Nomination by NSW Does Not Guarantee a Successful Visa Outcome

NSW Nomination Application Business Innovation and Investment (Permanent) visa (subclass 888) Significant Investor stream

Before completing this form, please carefully read the NSW nomination requirements and Department of Immigration and Border Protection criteria for the Significant Investor (Permanent) visa (subclass 888).

Nomination by NSW does not guarantee a successful visa outcome.

Applications should be supported by appropriate evidence (see Part 6 – Checklist).

Part 1 – Details of migration agent/representative (if applicable)

1.1 Migration agent/representative Title Name Business name MARN Telephone Email Address

Part 2 – Details of main applicant 2.1 Personal details Title Last name First name Date of birth Passport number Country of Country of birth passport Do you hold a Business Innovation and Yes Investment (Provisional) visa No If no, you are not eligible to apply for visa nomination (subclass 188) – Significant Investor stream? Date of 188C Date of 188C SIV nomination visa grant No. of days in Date of 188C SIV Australia on this visa expiry visa (approx) Main language Prefer language Yes No spoken assistance Email (a current personal email address is required) Country of current Telephone residence

Document last updated June 2017 Page 1 of 13 Province/State City Address

See Part 6 - Checklist – Item 1 for evidence required

2.2 Provisional visa 188C SIV details Name of primary applicant for 188C SIV What state/territory nominated you for the 188C SIV

2.3 Details of secondary applicants (if applicable)

Full name DOB Relationship to you

Part 3 – Complying Investment information See Part 6 - Checklist – Item 2 for evidence required

3.1 If you were nominated prior to 1 July 2015 Please provide details of all complying investments held during your provisional visa period. (NSW had a mandatory investment of at least 30% or equivalent of A$1.5 million for applicants nominated prior to 1 September 2014)

NSW Waratah Bonds A$ Investment date Maturity date TCorp statement attached

Amount invested A$ Dates held: From: To: Name of fund Current investment in Managed Fund Managing institution

Form 1413 & letter from Fund Manager name my Fund Manager attached Fund Manager phone

Fund Manager email

Document last updated June 2017 Page 2 of 13 Amount invested A$ Dates held: From: To:

Name of fund Current investment in Managed Fund Managing institution

Form 1413 & letter from Fund Manager name my Fund Manager attached Fund Manager phone

Fund Manager email

Document last updated June 2017 Page 3 of 13 Amount invested A$ Dates held: From: To:

Name of fund

Managing institution Previous investment in Managed Fund Fund Manager name

Fund Manager phone

Fund Manager email

Amount invested A$ Dates held: From: To:

Name of fund

Managing institution Previous investment in Managed Fund Fund Manager name

Fund Manager phone

Fund Manager email

Name of business Type of business

Address of business

Amount of total investment A$ Direct investment in an Ownership interest % Date ownership started Australian Proprietary Company Yes If yes, detail Has this business produced any Current and historical ASIC new full-time jobs in the last 4 years?* No extracts for my business attached Yes If yes, total A$ Has this business exported any goods in the last 4 years?* No

* This information is requested for information purposes only, please complete to assist this purpose

3.2. If you were nominated after 1 July 2015 Please provide details of all complying investments held during your provisional visa period. VCPE Amount invested A$ Dates held: From: To:

Form 1413D & letter from Name of fund my Fund Manager attached Managing institution Fund Manager name

Document last updated June 2017 Page 4 of 13 Fund Manager phone

Fund Manager email

Document last updated June 2017 Page 5 of 13 Amount invested A$ Dates held: From: To:

Name of fund Emerging Companies Managing institution Form 1413D & letter from Fund Manager name my Fund Manager attached Fund Manager phone

Fund Manager email

Amount invested A$ Dates held: From: To:

Name of fund Balancing Investment Managing institution Form 1413D & letter from Fund Manager name my Fund Manager attached Fund Manager phone

Fund Manager email

3.3 Additional investment in NSW (if applicable) (Note: It is not a requirement for you to make any additional investments. This is for our information only)

Type of investment Amount of total investment A$

I intend on making additional investments in NSW.

Please describe your intended additional investments and include which sector you consider to be attractive for a future investment (approx. 150 words):

3.4 Additional business activity in NSW (if applicable) (Note: It is not a requirement for you undertake additional business activity. This is for our information only)

Type of investment Amount of total investment A$

I intend on undertaking additional business activity in NSW?

Please describe your intended additional business activity (approx. 150 words):

Document last updated June 2017 Page 6 of 13 Part 4 – Applicants nominated by another state/territory before 1 September 2014 See Part 6 - Checklist – Item 3 for evidence required

4.1 If you were nominated by another state/territory before 1 September 2014 (NSW had a mandatory investment of at least 30% or equivalent of A$1.5 million for applicants nominated prior to 1 September 2014)

If you were nominated by another state/territory before 1 September 2014 , you have held a complying investment continuously for the whole period during which you held your Provisional 188C SIV and you must meet Option A or Option B below:

Option A I have invested at least A$1.5 million in NSW Waratah Bonds - go to Part 4.2

I have invested at least A$1.5 million in investment activity in NSW (excluding residential real estate) and Option B I have established residence in NSW and I have a genuine commitment to undertake further beneficial business or investment activity in NSW - go to Part 4.3

4.2 If you have invested at least A$1.5 million in NSW Waratah Bonds

I have attached my NSW Waratah Bond statement issued by NSW Treasury Corporation (TCorp) showing that I held this investment for the whole period during which I held my Provisional 188C SIV.

4.3 If you have invested at least A$1.5 million in NSW (Note: A$1.5 million investment in NSW excludes residential real estate)

I have attached a statement and evidence describing my investment activity in NSW of at least A$ 1.5 million

I have attached a statement and evidence to demonstrate that I have established a residence in NSW (Evidence of your living arrangements such as purchase of your home, tenancy agreement, enrolment of your children in NSW schools or other documents that show you have established a residence in NSW)

I have attached a statement and - where possible - evidence to demonstrate my genuine commitment to undertake further beneficial business or investment activity in NSW

See Part 6 - Checklist – Item 3 for evidence required

Document last updated June 2017 Page 7 of 13 Part 5 – Declarations

5.1 Privacy statement

The personal information you provide on this form is subject to the Privacy & Personal Information Protection Act 1998. It is being collected by NSW Department of Industry and will be used for purposes related to NSW nomination for a Business Innovation and Investment (Permanent) visa (subclass 888) in the Significant Investor stream (“Significant Investor visa”).

NSW Department of Industry will not disclose your personal information to anybody else unless authorised by law. The provision of the requested information is required for the purpose of assessing your eligibility for NSW nomination for a Significant Investor visa. If you choose not to provide this information we may not be able to process your application.

You have the right to request access to, and correct the details of, your personal information held by us. Further information regarding privacy can be obtained from our website at www.industry.nsw.gov.au/legal/privacy.

5.2 Applicant’s declaration

I solemnly and sincerely declare the following:

 I understand that a NSW nomination decision will be made on the basis of the information provided in my application. To the best of my knowledge, all information provided in this application is complete, true and accurate, and I believe I satisfy all relevant NSW nomination requirements and the Commonwealth visa criteria.

 Applicants nominated by NSW before 1 September 2014 I have held a complying investment as per the DIBP definition for the whole of the period during which I have held the visa/s, including a minimum of 30% or at least A$1.5 million in NSW Waratah Bonds

 Applicants nominated after 1 September 2014 I have held a complying investment as per the DIBP definition for the whole of the period during which I have held the visa/s.

 Applicants nominated by another state/territory before 1 September 2014 I have invested at least A$ 1.5 million in NSW Waratah Bonds or I have invested at least A$ 1.5 million in NSW (excluding residential real estate) and

I have established residence in NSW and

I have a genuine commitment to undertake further beneficial business or activity in NSW.

 I have sufficient funds available to finance my settlement and living expenses in NSW.

Document last updated June 2017 Page 8 of 13  Neither I or my spouse or de facto partner (if any) has a history of involvement in business or investment activities that are of a nature that is not generally acceptable in Australia.

 The information provided in this application on my complying investments that relates to a managed fund has been directly provided to me by the fund manager(s) for the respective investment, and is correct to the best of my knowledge.

 I acknowledge that it is my own commercial decision to invest in NSW, and my sole responsibility to obtain independent legal and financial advice in relation to any risk. I have not relied on any information or advice from the NSW Government in relation to my investment. I understand and acknowledge that the NSW Government does not accept any liability for any loss I may sustain as a result of my investment.

5.2 Applicant’s declaration continued

 I authorise NSW Department of Industry to share the information provided in this application with DIBP and other parties for purposes of verifying and processing my application.

 If granted a subclass 888 visa by DIBP, I will advise NSW Department of Industry for the first two years of holding this visa of any change of my contact details within 28 days and respond to NSW Department of Industry surveys or market research or requests for updated information on my investment activity in NSW.

Applicant’s signature ______

Applicant’s name Date

5.3 Declaration by migration agent/representative

I have explained all of the NSW nomination requirements and conditions to the applicant, and believe that the applicant understands the information, including the privacy statement and the applicant’s declaration above.

To the best of my knowledge, I believe that the information provided in this application is complete, true and accurate.

Signature ______

Name Date

Document last updated June 2017 Page 9 of 13 Part 6 – Checklist (tick if provided)

Below are examples of the types of documents you can submit to support your claims. You do not need to provide all documents listed below but you should provide sufficient evidence to demonstrate that you meet each criterion.

How to label your documents Please label each document so that it identifies the criteria that the document relates to. For example, Passport bio-data page should be labelled: Item 1: Applicant details_Passport.” etc. For applications submitted by email, please name the electronic file accordingly.

Criteria Supporting documents provided

Passport bio-data page and visa grant page Item 1: Identity Other, please specify

NSW Waratah Bond statement issued by the NSW Treasury Corporation (TCorp) showing initial investment date and maturity date

Item 2: Complying Investments Form 1413 that you will submit to DIBP If you were nominated before 1 July 2015 Shareholder certificate, company extract from ASIC and financial documents showing your investment in an Australian Proprietary Company

Form 1413D that you will submit to DIBP Item 2: Complying Investments If you were nominated after 1 July 2015 Other, please specify

Item 3: Applicants nominated by another Evidence of original state/territory nomination (If nominated by state/territory If you were nominated by another state/territory another state/territory) before 1 September 2014 Please provide evidence against item 1 or 2 below

1. Evidence of investment in NSW Waratah Bonds

NSW Waratah Bond statement issued by the NSW Treasury Corporation (TCorp) showing initial investment date and maturity date (if relevant)

2a. Investment activity in NSW of A$1.5 million

Statement describing my investment activity in NSW

Evidence that demonstrate my investment activity in NSW (ownership of assets, financial products etc) 2b.Details of my established residence in NSW

Document last updated June 2017 Page 10 of 13 Statement outlining my residence in NSW

Evidence of my established residence in NSW Tenancy agreement

Purchase of your home

Enrolment of your children in NSW schools

Item 3: Continued 2c. Commitment to further invest in NSW

Other – A statement outlining your further investment or business activity in NSW and how this will benefit the NSW economy. Attach evidence where possible * * mandatory for applicants who did not invest in NSW Waratah Bonds

Item 5: DIBP Form Form 1414 that you will submit to DIBP Nomination – Business Skills class

Item 6: Payment of application fee

A$1,270 Nominated by NSW for Provisional 188C SIV Online payment receipt A$2,090 Nominated by another state/territory for Provisional 188C SIV

Document last updated June 2017 Page 11 of 13 Part 7 – Lodgement

Please return the completed form and the supporting documentation to NSW Business & Skilled Migration through one of the following methods:

1. Email (preferred) to [email protected]

Please include the following in the email subject line: 888SIV nomination application_ [ApplicantName]

2. Post:

Business & Skilled Migration NSW Department of Industry GPO Box 5477 Sydney NSW 2001 Australia

3. Courier:

Business & Skilled Migration NSW Department of Industry L48 MLC Centre 19 Martin Place Sydney NSW 2000 Australia

Before lodging the application, please note the following:

 All supporting documents must be certified copies, or if the application is being lodged by

email, colour scanned copies.

 Please do not send original documents, as we are unable to return them to you.

 Documents in a language other than English must be accompanied by a certified English

translation. Document last updated June 2017 Page 12 of 13 If you have any questions about completing or returning this form, please contact us at [email protected] or on (+61) 2 9934 0704.

Document last updated June 2017 Page 13 of 13