Date submitted

Visa

Which type of visa are you intending to apply for? *

Provisional visaPermanent visa

Which provisional visa are you intending to apply for: *

Extension - 188 Business Innovation and Investment - Business InnovationExtension - 188 Business Innovation and Investment - Significant Investor

Which permanent visa are you intending to apply for: *

888 Business Innovation and Investment - Business Innovation888 Business Innovation and Investment - Investor888 Business Innovation and Investment - Significant Investor

For any other provisional visas not listed above please contact the Business Migration Centre:

Telephone: +61 8 6552 3300

Email: businessmigration@smallbusiness.wa.gov.au

For any other permanent visas not listed above please contact the Business Migration Centre:

Telephone: +61 8 6552 3300

Email: businessmigration@smallbusiness.wa.gov.au

Document checklist

A copy of the passport data page for all persons included in this application.

ABN Registration.

Evidence of business ownership. (ASIC historical extract)

Business Activity Statements for the past 2 years (generated from ATO portal).

Business financial statements no more than 3 months old for the past 12 months.

Business financial statements no more than 3 months old for the past 12 months. (If claiming net business assets for DHA's visa criteria, please provide financial statements for the past 2 years)

If applicable, evidence of any Australian citizen, PR or New Zealand citizen employees (contract of employment/pay record history)

Evidence of complying investment and maturity date.

Evidence of complying investments held for the required period.

Evidence of your Designated Investment held (Certificate of Inscription) or Complying Investment.

Form 1139a (no more than 3 months old) for the past 12 months along with supporting evidence of any assests/liabilities being claimed.

Form 1139a (no more than 3 months old) for the past 12 months along with supporting evidence of any assests/liabilities being claimed. (If claiming net assets to meet DHA's visa criteria please provide a form 1139a and supporting evidence for the past 2 years)

Completed Form 1414

Application

Does your application include a spouse or partner? *

YesNo

Does your application include dependents? *

YesNo

Are you using the services of a migration agent or authorised representative? *

YesNo

Were you the primary applicant for your Significant Investor provisional visa? *

YesNo

Were you the primary applicant for your provisional visa? *

YesNo

If you were not the primary applicant of the Significant Investor visa, you must have been the spouse or defacto partner of a person who held a Business Innovation and Investment (Provisional)(subclass 188) visa in the Significant Investor stream or extension, and have ceased to be their spouse or the defacto partner, or that person is deceased.

Provisional visa primary applicant's given name(s) *

Provisional visa primary applicant's family name *

Main applicant

Given name(s) *

Family name *

Gender *

Male FemaleAnother self-identityPrefer not to say

Date of Birth *

Over 55

If you are 55 years of age or older please tick the following box

If you are applying for {{Provisional visa}} and are over the age of 55, you must refer to the BMC State Nomination Policy Guidelines to ensure your proposed business or investment activity meets the higher economic requirements and will be of exceptional economic benefit to the State.

Current residential address *

Street address *Street address line 2

City / Town *

State/ Province *

Postcode/ Zip code *

Country *

Preferred telephone contact: *

Personal mobileHome

Applicant's mobile phone number *Please include your country code if not within Australia.

Applicant's home phone number *Please include your country code if not within Australia.

Applicant's email address *

Passport number *

Country of issue *

Country *

Date of issue *

Date of expiry *

Passport bio data page *

Browse

Please provide a clear copy of your passport bio data page.

Do you hold an Australian visa? *

YesNo

Please provide visa type and subclass *

Visa expiry date *

Have you ever applied for nomination from any other Australian state or territory government? *

YesNo

Which state or territory? *

State *

Date applied *

If other, please provide details *

Spouse or partner

Given name(s) *

Family name *

Country of current residence *

Country *

Which visa do they currently hold?

Passport bio data page *

Browse

Please provide a clear copy of your spouse or partner passport bio data page.

Dependents

Please provide details of any dependents you are including in this application.

How many dependents are you including in this application? *You can provide details for up to four dependents, if you need more, please provide a copy of their passport bio data page at the bottom of this section.

Given name(s) *

Family name *

Is this dependent currently studying in Australia? *

YesNoDependent is not studying

Current country of study *

Country *

Current state of study: *

State *

Name of education provider *

Passport bio data page *

Browse

Please provide a clear copy of dependent one's passport bio data page.

Given name(s) *

Family name *

Is this dependent currently studying in Australia? *

YesNoDependent is not studying

Country of study *

Country *

Current state of study *

State *

Name of education provider *

Passport bio data page *

Browse

Please provide a clear copy of dependent two's passport bio data page.

Given name(s) *

Family name *

Is this dependent currently studying in Australia? *

YesNoDependent is not studying

Current country of study *

Country *

Current state of study *

State *

Name of education provider *

Passport bio data page *

Browse

Please provide a clear copy of dependent three's passport bio data page.

Given name(s) *

Family name *

Is this dependent currently studying in Australia? *

YesNoDependent is not studying

Current country of study *

Country *

Current state of study *

State *

Name of education provider *

Passport bio data page *

Browse

Please provide a clear copy of dependent four's passport bio data page.

Additional dependents passport bio pages *

Browse

Please provide a clear copy of any additional dependent's passport bio data pages here.

Migration agent or authorised representative

Given name(s) *

Family name *

Business name

Address *

Street address *

City *

State *

Postcode *

Country *

Preferred telephone contact: *

Business mobileBusiness phone

Business mobile *

Business phone *

Email address *

Australian Migration Agent Registration Number (MARN) *

Extension stream criteria

Significant Investor:

You are the holder of a Business Innovation and Investment (Provisional) visa (subclass 188) Significant Investor Stream visa.
*

You have not held more than one visa in the Significant Investor Extension Stream. *

You have continuously maintained your complying investments in accordance with the complying investment framework in place at the time you applied for your original subclass 188 visa. *

Business Innovation:

You are the holder of a Business Innovation and Investment (Provisional) Business Innovation Stream visa 188. *

You had, and continue to have, an ownership interest in up to two actively operating businesses in Western Australia for at least two years immediately before your application. *

It is a Department of Home Affairs requirement that you have not acquired the ownership in your main business (or two main businesses) from a person who was an applicant for, or a holder of, a permanent Business Innovation and Investment visa (subclass 888), unless you and that person had a joint interest in the main business for at least one year before you lodge your application for this visa. *

Confirm

You have held this visa for at least three years. *

Are you living in Western Australia *

YesNo

Where do you live in Western Australia? *

City/ town *

Where do you currently live? *

List your current complying investments: *

Evidence of your complying investments and their maturity dates: *

Browse

Confirm you will maintain your funds in Western Australia upon maturity of your complying investments. *

Detail how you will maintain your complying investment funds in Western Australian assets upon their maturity. List the Western Australian Assets in which the funds will be invested. *

Explain your need to be a resident in Western Australia to operate your business(es). *

Explain how you will stay directly involved in the day-to-day management and key decision-making of your business(es) *

Explain the reasons why you are seeking an extension on your visa. *

Current Statement of Assets and Liabilities Position (SALP)

Please complete the Department of Home Affairs Statement of Assets and Liabilities Position (SALP) Form 1139a and attach below.

You must include all major assets and liabilities in Western Australia.

Please upload your current Statement of Assets and Liabilities Position (SALP) *

Browse

Please complete and attach form 1414 below.

Please upload your Form 1414 *

Browse

Permanent residency criteria

Department of Home Affairs criteria

Confirm you meet the Department of Home Affairs criteria for this visa.

You currently hold a 188 Business Innovation (Provisional) visa (subclass 188) Innovation Stream or a 444 Stream Category visa. *

You currently hold a 188 Business Innovation (Provisional) visa (subclass 188) Investor stream. *

You have been in Australia as the holder of one of these visas for the total of at least one year in the two years immediately before your application. *

You, or you and your spouse or partner combined have had, and continue to have, an ownership interest in up to two main businesses in Australia and had a direct and continuous management role in that business for at least two years immediately before your application. For each of these businesses you must have obtained an Australian Business Number and demonstrated active trading in Australia. Business Activity Statements for the period need to be provided as supporting documentation. *

You did not acquire the ownership in your main business (or two main businesses) from a person who was an applicant for, or a holder of, a permanent Business Innovation and Investment visa (subclass 888) or a permanent Business Skills visa (in subclass 890,891,892, or 893) unless you and that person had a joint interest in the main business for at least one year before you lodge your application for this visa. *

You currently hold a 188 Business Innovation (Provisional) visa (subclass 188) Significant Investor Stream. *

You have been in Australia as the holder of this visa for at least two years in the four years immediately before your application? *

You have lived in Australia for at least 160 days in the four years immediately before this visa application, or your partner has lived in Australia for a total of at least 720 days. *

You, or you and your partner combined have held complying investments continuously for at least four years while holding your Business Innovation and Investment (Provisional) Significant Investor visa (subclass 188). *

If you applied for your provisional visa (subclass 188) in the Significant Investor stream prior to 1 July 2015, you are eligible to apply for a subclass 888 visa after holding your provisional visa for 3 years and 11 months. If you applied for your provisional visa after 1 July 2015, you are required to hold your provisional visa for at least 4 years prior to applying for subclass 888 visa.

Evidence of your complying investments held for the required period. *

Browse

Designated Investment

If you applied for your provisional visa (subclass) 188 in the Investor stream prior to 1 July 2015, you are eligible to apply for a subclass 888 visa after holding your provisional visa for three years and 11 months.

If you applied for your provisional visa after 1 July 2015, you are required to hold your provisional visa for at least four years prior to applying for your subclass 888 visa.

You have held your designated investment with the Western Australian Treasury Corporation (WATC) for at least four years. *

Date of maturity of your designated investment *Applications for State nomination will be accepted if the designated investment has matured or is due to mature within the next three months.

Evidence of your designated investment held with the Western Australian Treasury Corporation *

Browse

Certificate of Inscription.

Other criteria

Have you purchased a residence in WA? *

YesNo

Additional investment or business activities

Have you undertaken additional business or investment activities in Western Australia while holding your provisional visa? *

Yes No

I have undertaken additional: *

Business activitiesInvestment activities

Confirm you complied with Commonwealth laws and state or territory laws with respect to taxation, superannuation and workplace relations while operating your business. *

Business activities

Business name *

Australian Business Number (ABN)

Date of ownership of business from: *

Date of ownership of business to:

Business Activity *

Your position in the business *

Your business ownership interest (%) *

Turnover for the last 12 months: *

The number of new permanent full time equivalent jobs your business has created: *

Investment activities

Date of ownership of investment from: *

Date of ownership of investment to:

Investment name *

Investment type *

Your investment ownership interest (%) *

Business activity

Provide details of your business or businesses in Western Australia.

How many businesses do you currently own in Western Australia? *

One Two

How many businesses are you using to qualify? *

One Two

Business one name *

Business address *

Street address *

City *

State *

Postcode *

Australian Business Number (ABN) *

Copy of ABN registration *

Browse

For this business, did you: *

Create this businessPurchase an existing business

You and your spouse or partner's combined ownership interest (%) for this business *

Provide the names of all the owners, their relationship to you and their ownership interest for this business *

Date of ownership from *Provide month and year.

Date of ownership to:Provide month and year, if current, please leave blank

Business evidence of ownership *

Browse

ASIC historical extract.

Business structure type: *

Please provide financial information for the past 12 months (financial statements must not be more than three months old). Please use the same 12 month period for both turnover and net business assets.

Date of financial period from: *

Date of financial period to: *

Business turnover for the last twelve months *AUD$

Business turnover must be at least $300,000 excluding GST.

Net business assets *AUD$

Financial statements for the past two years *

Browse

Business Activity Statements (BAS) generated from the ATO portal for the past two years *

Browse

How many full-time equivalent employees are currently employed? *Employees must be full-time equivalent, Australian citizens, Australian permanent residents or New Zealand passport holders.

How many full-time equivalent employees were there at the time of purchase? *Employees must be full-time equivalent, Australian citizens, Australian permanent residents or New Zealand passport holders.

Evidence of employees *

Browse

Include contract of employment, pay record history and evidence of Australian citizenship, permanent residence or New Zealand citizenship. Do not include any tax file details for your employees.

Describe the business activities *

Explain your key and direct management roles and responsibilities for the business *

Business two

Business two name *

Business two address *

Street address *

City *

State *

Postcode *

Australian Business Number (ABN)

Copy of ABN registration *

Browse

For this business did you: *

Create this businessPurchase an existing business

You and your spouse or partner's combined ownership interest (%) for this business *

Provide the names of all the owners, their relationship to you and their ownership interest for this business *

Date of ownership from: *Provide month and year

Date of ownership to:Provide month and year. If current, leave blank

Business evidence of ownership *

Browse

ASIC historical extract.

Business structure *

Turnover *AUD$ Financial statements must be no more than three months old.

Business turnover for the last twelve months *AUD$

Date of turnover from *

Date of turnover to *

Net business assets for the same twelve month period prior to application *AUD$

Financial statements for the past two years *

Browse

Business Activity Statements (BAS) generated from the ATO portal for the past two years *

Browse

How many full-time equivalent employees are currently employed? *Employees must be full-time equivalent, Australian citizens, Australian permanent residents or New Zealand passport holders. Do not include any tax file details for your employees.

Evidence of employees *

Browse

Include contract of employment, pay record history and evidence of Australian citizenship, permanent residence or New Zealand citizenship. Do not include any tax file details for your employees.

Describe the business activities *

Explain your key and direct management roles and responsibilities for the business *

Please confirm you agree to meet all requirements of your current State Nomination Agreement prior to lodging an application for your visa subclass 888. *

Western Australian State nomination agreement

My signed State Nomination Agreement was for the following proposal

Proposed total net assets to be in Western Australia *AUD$

Proposed designated investment into Western Australian Treasury Bonds for a four year period. *AUD$

Agreed to maintain your funds in Western Australia on maturity of your designated investment. *

Proposed total complying investment in Australia *AUD$

Agreed to maintain your funds in Western Australia on maturity of your complying investment. *

Proposed net assets to be in business in Western Australia *AUD$

Proposed business activity in Western Australia *

Proposed location of business activity *

MetropolitanRegional

Proposed employment creation in Western Australia *

My actual outcomes

Total net assets in Western Australia *AUD$

Designated investment held in Western Australian Treasury Bonds for a four year term. *AUD$

Total complying investments in Australia. *AUD$

Total net assets in business in Western Australia *AUD$

Type of business activity in Western Australia. *

Location of business activity *

MetropolitanRegional

Employment creation in Western Australia. *

Please note your application may not be nominated if you have not met the current requirements of your State nomination agreement. If your actual outcomes do not meet your signed agreement, please provide an explanation here.

List the Western Australian assets your funds will be invested into upon maturity of your designated investment. *

List the Western Australian assets your funds will be invested in upon maturity of your complying investments. *

Please complete the Department of Home Affairs Statement of Assets and Liabilities Position (SALP) Form 1139a and attach below.

Current SALP *

Browse

No more than 3 months old

Evidence of all assets and liabilities in WA claimed in form 1139a *

Browse

Please number each piece of evidence. Include this number in column 6 against the corresponding asset or liability

Please download and complete Form 1414 and attach below.

Form 1414 *

Browse

Has the applicant met the Department of Home Affairs requirements in Q25 on Form 1414 ? *

YesNo

Please provide the reason you are seeking a waiver of the DHA criteria. *

Main applicant declaration

Note to migration agents and authorised representatives

Before lodging this application, the client is required to respond to the following questions personally. In order to do so you need to save this application.

You will be provided an option to email the form directly to your client, or to yourself (which can then be forwarded to your client).

I have read and confirm the information provided by my agent;: *

Is true and correct; I have read the application and agree with its contents

Have you been involved in any business or investment activities that are unacceptable in Australia *

YesNo

Have you or anyone else included in the your application been involved in any business or investment activities that are unacceptable in Australia? *

YesNo

Please provide details of any business or investment activities that are unacceptable in Australia. *

Do you have a history of bankruptcy or liquidation proceedings? *

YesNo

Do you or anyone else included in your application have a history of bankruptcy or liquidation proceedings? *

YesNo

Please provide details of any history of bankruptcy or liquidation proceedings. *

Have you ever been charged (or currently have a pending charge), or been convicted of an offence? *

YesNo

Have you or anyone else included in your application been charged (or currently have a pending charge), or been convicted of an offence? *

YesNo

Please provide details of charges or convictions. *

I declare that: *

All information contained in my application is true and correct and I understand that if any misleading information is provided in this application, State nomination will not be available from the government of Western Australia and the matter may be reported to the Department of Home Affairs to conduct their own investigation.I have assessed myself against the Department of Home Affairs criteria and believe I meet all the requirements.

Note to applicants

Once you have reviewed your application and completed all the questions on this page, please sign on this page.

You need to save this application.

You will be provided with an option to email the form directly to your migration agent or authorised representative, or to yourself (which can then be forwarded).

Applicant signature *

Draw signature|Type signatureClear

Date signed *

Migration agent or authorised person declaration

Are you a: *

Migration agentAuthorised representative

As the appointed migration agent or authorised representative I declare that: *

All information contained in this application is true and correct and I understand that if any misleading information is provided in this application, State nomination will not be available from the government of Western Australia and the matter may be reported to the Department of Home Affairs to conduct their own investigation; andThe applicant has read and understands the contents of this application.

I have assessed the applicant against the Western Australian government State nomination requirements and the Department of Home Affairs criteria for this visa and believe they are a qualifying applicant. *

Name of signatory *

Signature *

Draw signature|Type signatureClear

Date signed *

Please note: The Business Migration Centre reserves the right to request applicants, agents or representatives of applicants for State Nomination to formally attest to the accuracy of the information contained in this application or its attachments.

Before submitting this application form, please ensure you have attached all the supporting documents where required. Decisions may be made on the information provided, without seeking further clarification.

Billing information

Payment for State Nomination Application Fee

Sub-total	$750.00
Grand total (Excl. Tax)	$750.00
GST	$0.00

Grand total (Incl. Tax)	$750.00

Small Business Development Corporation

ABN: 68 066 414 034

Level 2, 140 William Street

Perth

Western Australia 6000

State Nomination Application fee

A non refundable fee of $750.00 AUD applies for all Business nomination applications lodged with the Government of Western Australia.

You must make payment in order to submit your application.

Please note: The fee will not be refunded if any application is refused or withdrawn.

Small Business Development Corporation

ABN: 68 066 414 034

State Nomination Application Fee

$750

Pay now *

Save and Complete Later