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Declaration of passenger and crew vaccination status for all vessels

To assist with Australia’s COVID-19 vaccination requirements for international travel, vessel masters should provide
Australian border officials with information about the COVID-19 vaccination status of all passengers and crew on
board the vessel. Vessel masters should obtain the information from all passengers and crew on board the vessel
and provide it to the Department of Home Affairs (the Department) with the consent of the passengers and crew,
as part of the pre-arrival notification process. This form must be completed in English, and be legibly and
clearly written.

Temporary visa holders who are fully vaccinated for the purposes of international travel are able to enter Australia.

Australian citizens, permanent residents, and New Zealand citizens usually resident in Australia are able to enter
Australia regardless of their vaccination status, however information about their vaccination status may be used
to determine the arrangements in place after their arrival (for example, quarantine requirements).

Fully vaccinated for the purpose of international travel to Australia

Travellers to Australia are considered fully vaccinated for the purposes of international travel if they have completed
a primary course of a vaccine approved or recognised by the Therapeutic Goods Administration (TGA).

At least 7 days must have passed since the final dose of vaccine in a course of immunisation for a person to be
considered fully vaccinated for international travel purposes. Mixed doses count towards being fully vaccinated
as long as all vaccines are approved or recognised by the TGA.

Current approved or recognised vaccines and dosages accepted for travel are:
• Two doses at least 14 days apart of:
o AstraZeneca Vaxzevria
o AstraZeneca Covishield
o Pfizer/Biontech Comirnaty
o Moderna Spikevax or Takeda
o Sinovac Coronavac
o Bharat Biotech Covaxin
o Sinopharm BBIBP-CorV (for people under 60 years of age on arrival in Australia)
o Gamaleya Research Institute Sputnik V
o Novavax/Biocelect Nuvaxovid.

• Or one dose of:

o Johnson & Johnson/ Janssen-Cilag COVID Vaccine.

The following groups can also access the same arrangements as fully vaccinated travellers:
• Children under the age of 12 years and 3 months.
• Children aged 12-17 who are unvaccinated/partially vaccinated and travelling with at least one adult who is fully
vaccinated for international travel purposes.
• People who have acceptable proof that they cannot be vaccinated for medical reasons.

Passengers and crew who cannot be vaccinated for medical reasons

Passengers and crew who cannot be vaccinated for medical reasons should show vessel masters acceptable proof of
the medical reasons.

The Australian Department of Health website provides information on medical conditions that mean a person cannot
be vaccinated. It also includes information on conditions not considered to be a medical reason and not accepted for
the purpose of travel to Australia.

NOTE: Previous infection with COVID-19 is not a medical reason that a person is unable to be vaccinated.

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For passengers and crew who have a medical reason recorded in the Australian Immunisation Register (AIR),
acceptable evidence may include their Australian COVID-19 digital certificate or immunisation history statement.

Passengers and crew who do not have a medical reason recorded in the AIR will need to show a medical certificate
that indicates they are unable to be vaccinated with a COVID-19 vaccine because of a medical condition.
The medical certificate must be in English and include the following information:
• the person’s name (this must match their travel identification documents)
• date of medical consultation and details of their medical practitioner
• details that clearly outline that they have a medical condition which means they cannot receive a COVID-19
vaccination.

NOTE: The master of the vessel must ensure that this form, including the Privacy Notice and the Consent and
Declaration, is made available to every person on board the vessel for them to read.

Privacy Notice
The Department of Home Affairs (the Department) is bound by the Australian Privacy Principles (APPs) in Schedule 1
to the Privacy Act 1988 (Cth) (Privacy Act). The APPs regulate how we collect, use, store and disclose personal
information, and how you may seek access to, or correction of, the personal information that we hold. This includes
sensitive information, which includes health information such as a person’s COVID-19 vaccination status.

The personal information in this form is collected by the Department (including the Australian Border Force)
to assist with Australia’s COVID-19 vaccination requirements, and to support the response of the Australian
Government and state and territory governments to COVID-19. The Department collects the information to fulfil our
border-related and emergency management functions, and to assist the relevant Australian Government agencies and
state and territory agencies with activities associated with tracking and slowing the spread of
COVID-19 in Australia.

If you (and the passengers and crew on board the vessel) do not provide personal information in this form, it will limit
the ability of Australian Government agencies and state and territory agencies to reduce the spread of
COVID-19 and protect you, the other passengers and crew on the vessel, and the Australian community. Additionally,
the Department may assume you and the passengers and crew on board the vessel are not fully vaccinated for the
purpose of international travel.

The personal information collected in this form will be disclosed to agencies including the Australian Government’s
Department of Health, state and territory agencies responsible for health and quarantine, and police forces. It may
also be disclosed to overseas government agencies that are responsible for border control, health and quarantine.

Your personal information (and the personal information of the other passengers and crew on the vessel) will not be
collected, used or disclosed without your (or their) consent unless otherwise permitted by the Privacy Act or other
applicable legislation.

Accessing or correcting your personal information, making complaints, contacting us

The Privacy Policy of the Department of Home Affairs (see https://www.homeaffairs.gov.au/access-and-
accountability/our-commitments/plans-and-charters/privacy-policy) explains how you can seek access to the personal
information that we hold about you, or how you can seek to have this information corrected. It also explains how you
can make a complaint about a breach of the APPs, how we will deal with your complaint, and how you can contact us.

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COVID-19 VACCINATION STATUS DECLARATION

The master of the vessel should provide the following information and complete the consent and
declaration below.

Please list the crew and/or passengers on board the vessel who are not fully vaccinated for the purpose
of international travel. (People who cannot be vaccinated for medical reasons should be listed
further below).

Name Date of Birth Nationality Passport Number

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COVID-19 VACCINATION STATUS DECLARATION

The master of the vessel should provide the following information and complete the consent and
declaration below.

Please list the crew and/or passengers on board the vessel who cannot be vaccinated for medical reasons.
Ensure that each person has shown you acceptable evidence of their medical reasons (see previous page
for more information).

Name Date of Birth Nationality Passport Number

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[Tick if applicable]

All other crew and/or passengers on board the vessel are:

• fully vaccinated for the purpose of international travel to Australia; or
• under the age of 12 years and 3 months at the time of commencement of the voyage; or
• aged 12-17 years and unvaccinated/partially vaccinated and travelling with at least one adult who is fully
vaccinated for the purpose of international travel to Australia.
• Ensure that each person has shown you evidence of their vaccination status (see previous page for more
information) or evidence of their age (as applicable).

Consent and Declaration

I understand that if I consent to the disclosure of my personal information to overseas recipients, APP 8.1 in the
Privacy Act will not apply to the disclosure. Under APP 8.1, before the Department of Home Affairs (the Department)
discloses personal information about an individual to an overseas recipient, the Department must take such steps as
are reasonable in the circumstances to ensure that the overseas recipient does not breach the APPs (other than
APP 1) in relation to the information.

I understand that I can withdraw my consent to the use and/or disclosure of my personal information, including
sensitive information, at any time by contacting the Department on 131 881 (in Australia) or +61 2 6196 0196 (outside
of Australia) Monday to Friday 9am to 5pm local time in my country. I understand that this may limit the ability of
Australian Government agencies and state and territory agencies to reduce the spread of COVID-19 in Australia.

I consent to:
• The Department (including the Australian Border Force (ABF)) collecting my personal information, including my
sensitive information, for the purposes explained in this form.
• The Department (including the ABF) using my personal information, including my sensitive information,
and disclosing the information to other Australian government agencies, state and territory government agencies,
contracted service providers and overseas recipients for the purposes explained in this form.

I declare that:
• The information in this form covers the COVID-19 vaccination status of every person on board the vessel including
the master of the vessel.
• The information provided in this form is complete, correct and up-to-date.
• I understand that giving false or misleading information to the Australian Government is a serious offence.
• This form, including the Privacy Notice and the Consent and Declaration, has been made available to every person
on board the vessel for them to read.
• Each person on board the vessel has authorised me to act on their behalf including consenting to and declaring the
matters set out above.
• Each person has consented to the Department (including the ABF) collecting their information from me.
• Each person has consented to their information being provided to me (and if I am overseas, the person
understands that the Department (including the ABF) has not taken any steps to ensure that I comply with the
Australian Privacy Principles).
• Each person has consented to all other relevant collections, uses and disclosures of their information as described
in this form.

Sign document by writing or inserting a signature in the signature field:

Signature:

Name:

Vessel name:

Date:
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