Fillable Form 681: humanitarian proposal Refugee and special (Department of Home Affairs)

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Form 681: humanitarian proposal Refugee and special (Department of Home Affairs)

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Country of origin: AUSTRALIA
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681 (Design date 09/20) - Page 1© COMMONWEALTH OF AUSTRALIA, 2020
Refugee and special
humanitarian proposal
Form
681
Department of Home Affairs
Who should use this form?
This form should be used by persons wishing to propose
applicants under the Refugee and Special Humanitarian Program,
including those eligible under the ‘split family’ provisions that
apply to immediate family members.*
Proposals may be submitted by individuals or by organisations
operating in Australia. To be eligible to propose as an individual,
you must be:
• an Australian citizen; or
• a permanent resident of Australia; or
• an eligible New Zealand citizen.
You must not be an illegal maritime arrival who arrived on or after
13 August 2012. More information is available on the Department
of Home Affairs (the Department) website
https://immi.homeaffairs.gov.au/visas/getting-a-visa/visa-
listing/global-special-humanitarian-202#Eligibility
If you are eligible to propose, you will also need form 842
Application for an Offshore Humanitarian visa to be completed
by the visa applicant and submitted together with this form.
This form must not be used for applications under the
Community Support Program.
About this form
Important – Please read this information carefully before you
complete your proposal. Once you have completed your
proposal we strongly advise that you keep a copy for your
records.
What is required of proposers?
If you are proposing applicants who are granted a subclass 202
(Global Special Humanitarian) visa you and the applicants are
responsible for the applicants’ travel to Australia, including
airfares.
If you are proposing applicants under the ‘split family’ provisions,
and any of the following visa subclasses are granted:
200 – Refugee
201 – In-country Special Humanitarian
203 – Emergency Rescue
204 – Woman at Risk
the Australian Government will arrange and pay for the
applicants’ travel to Australia.
An ‘applicant’ who is granted a visa and travels to Australia,
becomes an ‘entrant’ on arrival.
Your role as a proposer is to assist in the settlement of the
entrants you have proposed. This includes:
• meeting the entrants at the airport
• providing accommodation for the entrants on arrival
• assisting the entrants to find permanent accommodation; and
• introducing the entrants to relevant services.
The Department provides settlement services to humanitarian
entrants. A Humanitarian Settlement Program (HSP) service
provider will contact you to settle those you have proposed.
After a visa has been granted
If the people you are proposing are granted a humanitarian visa
before they leave for Australia, please encourage them to attend:
• the Australian Cultural Orientation Program (AUSCO).
AUSCO courses prepare participants for their life in Australia.
More information is available on the Department’s website
https://immi.homeaffairs.gov.au/settling-in-australia/
ausco; and
• a departure health check (DHC). Visa holders undergo
a health check within 72 hours of departure for Australia
to ensure they are ‘fit to fly’ and to identify any medical
conditions requiring treatment on arrival in Australia.
Integrity of application
The Department is committed to maintaining the integrity of the
visa and citizenship programs. Please be aware that if you or the
person you are proposing provide us with fraudulent documents
or information, this may result in processing delays and possibly
the application being refused.
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
https://www.homeaffairs.gov.au/access-and-accountability/
our-commitments/privacy
* Under the ‘split family’ provisions, holders of humanitarian (Class XB), or
permanent Protection (Class XA) or Resolution of Status (Class CD) visas
may support the applications of immediate family members to enter
Australia under the Humanitarian Program. ‘Immediate family’ means the
spouse or de facto partner (including same-sex partner), dependent child,
or parent (if the proposer is under 18 years of age).
681 (Design date 09/20) - Page 2 © COMMONWEALTH OF AUSTRALIA, 2020
Application process
Special Humanitarian Program applications and proposals
may now be lodged electronically. Instructions and guidance
are available on the Department’s website
https://immi.homeaffairs.gov.au/help-support/
departmental-forms/online-forms/special-
humanitarian-visa-submission-form
Applications lodged electronically may be processed more
quickly.
Step 1 – Complete this form
Carefully read and fully complete this form (form 681).
Step 2 – Establish your eligibility to propose
If you are proposing as an individual, you must provide
evidence of your eligibility to propose (see Question 20).
Please provide a certified copy of your:
• Australian birth certificate/certificate of Australian citizenship; or
• evidence of your permanent residence in Australia; or
• evidence that you are an eligible New Zealand citizen.
Copies of documents must be certified as true copies of the
original by a Justice of the Peace, a Commissioner for
Declarations or a person before whom a statutory declaration
may be made under the Statutory Declarations Act 1959.
If you are proposing as an organisation, you must provide the
names of office holders, and a statement of the organisation’s
objectives, activities and funding (see Part C).
Step 3 – Send application form to the applicant
Send form 842 Application for an Offshore Humanitarian visa
to the applicant.
Step 4 – Applicant completes and signs application form
The applicant should fully complete form 842 in accordance with
the instructions on that form and return it to you.
Step 5 – Lodge the completed application
You should lodge this form (form 681) and the completed and
signed form 842 Application for an Offshore Humanitarian
visa.
Further information, including details on how to lodge this
application electronically, is available from the Department’s
website https://immi.homeaffairs.gov.au/visas/getting-a-
visa/visa-listing/global-special-humanitarian-202#HowTo
Step 6 – Receipt of application
The office processing the visa application will acknowledge
receipt of the application accompanying your proposal via email.
How to complete this form
• Please open this form using Adobe Acrobat Reader.
Either type (in English) in the fields provided or print this
form and complete it (in English) using a pen and BLOCK
LETTERS.
• Tick where applicable.
• Answer all questions truthfully and completely.
• Where there is insufficient space for your answer please
continue on a separate page of paper. Clearly mark the
separate page with the question number it relates to.
For information on how to make a valid application, see
information form 1025i Visa applications.
Home page
www.homeaffairs.gov.au
General
enquiry line
Telephone 131 881 during business hours
in Australia to speak to an operator (recorded
information available outside these hours).
If you are outside Australia, please contact
your nearest Australian mission.
681 (Design date 09/20) - Page 3© COMMONWEALTH OF AUSTRALIA, 2020
Refugee and special
humanitarian proposal
Form
681
Department of Home Affairs
Please open this form using Adobe Acrobat Reader.
Either type (in English) in the fields provided or print this form
and complete it (in English) using a pen and BLOCK LETTERS.
Tick where applicable
3
All questions on this form need to be completed (unless instructed
otherwise via steps).
Part A – Details of the persons you wish to
propose for entry to Australia
1 How many people are included in your proposal?
2 Give details of the main applicant
Family name
A1
Given names
3 Has the person you are proposing been known by any other names?
(such as name at birth, alias, previous married name)
No
Yes Give details
Family name
Given names
4 Citizenship
5 Sex Male Female
Indeterminate /
Intersex / Unspecified
6 Date of birth
Day Month Year
7 Place of birth
Town/city
Country
8 Current country of residence
9 Date of arrival in current country of residence
Day Month Year
10 Relationship status
Married legally Engaged Widowed
Married by
tradition/custom
Married religiously
De facto
Separated
Divorced
Never married or
been in a de facto
relationship
11 Precise relationship of main applicant to you (give full details)
12 Full residential address (not post office box)
Postcode
13 Give details of all other dependent family members of the main
applicant who are included in this proposal
A2
Family name
Given names
Sex
Indeterminate /
Intersex / Unspecified
Male Female
Date of birth
Day Month Year
Relationship status
Married legally Engaged Widowed
Married by
tradition/custom
Married religiously
De facto
Separated
Divorced
Never married or
been in a de facto
relationship
Precise relationship to the main applicant
681 (Design date 09/20) - Page 4 © COMMONWEALTH OF AUSTRALIA, 2020
A3
Family name
Given names
Sex
Indeterminate /
Intersex / Unspecified
Male Female
Date of birth
Day Month Year
Relationship status
Married legally Engaged Widowed
Married by
tradition/custom
Married religiously
De facto
Separated
Divorced
Never married or
been in a de facto
relationship
Precise relationship to the main applicant
A4
Family name
Given names
Sex
Indeterminate /
Intersex / Unspecified
Male Female
Date of birth
Day Month Year
Relationship status
Married legally Engaged Widowed
Married by
tradition/custom
Married religiously
De facto
Separated
Divorced
Never married or
been in a de facto
relationship
Precise relationship to the main applicant
A5
Family name
Given names
Sex
Indeterminate /
Intersex / Unspecified
Male Female
Date of birth
Day Month Year
Relationship status
Married legally Engaged Widowed
Married by
tradition/custom
Married religiously
De facto
Separated
Divorced
Never married or
been in a de facto
relationship
Precise relationship to the main applicant
A6
Family name
Given names
Sex
Indeterminate /
Intersex / Unspecified
Male Female
Date of birth
Day Month Year
Relationship status
Married legally Engaged Widowed
Married by
tradition/custom
Married religiously
De facto
Separated
Divorced
Never married or
been in a de facto
relationship
Precise relationship to the main applicant
A7
Family name
Given names
Sex
Indeterminate /
Intersex / Unspecified
Male Female
Date of birth
Day Month Year
Relationship status
Married legally Engaged Widowed
Married by
tradition/custom
Married religiously
De facto
Separated
Divorced
Never married or
been in a de facto
relationship
Precise relationship to the main applicant
If insufficient space, attach additional details
681 (Design date 09/20) - Page 5© COMMONWEALTH OF AUSTRALIA, 2020
Part B – Proposer’s details – Individual
Note: This part should only be completed if you are proposing visa
applicants in your private capacity as an individual, and not as the
representative of an organisation.
14 Are you submitting this proposal as an individual?
No
Go to Part C – Proposer’s details – Organisation
Yes
Complete the details below
15 Family name
Given names
16 Sex Male
Female
Indeterminate /
Intersex / Unspecified
17 Date of birth
Day Month Year
18 Place of birth
Town/city
Country
19
If born outside Australia:
Date of arrival in Australia
Day Month Year
20 Are you an Australian citizen, Australian permanent resident or an
eligible New Zealand citizen?
No
You are unable to propose
Yes
Please provide evidence as described on page 3
21 Full residential address (not postal address)
Postcode
Note: If you are living in regional Australia, provide evidence of your
residential address so that your application is prioritised accordingly.
22 Postal address
(If the same as your residential address, write ‘AS ABOVE’)
Postcode
23 Your contact telephone numbers (if available)
Office hours
( ) ( )
Country code Area code Number
After hours
( ) ( )
Mobile/cell
Note: If your contact details change before this application is finalised,
it is your responsibility to notify the office of the Department at which the
application is being processed.
24 Do you agree to the Department communicating with you by email?
No
Yes
Provide at least one primary and any secondary email
addresses you can be contacted on
Primary
Secondary
Secondary
25 Your current occupation (if not employed, write ‘unemployed’)
For how many years have you been
in this occupation?
26 Your partner’s occupation (if applicable)
For how many years has your partner been
in this occupation?
27 List all Australian visas you have held including your current visa
(if appropriate)
681 (Design date 09/20) - Page 6 © COMMONWEALTH OF AUSTRALIA, 2020
Part C – Proposer’s details – Organisation
Note: This part should only be completed if you are representing an
organisation, and you have the authority to represent your organisation.
28 Organisation’s full name/title
29
Name of person authorised to sign this form on behalf of the organisation
Family name
Given names
30 Position held by this person in above organisation
31 Please list all other office holders
32 Full street address of organisation (not post office box)
Postcode
33 Postal address
(If the same as street address, write ‘AS ABOVE’)
Postcode
34 Contact telephone numbers of person authorised to sign this form
Office hours
( ) ( )
Country code Area code Number
After hours
( ) ( )
Mobile/cell
Note: If the contact details of the person signing this form on behalf of
the organisation change before the application is finalised, it is your
responsibility to notify the office of Department at which the application
is being processed.
35 Please attach a written statement explaining your organisation’s
objectives (clearly mark this statement as ‘Question 35’)
Is the statement attached?
No
Yes
36 Do you agree to the Department communicating with you by email?
No
Yes
Provide at least one primary and any secondary email
addresses you can be contacted on
Primary
Secondary
Secondary
Part D – Previous proposals
37 Have you (or your organisation) previously proposed these visa
applicants or any other applicants for a humanitarian visa?
No
Yes
Please provide the following details
Name of the visa applicant you have proposed
Date of previous application
Day Month Year
File number
Office of the Department where the application was lodged
Outcome of the application
Granted
Refused
Not yet decided
Name of the visa applicant you have proposed
Date of previous application
Day Month Year
File number
Office of the Department where the application was lodged
Outcome of the application
Granted
Refused
Not yet decided
If you have proposed more than 2 applicants, please attach
details on a separate sheet.
681 (Design date 09/20) - Page 7© COMMONWEALTH OF AUSTRALIA, 2020
Part E – Acknowledgement
WARNING: Giving false or misleading information is a serious offence.
38 • I acknowledge that the applicants and I are responsible for
arranging and paying for the travel to Australia by the applicants I
have proposed if they are granted a subclass 202 (Global Special
Humanitarian) visa.
• I give permission for the information in this form to be given to other
agencies and contracted service providers to assist me in my role as
the proposer of humanitarian entrants and to assist in the settlement
of the entrants.
• I acknowledge that the information on my record as a proposer may
be used by the Department in deciding visa applicants made under
the Refugee and Special Humanitarian Program where I am the
proposer.
I declare that:
• I have read the information contained in form 1442i Privacy notice.
• I understand the Department may collect, use and disclose my
personal information (including biometric information and other
sensitive information) as outlined in form 1442i Privacy notice.
Note: In order for the Humanitarian Settlement Program (HSP) service
provider to help you with relevant advice and assistance, it is necessary
for the information that you give in this form to be made available to the
provider. This acknowledgement enables the Department to share the
information on this form with the HSP service provider and other
settlement service providers as appropriate.
Printed name
Signature
of proposer
-
Date
Day Month Year
We strongly advise that you keep a copy of your proposal and
all attachments for your records.
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Form 681: humanitarian proposal Refugee and special (Department of Home Affairs)

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Completed 4 September 2021

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