Form
1257
Undertaking declaration
© COMMONWEALTH OF AUSTRALIA, 2015
Important – Please read this information carefully before you
complete this declaration. Once you have completed this
declaration we strongly advise that you keep a copy for your
records.
Who should use this form?
This form is to be completed by the person (21 years or older)
who has been nominated by parent(s) or legal guardian(s) to be
responsible for a child/children (under 18 years of age) who:
intend to stay in Australia; and
whose stay will not be in the company of one, or both of
his/her parent(s) or legal guardian(s); and
who will not be staying with a relative; and
who is not a member of an organised tour providing adequate
maintenance and support arrangements for their stay in
Australia.
The person nominated must provide an undertaking to provide
accommodation and be responsible for the support and general
welfare of the child during their stay in Australia. This
undertaking must be provided by a person who, in the belief of
the Minister, is of good character.
The person providing the undertaking should be physically
present in Australia for the period of the child’s/children’s
intended stay.
Important information about privacy
Your personal information is protected by law, including the
Privacy Act 1988. Important information about the collection,
use and disclosure (to other agencies and third parties, including
overseas entities) of your personal information, including
sensitive information, is contained in form 1442i Privacy notice.
Form 1442i is available from the department’s website
www.border.gov.au/allforms/ or offices of the department.
You should ensure that you read and understand form 1442i
before completing this form.
1257 (Design date 10/15) - Page 1
Part A – Child’s/Children’s details
Give details of each child included in this undertaking
Provide details as shown in passport
2
Family name
Given names
Date of birth
DAY MONTH YEAR
Passport number
1.
How many children are included in
this undertaking?
1
Transaction
Reference Number
If insufficient space attach additional details
Tick where applicable
Please use a pen, and write neatly in English using BLOCK LETTERS.
Family name
Given names
Date of birth
DAY MONTH YEAR
Passport number
2.
Transaction
Reference Number
Family name
Given names
Date of birth
DAY MONTH YEAR
Passport number
3.
Transaction
Reference Number
Family name
Given names
Date of birth
DAY MONTH YEAR
Passport number
4.
Transaction
Reference Number
Part B – Responsible nominee’s details
© COMMONWEALTH OF AUSTRALIA, 2015
3
Family name
Given names
Other names you are, or have been, known by
(including name at birth, previous married names, aliases)
4
Place of birth
12
Town/city
Country
Details of your passport
13
Passport number
Country of
passport
16
Employment status
Employed/
self-employed
Retired
Other Please specify
Student
Unemployed
Employer/Business name
Address
POSTCODE
Telephone
Sex
5
Male Female
Date of birth
6
DAY MONTH YEAR
1257 (Design date 10/15) - Page 2
Are you:
A permanent resident in Australia
Visa label number
A temporary resident
An Australian citizen
An eligible New Zealand citizen
File number
(if you are applying for a visa)
Current residential address
8
POSTCODE
Postal address
(if same as the residential address, write ‘as above’)
9
POSTCODE
Telephone numbers
10
Mobile/cell
11
In the course of deciding on the application, we may need to contact you
about the undertaking provided by you.
Do you agree to the department communicating with you by fax,
email, or other electronic means?
Email address
No
Yes Give details
V<
Date of issue
Date of expiry
Issuing authority/
Place of issue as
shown in your
passport
DAY MONTH YEAR
Go to Question 15
Go to Question 16
15
Are you currently holding or applying for an Australian visa?
No
Yes Give details
Visa grant number
Office hours
COUNTRY CODE AREA CODE NUMBER
()()
Fax number
COUNTRY CODE AREA CODE NUMBER
()()
COUNTRY CODE AREA CODE NUMBER
()()
Relationship status
7
Married Never married or
been in a de facto
relationship
Separated
De facto
Engaged
Widowed
Divorced
14
© 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
child’s/children’s stay;
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
Privacy notice
; and
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
.
18
Signature
of responsible
nominee
Date
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
Interpol notice?
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
criminal conduct?
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?
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
trafficking offences?
been removed, deported or excluded from any
country (including Australia)?
overstayed a visa in any country (including
Australia)?
had any outstanding debts to the Australian
Government or any public authority in
Australia?
17
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome