Payment Invoice/Receipt No. ______
APPLICATION FOR WESTERN AUSTRALIAN STATE NOMINATION
BUSINESS INNOVATION AND INVESTMENT (PERMANENT) VISA 888 – INVESTOR STREAM
Applicant Name:
Attached is my completed State Nomination Application form, including (a):
Copy of passport bio-data page and visa expiry
Evidence of Designated Investment held and maturity date
Completed Form 1414 https://www.border.gov.au/Forms/Documents/1414.pdf
Applicant Declaration
I declare that
· All of the information contained in my application is correct; and
· I have assessed myself against the Department of Home Affairs Visa 888 Investor Stream criteria and believe I meet all the requirements.
Name of Applicant: ______
Signature of Applicant:______
Dated (dd/mm/yyyy): _____
Migration Agent Declaration (if applicable)
As the appointed migration agent for the above named applicant I declare that
· To the best of my knowledge the information contained in the application is correct;
· I have assessed the applicant against the Department of Home Affairs Visa 888 Investor Stream criteria and believe he/she meets all the requirements;
· The applicant has read and understands the content of this application.
Name of Migration Agent: ______
Signature of Migration Agent: ______
Dated (dd/mm/yyyy): ______
Please Note: The Business Migration Centre reserves the right to request applicants, agents or representatives of applicants for State nomination to formally attest to the accuracy of the information contained in this application or its attachments.
Please send your application to:Business Migration Centre
Small Business Development Corporation
GPO Box C111
PERTH WESTERN AUSTRALIA 6001 / Telephone: (+618) 6552 3300
Facsimile: (+618) 6552 3399
Email:
WESTERN AUSTRALIAN GOVERNMENT
STATE NOMINATION APPLICATION FORM
Applicant Details:
Family Name:
Given Names:
Gender: M / F Date of birth (dd/mm/yyyy):
Were you the primary applicant for your provisional visa? Yes No
If no, please provide the full name of the primary visa holder:
Family Name: Given Name:
Applicant’s Address:
Postcode:
Telephone: Mobile:
Email address:
Level of English language ability:
Details of any Australian visa held: Visa Expiry Date:____
Passport number: Country of issue:
Date of issue of passport (dd/mm/yyyy):
· Have you applied for nomination from any other Australian State or
Territory government? Yes No
If yes, name of State or Territory government:
· Net assets (business and personal) currently in Western Australia:
A$ _____ (as per Statement of Assets and Liabilities on page 3)
· Are you using the services of a migration agent? Yes No
If yes, please provide Migration agent details:
Migration agent name:
Business name:
Postal Address:
Postcode:
Telephone - mobile: Office:
Email address:
STATEMENT OF ASSETS AND LIABILITIES
Name: Statement Date (dd/mm/yyyy): _
NB: Currency must be in Australian Dollars www.oanda.com/currency/converter/
Please include all your assets held in Western Australia.
Please tick any assets or liabilities shown that are NOT in Western Australia.
ASSETS / AUD $ / LIABILITIES / AUD $Family Home / Home Mortgage
Investment Property / Investment Loan
Household Contents / Personal Loan
Motor Vehicle / Other Loans
Net Assets in Business / Business Loan(s)
Superannuation / Other (Please List)
Cash at Bank
Term Deposits
Shares
Managed Investments
Other (Please List)
TOTAL ASSETS / $ / TOTAL LIABILITIES / $
NET ASSETS
(Business and Personal in WA) / $
BUSINESS INNOVATION AND INVESTMENT (PERMANENT) VISA
888 - INVESTOR STREAM
State nomination applicants must demonstrate they meet the Department of Home Affairs criteria for the business visa they are applying for. Supporting documents must be attached as requested on page 1.
1. Are you the holder of a Business Innovation and Investment (Provisional) Visa Subclass 188 – Investor Stream?
Yes No
2. Have you been resident in Western Australia as the holder of this visa for a total of at least 2 years in the 4 years immediately before your application?
Yes No
If you have answered no to questions 1 or 2, please provide further information.
3. Do you or your partner have a history of involvement in business or investment activities that are of a nature that is not generally accepted in Australia:
Yes No
If you have answered yes to question 3 please provide further information.
4. Your Designated Investment must be held with the Western Australian Treasury Corporation for at least four years.
If you applied for your provisional visa (subclass 188) in the Investor stream prior to 1 July 2015, you are eligible to apply for a subclass 888 visa after holding your provisional visa for 3 years and 11 months.If you applied for your provisional visa after 1 July 2015, you are required to hold your provisional visa for at least 4 years prior to applying for a subclass 888 visa.
Please attach evidence that your Designated Investment has matured or that it will mature in the next three months (a) :
5. If applicable, please provide details of any investments in Western
Australia (other than your Designated Investment):
Investment 1
Investment Type:
Ownership interest: % Dates involved:
Investment Amount:
Investment 2
Investment Type:
Ownership interest: % Dates involved:
Investment Amount:
6. Have you purchased a residence in Western Australia?
Yes No
7. If applicable, please provide details of your business in Western
Australia.
Business name:
Please select one of the following:
You created this business You purchased an existing business
Ownership interest: % Dates of ownership: From: To:
ABN: Turnover in the past 12 months: A$
Nature of business activity:
If you purchased an existing business how many full time equivalent staff:
a) Were employed at time of purchase
b) Are currently employed
If you created a new business how many new full time positions has your business created? ______
8. Please provide details to demonstrate that you will maintain your funds in Western Australia on maturity of your treasury bonds.
9 . Western Australian State Nomination Commitment
Please complete the following:
My signed State Nomination Agreement was for the following business proposal:
Total net assets in Western Australia: $______
Designated Investment into Western Australian
Treasury Bonds for a four (4) year term: $______
Maintain your funds in Western Australia on maturity of your treasury bonds
Please note that your application may not be supported if you have not satisfied your original business proposal or an approved amended proposal.
If your actual business proposal does not meet your original business proposal in your signed agreement, please provide an explanation.
Note: Please complete all questions and attach supporting documents
where required. All documents submitted with your State
Nomination application will be retained by the Business
Migration Centre. Original documents are not required.
Please submit copies of any original documents.
Please ensure your application is complete as decisions may be made on the application as submitted without seeking further information.
888 Business Innovation – INVESTOR – Designed 07/16
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