Form

Communicating by email
with the department 1193

Purpose of this form Applicant details

The purpose of this form is to assist clients in contacting the
Department of Immigration and Border Protection (the 1 Family name
department) by electronic means.
Given names
Consent to communicate electronically DAY MONTH YEAR

The department may use a range of means to communicate Date of birth

with you. However, electronic means such as fax or email will
File number
only be used if you indicate your agreement to receive
communication in this way.
2 Do you agree to the department communicating with you by fax, email
To process your application the department may need to or other electronic means?
communicate with you about sensitive information, for example,
health, police checks, financial viability and personal No
relationships. Electronic communications, unless adequately Yes Give details
encrypted, are not secure and may be viewed by others or
interfered with. If you agree to the department communicating Fax number (AREA CODE )

with you by electronic means, the details you provide will only
Email address
be used by the department for the purpose for which you have
provided them, unless there is a legal obligation or necessity to
use them for another purpose, or you have consented to use Signature of
for another purpose. They will not be added to any mailing list applicant
without your consent.
The Australian Government accepts no responsibility for the DAY MONTH YEAR

security or integrity of any information sent to the department Date

over the internet or by other electronic means.
If you authorise another person to receive documents on your
behalf and they wish to be contacted electronically, their
Consent by authorised person or
signature is required on the form to indicate their consent to migration agent
this form of communication.
I understand the information provided and agree to the
department communicating with me by email.
Important information about privacy
Your personal information is protected by law, including the 3 Family name
Privacy Act 1988. Important information about the collection,
use and disclosure (to other agencies and third parties, Given names
including overseas entities) of your personal information,
including sensitive information, is contained in form 1442i Email address
Privacy notice. Form 1442i is available from the departments Tick one box only
website www.border.gov.au/allforms/ or offices of the Authorised person
department. You should ensure that you read and understand
form 1442i before completing this form. Migration agent Migration Agent Registration Number
: : : : : 7 DIGITS

4 DECLARATION
Home page www.border.gov.au Warning: Under the Migration Act 1958, there are penalties for
General Telephone 131 881 during business hours deliberately giving false or misleading information.
enquiry line in Australia to speak to an operator (recorded I declare that:
information available outside these hours). the information I have supplied in this application is complete,
If you are outside Australia, please contact correct and up-to-date in every detail
your nearest Australian mission. 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.
Signature of
authorised
person or
migration agent
DAY MONTH YEAR

Date
COMMONWEALTH OF AUSTRALIA, 2016 1193 (Design date 04/16) - Page 1