Department of Immigration and Border Protection Record of

Application for a Visitor Short Stay Visa Responses

Terms and Conditions

View Terms and Conditions View Privacy statement
Yes
I have read and agree to the terms and conditions:
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: PHILIPPINES
Legal status: Citizen

Purpose of stay

Select the stream the applicant is applying for:

Tourism/Visit family or friends
List all reasons for visiting Family visit
Australia: Tourism
Give details of any significant dates on which the applicant needs to be in Australia:
December 27, 2017 up until January 16, 2018
Group processing

Is this application being lodged as part of a group of applications?

Yes
Group ID: XMT3S2
Group name: Malimban Family
Special category of entry

OFFICE USE ONLY

This form submitted by : rmmalimban
Role(s) : Self-registered user
Submitted on : 24/07/2017 02:36

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 Application for a Visitor Short Stay Visa

Is the applicant a representative of a foreign government, or travelling on a United Nations Laissez-

Passer, or a member of an exempt group?
No
Applicant
Information: Entering names incorrectly may result in denial of permission to board an aircraft to Aust
ralia, 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: MALIMBAN
Given names: ROSVELLE
Sex: Female
Date of birth: 06 Mar 1996
Passport number: P2171788A
Country of passport: PHILIPPINES - PHL
Nationality of passport holder: PHILIPPINES - PHL
Date of issue: 07 Mar 2017
Date of expiry: 06 Mar 2022
Place of issue / issuing DFA MANILA
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: MALIMBAN
Given names: ROSVELLE
Identification number: 007762
Country of issue: PHILIPPINES
Date of issue: 22 Sep 2016
Date of expiry: 06 Mar 2019
Place of birth

Town / City: CAVITE CITY

State / Province: CAVITE

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 Application for a Visitor Short Stay Visa

Country of birth: PHILIPPINES

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 country of passport?

Yes
Is this applicant a citizen of any other country?
No
Other passports

Does this applicant have other current passports?

No
Other identity documents

Does this applicant have other identity documents?

Yes

Other identity documents

Enter details exactly as shown on the identity document.

Family name: MALIMBAN

Given names: ROSVELLE
Type of document: Birth certificate
Identification number: 96773
Country of issue: PHILIPPINES
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.

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 Application for a Visitor Short Stay Visa

Family name: MALIMBAN

Given names: ROSVELLE
Sex: Female
Date of birth: 06 Mar 1996
Country of birth: PHILIPPINES
Passport number: P2171788A
Country of passport: PHILIPPINES - PHL

Is the above information Yes

correct?
Additional identity questions
Provide further details below, where available.
Previous travel to Australia

Has this applicant previously travelled to Australia or previously applied for a visa?
No
Travelling companions
Are there any other persons travelling with the applicant to Australia?
Yes
Relationship to the applicant: Brother
Family name: MALIMBAN
Given names: JOHN CARLO
Sex: Male
Date of birth: 21 May 1994
Relationship to the applicant: Parent
Family name: MALIMBAN
Given names: ROSMELITO
Sex: Male
Date of birth: 05 Jan 1962
Contact details

Country of residence

Usual country of residence: PHILIPPINES

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?

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 Application for a Visitor Short Stay Visa

Office: Manila
Residential address
Note that a street address is required. A post office address cannot be accepted as a residential
address.

Country: PHILIPPINES
Address: 214 LIWAYWAY STREET
SAN ANTONIO
Suburb / Town: CAVITE CITY
State or Province: CAVITE
Postal code: 4100
Contact telephone numbers

Home phone: 09354106479

Business phone: 09354106479
Mobile / Cell phone: 09354106479
Postal address

Is the postal address the same as the residential address?

Yes
Email address

Email address: rosvellemalimban@gmail.com

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.
No
This person is referred to as the 'authorised recipient'.

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: rosvellemalimban@gmail.com

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 Application for a Visitor Short Stay Visa

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
Relationship to the applicant: Parent
Family name: MALIMBAN
Given names: AVELINA
Sex: Female
Date of birth: 11 Sep 1972
Country of birth: PHILIPPINES
Entry to Australia

Proposed period of stay

Give details of the proposed period of stay in Australia.
Length of stay in Australia: Up to 3 months
Date from: 27 Dec 2017
Date to: 16 Jan 2018
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.
Multiple entries

Does the applicant intend to enter Australia on more than one occasion?
No
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?
Yes

Relationship to applicant

Relationship to the applicant: Sister

Contact's details

Family name: MALIMBAN

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 Application for a Visitor Short Stay Visa

Given names: WINZELLE

Sex: Female
Date of birth: 26 Jul 1991
Residential address
Note that a street address is required. A post office address cannot be accepted as a residential
address.

Country: AUSTRALIA
Address: 28 BRISTOL RD.
Suburb / Town: HURTSVILLE
State / Territory: New South Wales
Postcode: 2220
Contact telephone numbers

Home phone: 0420272242

Business phone: 0420272242
Mobile / Cell phone: 0420272242
Electronic communication

Email address: winzellemalimban@gmail.com

Australian residency status

Australian residency status: Australian Temporary Resident (Work visa)

Relationship to applicant

Relationship to the applicant: Grand Parent

Contact's details

Family name: LADHAMS

Given names: LOLITA
Sex: Female
Date of birth: 22 May 1949
Residential address
Note that a street address is required. A post office address cannot be accepted as a residential
address.

Country: AUSTRALIA
Address: 85 BENT STREET

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 Application for a Visitor Short Stay Visa

Suburb / Town: CHESTER HILL

State / Territory: New South Wales
Postcode: 2162
Contact telephone numbers

Home phone: 97864487

Business phone: 97864487
Mobile / Cell phone: 97864487
Electronic communication

Email address: donaldladhams@y7mail.com

Australian residency status

Australian residency status: Australian Citizen

Relationship to applicant

Relationship to the applicant: Grand Parent

Contact's details

Family name: LADHAMS

Given names: DONALD
Sex: Female
Date of birth: 10 Oct 1936
Residential address
Note that a street address is required. A post office address cannot be accepted as a residential
address.

Country: AUSTRALIA
Address: 85 BENT STREET
Suburb / Town: CHESTER HILL
State / Territory: New South Wales
Postcode: 2162
Contact telephone numbers

Home phone: 97864487

Business phone: 97864487
Mobile / Cell phone: 97864487

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 Application for a Visitor Short Stay Visa

Electronic communication

Email address: donaldladhams@y7mail.com

Australian residency status

Australian residency status: Australian Citizen

Relationship to applicant

Relationship to the applicant: Uncle

Contact's details

Family name: MATI

Given names: CHARITO
Sex: Male
Date of birth: 14 Sep 1974
Residential address
Note that a street address is required. A post office address cannot be accepted as a residential
address.

Country: AUSTRALIA
Address: 150 JOHNSTON ROAD
Suburb / Town: BASSHILL
State / Territory: New South Wales
Postcode: 2197
Contact telephone numbers

Home phone: 0449079907

Business phone: 0449079907
Mobile / Cell phone: 0449079907
Electronic communication

Email address: charitomati@hotmail.com

Australian residency status

Australian residency status: Australian Citizen

Current overseas employment

Current employment details

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 Application for a Visitor Short Stay Visa

Employment status: Other

Give details: I AM A FRESH GRADUATE AND STILL REVIEWING FOR MY
BOARD EXAMINATION.
Funding for stay

Funding details

Give details of how the stay in Australia will be funded.

Supported by other person
What funds will the applicant MY MOTHER, AVELINA M. MALIMBAN, WILL SUPPORT OUR
have available to support their FINANCIAL EXPENSES DURING OUR VACATION IN AUSTRALIA.
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: MALIMBAN

Given names: AVELINA
Country: PHILIPPINES
Address: 214 LIWAYWAY STREET
SAN ANTONIO
Suburb / Town: CAVITE CITY
State or Province: CAVITE
Postal code: 4100
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.
No
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 to be a doctor, dentist, nurse or paramedic during their
stay 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?

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 Application for a Visitor Short Stay Visa

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 assistance with mobility or care due to a medical condition?
No
Character declarations
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 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

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 Application for a Visitor Short Stay Visa

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
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?
No
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 an application for entry or further stay in Australia or any other country
refused, or had a visa 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.
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 Application for a Visitor Short Stay Visa

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.
Yes
Will inform the Department of Immigration and Border Protection 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.
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 of Immigration and Border
Protection 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 of Immigration and Border Protection
to help identify the applicant, to determine eligibility for grant of a visa and for law enforcement
purposes.
Yes
Give consent to the Department of Immigration and Border Protection 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

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 Application for a Visitor Short Stay Visa

Supporting evidence

Applicant 1 - ROSVELLE MALIMBAN (06 Mar 1996)

Evidence type Document type Description Date received Filename
Planned tourism activities, Evidence Itinerary null 24/07/2017 Australian Tour Itinerary.pdf
of
Invitation, Evidence of Other (specify) Pay slip of Winzelle 04/07/2017 PY0000676034333.PDF
Malimban
National Identity Document (other National ID Card professional id 04/07/2017 id rosvelle.pdf
than Passport)
Travel Document Passport null 04/07/2017 image2.JPG
Financial Capacity - Personal, Bank Statement - Personal BANK STATEMENT 04/07/2017 image7.JPG
Evidence of OF MY MOTHER
Birth or Age, Evidence of Birth Certificate null 04/07/2017 image8.JPG
Invitation, Evidence of Letter/Statement - Sponsor null 04/07/2017 invi letter.pdf
(Relative)
Invitation, Evidence of Other (specify) Passport of Winzelle 04/07/2017 passport.pdf
Malimban
Evidence

Give details as to why the applicant will not be providing attachments prior to lodging this application.
I do not have a document of Evidence of Travel History since I never got a chance to travel
outside the Philippines.

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