Cardholders name
Telephone number
( ) ( )
Country code Area code Number
Email address
Business Partner number (if known)
Address
Postcode
As the cardholder I acknowledge and accept that a credit card
surcharge may apply to the transaction.
Signature of
cardholder
-
Date
Day Month Year
Credit card information will be used for charge paying purposes only.
Other payment methods
Bank cheque
Money order
Debit card Cannot be used for applications
lodged by mail
Office use only
Date payment processed
Day Month Year
Ofcer name
Logon ID
Receipt number
Business Partner number