Request for Extension of Skills Assessment Result

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Note: An extension will only be granted if an application is received by IML National within the two year period following the date of original validation.

Applicant Details

Assessment Reference Number (located on your letter from IML National)

Title

Please insert Title

Applicant First Name

Applicant Last/Surname

Date of Birth

Country of Birth

Other Names

(including your name before marriage, an English version of your first given name or any other name by which you have been known)

Residential Address

City

State/Province

Country

Zip/Postal Code

Country of Passport

Appointment of Person to Act as Agent

Are you using a Migration Agent or other party/person to lodge this extension application on your behalf?

YesNo

Agent Details

Agent First Name

Agent Last Name

Name of Agency

Agent's address

City

State/Province

Country

Agent's Registration Number (if applicable)

An Agent Authorisation Form will be required following this form submission. A copy of this form can be downloaded from _____________

Request for Extension

Please outline your reason for an extension below:

Employment Details

Please advise if you have had a change of employment since your initial assessment

No change, I remain employed at the same organisation and positionEmployment details have changed.

New Employment Details

Position Title

Name of Organisation

Month position started

Year position started

Business Address

Country

Telephone (incl. country and area code)

Applicant's work Email

Website address

Total number of employees in company:

Total managers directly reporting to you:

Total staff reporting directly or indirectly to you:

Applicant's immediate superior's name

Applicant's immediate superior's position

Supporting information will be required following this form submission. A link to upload your documentation will be sent on submission.

Payment Details

Credit Card Authorisation Form

Migration Skills Assessment Manager
Institute of Managers and Leaders
GPO Box 2229
Brisbane QLD 4000 Australia

I authorise the Institute of Managers and Leaders Limited (ABN 31 163 376 921), on behalf of IML National (ABN 56 004 525 017) to debit the sum of AUD $150.00 (plus 10% GST if applicable*) from my credit card in payment for a Management Skills Assessment Extension Request.

Based on the information you have provided, your card will be charged:

.00

Cardholders Name

Card Number

Expiry Month