© COMMONWEALTH OF AUSTRALIA, 2015
I declare that:
• the information supplied on this form is correct;
• I will be residing in Australia for the period of the above
• I will ensure that the adequate accommodation is available to the
child/children during the child’s/children’s stay in Australia;
• I will accept responsibility for the support and general welfare of the
child/children named on this form;
• I accept that I must immediately advise the Department of Immigration
and Border Protection (the department) if I become aware that any
information provided in this form is incorrect or if there is a change
in my circumstances that is relevant to this undertaking at any time;
• I accept that the Australian Federal Police or other Commonwealth
bodies may look into my history as necessary;
• I will inform the department in writing if I withdraw my undertaking;
• I have read the information contained in form 1442i
• I understand the department may collect, use and disclose my
personal information (including biometric information and other
sensitive information) as outlined in form 1442i
DAY MONTH YEAR
1257 (Design date 10/15) - Page 3
If you answered ‘Yes’ to any of the questions at Question 17, you must
give ALL relevant details. If the matter relates to a criminal conviction,
please give the nature of the offence, full details of sentence and dates
of any period of imprisonment or other detention.
We strongly advise that you keep a copy of this declaration
and all attachments for your records.
Part C – Undertaking declaration
WARNING: Giving false or misleading information is a serious offence.
Have you ever:
• been charged with any offence that is
currently awaiting legal action?
• been convicted of an offence in any country
(including any conviction which is now
removed from official records)?
• been the subject of an arrest warrant or
• been found guilty of a sexually based offence
involving a child (including where no
conviction was recorded)?
• been named on a sex offender register?
• been acquitted of any offence on the grounds
of unsoundness of mind or insanity?
• been found by a court not fit to plead?
• been directly or indirectly involved in, or
associated with, activities which would
represent a risk to national security in
Australia or any other country?
• 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?
• been associated with a person, group or
organisation that has been/is involved in
• been associated with an organisation
engaged in violence or engaged in acts of
violence (including war, insurgency, freedom
fighting, terrorism, protest) either overseas or
• served in a military force, police force, state
sponsored/private militia or intelligence
agency (including secret police)?
• undergone any military/paramilitary training,
been trained in weapons/explosives or in the
manufacture of chemical/biological products?
• been involved in people smuggling or people
• been removed, deported or excluded from any
country (including Australia)?
• overstayed a visa in any country (including
• had any outstanding debts to the Australian
Government or any public authority in