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80 (Design date 12/14) - Page 1
Ā© COMMONWEALTH OF AUSTRALIA, 2014
Personal particulars for assessment
including character assessment
Form
80
Important ā€“ Please read this information carefully before you
complete this form. Once you have completed this form we
strongly advise that you keep a copy for your records.
This form is to be completed in English by applicants who are
16 years of age or over, as requested by the office processing the
application.
Integrity of application
The Department of Immigration and Border Protection (the
department) is committed to maintaining the integrity of the visa
and citizenship programs. Please be aware that if you provide us
with fraudulent documents or claims, this may result in
processing delays and possibly your application being refused.
Important information about privacy
Your personal information is protected by law, including the
Privacy Act 1988. Important information about the collection,
use and disclosure (to other agencies and third parties, including
overseas entities) of your personal information, including
sensitive information, is contained in form 1442i Privacy notice.
Form 1442i is available from the departmentā€™s website
www.immi.gov.au/allforms/ or offices of the department.
You should ensure that you read and understand form 1442i
before completing this form.
Please use a pen, and write neatly in English using BLOCK LETTERS.
Tick where applicable 3
If you need more space for any answers, give details at Part T ā€“
Additional information
Part A ā€“ Applicant details
1 Please provide your details as they appear in your official documents.
For example, passport, identity document, travel document, birth
certificate.
Note: If you have one name only, please write it in the ā€˜Family nameā€™
field.
Family name
All given names
Sex Male Female
Date of birth
Day Month Year
Day, month and year
MUST be provided
Suburb of birth
Town/City of birth
State/Province/Region
Country
2 Do you ever use a Chinese Commercial Code Number for your names
shown in the passport/travel document at Question 1?
No
Yes Chinese Commercial Code Number (in full)
3 Are you of Arabic descent?
No
Yes In English, write the full name of your fatherā€™s father (ie.
your paternal grandfather)
4 Are you of Russian descent?
No
Yes In English, provide your patronymic name
80 (Design date 12/14) - Page 2 Ā© COMMONWEALTH OF AUSTRALIA, 2014
5 Have you been known by any other name(s)? Include:
ā€¢ name at birth
ā€¢ name before or after marriage
ā€¢ adoptive or foster name
ā€¢ alias or pseudonym
ā€¢ cultural or tribal name or
clan/subclan name
ā€¢ preferred name
ā€¢ other spellings of names
No
Yes Give details in English
Type of name
Family name
Given names
If more than one name, give details at Part T ā€“ Additional information
6 Have you ever had a different date of birth to the one shown at
Question 1?
No
Yes Different date of birth
Day Month Year
7 Do you currently have citizenship from any country?
No, I am stateless Give details
Yes How did you gain this citizenship (eg. birth, descent,
naturalisation)?
Date you gained this citizenship
Day Month Year
8 Do you hold or have you held citizenship from any other country
(including dual citizenships and all previous citizenships)?
No
Yes Country
How did you gain this citizenship (eg. birth, descent,
naturalisation)?
When did you have this citizenship?
From
Day Month Year
to
Day Month Year
Note: If you still have the citizenship, write ā€˜CURRENTā€™.
If more than one country, give details at Part T ā€“ Additional
information
9 Do you currently have permanent residency rights in any country other
than those declared in Questions 7 or 8?
No
Yes List all other countries
Part B ā€“ Passport / Travel document
details
10 Do you have a current passport or travel document?
No Go to Question 12
Yes Give details
Passport/travel document number
Country of passport/travel document
Date of issue
Day Month Year
Is this the original issue date?
No Give original issue date
Day Month Year
Yes
Date of expiry
Day Month Year
Nationality
Place of issue/issuing authority
Name on the document (if the same as Question 1, write ā€˜SAME AS
QUESTION 1ā€™)
Family name
Given names
80 (Design date 12/14) - Page 3
Ā© COMMONWEALTH OF AUSTRALIA, 2014
11 Do you have any other current passport or travel document?
No
Yes Give details
Passport/travel document number
Country of passport/travel document
Date of issue
Day Month Year
Date of expiry
Nationality
Place of issue/issuing authority
Name on the document (if the same as Question 1, write ā€˜SAME AS
QUESTION 1ā€™)
Family name
Given names
12 Have you ever had any previous passports or travel documents
(including expired, lost or stolen documents)?
No Go to Part C
Yes
13 What happened to this document (Tick one only)
Expired
Lost/stolen
Other Give details
14 Do you have, or remember, any of the document details?
No
Yes Give as much information as possible
Passport/travel document number
Country of passport/travel document
Date of issue
Day Month Year
Date of expiry
Nationality
Place of issue/issuing authority
Name on the document (if the same as Question 1, write ā€˜SAME AS
QUESTION 1ā€™)
Family name
Given names
Part C ā€“ Identity documents
15 Do you currently have, or have you ever had, any national identity
documents or numbers (including birth registration numbers, social
security cards etc)?
No
Yes Give details
Type of identification
document
Country of issue
Identification number
shown (if applicable)
80 (Design date 12/14) - Page 4 Ā© COMMONWEALTH OF AUSTRALIA, 2014
Part D ā€“ Address and contact details
16 Do you have any email addresses?
Note: Include all personal, student and work email addresses. Do not
include migration agent email addresses.
No
Yes Provide all of your email addresses
18 Your address history for the last 10 years.
Note: If you are applying for a refugee/humanitarian visa, you must provide all addresses for the last 30 years.
Include:
ā€¢ addresses inside and outside Australia
ā€¢ places you resided for study/work
ā€¢ refugee camps
ā€¢ any other place you have resided such as share houses, university residences and temporary accommodation.
Note: Provide your address history in chronological order with no gaps in the timeline. If there are gaps, you must provide an explanation at Part T ā€“
Additional information.
Date from Date to Full address (house number, street name, suburb, town/city, postcode) Country
Month Year Month Year
CURRENT
Part E ā€“ International travel / movements
19 Have you travelled to any country other than Australia in the last 10 years?
Note: If you are applying for a refugee/humanitarian visa, you must provide all visits to any country other than Australia for the last 30 years.
Include:
ā€¢ work or study outside your usual country of residence
ā€¢ holiday/leisure trips
ā€¢ business
ā€¢ military deployment
ā€¢ visits back to your own country.
No
Yes Give details in chronological order
Date from Date to Reason for visit Country
Day Month Year Day Month Year
17 Do you have current contact telephone numbers?
No
Yes Provide all telephone numbers
Work ( ) ( )
Country code Area code Number
Home ( ) ( )
Mobile/cell
Other
80 (Design date 12/14) - Page 5
Ā© COMMONWEALTH OF AUSTRALIA, 2014
Part F ā€“ Employment
20 Give details of all employment and unemployment since birth
Employment includes:
ā€¢ all paid employment
ā€¢ self-employment/family business
ā€¢ work experience/internships
ā€¢ unpaid employment/volunteer work.
Unemployment includes:
ā€¢ from date of birth up until first employment
ā€¢ all gaps/breaks between employment
ā€¢ all gaps between education.
If you are currently retired ā€“ write ā€˜CURRENTLY RETIREDā€™ in ā€˜Name of businessā€™ field and provide details in the ā€˜Your occupation and dutiesā€™ field.
If you have never worked ā€“ write your date of birth in the ā€˜Date fromā€™ field and ā€˜NEVER WORKEDā€™ in the ā€˜Name of business/companyā€™ field and provide details in the ā€˜Your occupation and dutiesā€™ field.
Note: Provide your employment and unemployment history with no gaps in the timeline. If there are gaps, you must provide an explanation at Part T ā€“ Additional information.
Date from Date to
Name of business/company
(no abbreviations)
Type of business
(eg. government
department, bakery)
Your occupation and duties
OR
If unemployed/retired/never worked,
provide details of how you occupied your time
and financially supported yourself
Full address of business/company
(Building number, street name, suburb,
town/city, state/province)
(no Post Office box)
Country
Month Year Month Year
CURRENT
80 (Design date 12/14) - Page 6 Ā© COMMONWEALTH OF AUSTRALIA, 2014
Part G ā€“ Education
21 Give details of all education and qualifications since birth
Education/qualification includes:
ā€¢ primary, middle and high school
ā€¢ college/vocational schools
ā€¢ university
ā€¢ research/thesis
ā€¢ specialist training
ā€¢ skill/trade qualifications.
Date from Date to Full name of institution
(no abbreviations)
Full name of course or description of research/
Thesis and supervisor details (no abbreviations)
Course status Campus/address of institution Country
Month Year Month Year
Completed
Withdrew
Currently enrolled
Completed
Withdrew
Currently enrolled
Completed
Withdrew
Currently enrolled
Completed
Withdrew
Currently enrolled
Completed
Withdrew
Currently enrolled
Completed
Withdrew
Currently enrolled
Completed
Withdrew
Currently enrolled
Completed
Withdrew
Currently enrolled
80 (Design date 12/14) - Page 7
Ā© COMMONWEALTH OF AUSTRALIA, 2014
Part H ā€“ Proposed travel or further stay
details
22 Are you currently in Australia?
No
Yes Go to Question 26
Proposed travel
23 Why are you travelling to Australia?
Include any relevant dates or events
24 Do you have any proposed or booked travel dates for your journey to
Australia?
No
Yes Give details of proposed arrival in Australia
Arrival date
Day Month Year
Flight number or vessel details (if known)
City of arrival
Give details of countries you will visit on your way to Australia
(write ā€˜N/Aā€™ if not applicable)
List the towns/cities you will visit during your time in Australia
25 Are you applying for a temporary visa?
No Go to Part I
Yes Give details of proposed final departure from Australia
Departure date
Day Month Year
Flight number or vessel details (if known)
City of departure
Give details of countries you will visit after your departure from Australia
(write ā€˜N/Aā€™ if not applicable)
Now go to Part I
Further stay
26 What is your main reason for remaining in Australia?
27 List the towns/cities you will visit during your further stay in Australia
28 Give details of your arrival in Australia
Arrival date
Day Month Year
City of arrival
29 Are you applying for a temporary visa?
No Go to Part I
Yes
30 Do you have any proposed or booked travel for your departure from
Australia?
No
Yes Give details
Departure date
Day Month Year
Flight number or vessel details (if known)
City of departure
Give details of countries you will visit after your departure from Australia
(write ā€˜N/Aā€™ if not applicable)
80 (Design date 12/14) - Page 8 Ā© COMMONWEALTH OF AUSTRALIA, 2014
Part I ā€“ Address(es) in Australia
31 Are you currently in Australia?
No
Yes Go to Question 34
Located outside Australia
32 Do you know any details of the places you will stay during your time in
Australia (eg. hotel, friends, relatives)?
No Go to Part J
Yes Give the residential address and contact numbers
Note: A post office box is not acceptable.
Address (including hotel name and/or unit and building number and
street name)
Suburb and town/city
State or territory Postcode
Telephone numbers
Office hours (Area code )
Mobile/cell
33 Will you stay at any other address?
No Go to Part J
Yes Give the residential address and contact numbers
Address (including hotel name and/or unit and building number and
street name)
Suburb and town/city
State or territory Postcode
Telephone numbers
Office hours (Area code )
Mobile/cell
If you will stay at any other address(es), give details at Part T ā€“
Additional information.
Now go to Part J
Located in Australia
34 Do you have any other addresses in Australia that have not been
declared at Question 18?
No Go to Part J
Yes Give the residential address and contact numbers
Address (including hotel name and/or unit and building number and
street name)
Suburb and town/city
State or territory Postcode
Telephone numbers
Office hours (Area code )
Mobile/cell
When and in what circumstances did you reside, or stay, at this
address?
If you have more than one other address in Australia that has not been
declared above or at Question 18, give details at Part T ā€“ Additional
information.
80 (Design date 12/14) - Page 9
Ā© COMMONWEALTH OF AUSTRALIA, 2014
Part J ā€“ Australian visa history
35 Are you currently in Australia?
No
Yes Give details of current visa
Type of visa you hold
(eg. visitor, business)
Reason for journey Name used on entry Place of visa issue
Arrival date
Day Month Year
36 Have you been to Australia before?
No
Yes Give details of previous visas
Type of visa you held
(eg. visitor, business)
Reason for journey Name used on entry Place of visa issue
Arrival date Departure date
Day Month Year Day Month Year
Part K ā€“ Character
37 Have you, or any other person included in this
application, ever:
ā€¢ been charged with any offence that is
currently awaiting legal action? No Yes
ā€¢ been convicted of an offence in any country
(including any conviction which is now
removed from official records)? No Yes
ā€¢ been the subject of an arrest warrant orąø€
Interpol notice? No Yes
ā€¢ been found guilty of a sexually based offence
involving a child (including where no
conviction was recorded)? No Yes
ā€¢ been named on a sex offender register? No Yes
ā€¢ been acquitted of any offence on the grounds
of unsoundness of mind or insanity? No Yes
ā€¢ been found by a court not fit to plead? No Yes
ā€¢ been directly or indirectly involved in, or
associated with, activities which would
represent a risk to national security in
Australia or any other country? No Yes
ā€¢ been charged with, or indicted for: genocide,
war crimes, crimes against humanity, torture,
slavery, or any other crime that is otherwise of
a serious international concern? No Yes
ā€¢ been associated with a person, group or
organisation that has been/is involved in
criminal conduct? No Yes
ā€¢ been associated with an organisation engaged
in violence or engaged in acts of violence
(including war, insurgency, freedom fighting,
terrorism, protest) either overseas or in
Australia? No Yes
ā€¢ served in a military force, police force, state
sponsored/private militia or intelligence
agency (including secret police)? No Yes
ā€¢ undergone any military/paramilitary training,
been trained in weapons/explosives or in the
manufacture of chemical/biological products? No Yes
ā€¢ been involved in people smuggling or people
trafficking offences? No Yes
ā€¢ been removed, deported or excluded from any
country (including Australia)? No Yes
ā€¢ overstayed a visa in any country (including
Australia)? No Yes
ā€¢ had any outstanding debts to the Australian
Government or any public authority in
Australia? No Yes
If you answered ā€˜Yesā€™ to any of the questions at Question 37, you must
state who it applies to and give ALL relevant details. If the matter relates
to a criminal conviction, please give the nature of the offence, full details
of sentence and dates of any period of imprisonment or other detention.
80 (Design date 12/14) - Page 10 Ā© COMMONWEALTH OF AUSTRALIA, 2014
Part L ā€“ Military service
38 Have you undertaken any military service?
Military service includes:
ā€¢ compulsory
ā€¢ conscription
ā€¢ military training
ā€¢ voluntary
ā€¢ professional.
No
Yes Give details in chronological order
Date from Date to Country of service
Full name of Unit/
Battalion/Brigade
Rank Duties
Country of
deployment
Day Month Year Day Month Year
Part M ā€“ Employed by intelligence or
security agency
39 Are you currently, or have you been employed as an intelligence
officer or an agent of an intelligence or security agency?
No
Yes Give details of organisation, role and dates you served
Part N ā€“ Visa refusals
40 Have you ever been refused a visa to any country?
No
Yes Give dates of refusal, countries and circumstances of
refusal
Part O ā€“ Deportations
41 Have you ever been excluded, asked to leave, deported or removed from
any country?
No
Yes Give details of dates, countries and circumstances
Part P ā€“ Citizenship refusals
42 Have you ever been refused, renounced or rescinded citizenship of any
country?
No
Yes Give dates of refusal, countries and circumstances of
refusal
80 (Design date 12/14) - Page 11
Ā© COMMONWEALTH OF AUSTRALIA, 2014
Part Q ā€“ Associated people
43 Do you have a partner?
Partner includes wife, husband, fiancƩ, boyfriend, girlfriend, significant other and de facto.
If widowed you must give details for your deceased partner.
No
Yes Give details
(If not living, write ā€˜DECEASEDā€™ in ā€˜Country of current residenceā€™ column)
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted
Country of current residence
(If not living, write ā€˜DECEASEDā€™)
Migrating with you?
Town/City State/Province/Region Country
No Yes
44 Do you have children?
Children includes biological or adopted, children from a current or previous marriage, all step-children and deceased children.
No
Yes Give details
(If not living, write ā€˜DECEASEDā€™ in ā€˜Country of current residenceā€™ column)
Child 1
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted
Country of current residence
(If not living, write ā€˜DECEASEDā€™)
Migrating with you?
Town/City State/Province/Region Country
No Yes
Child 2
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted
Country of current residence
(If not living, write ā€˜DECEASEDā€™)
Migrating with you?
Town/City State/Province/Region Country
No Yes
80 (Design date 12/14) - Page 12 Ā© COMMONWEALTH OF AUSTRALIA, 2014
Child 3
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted
Country of current residence
(If not living, write ā€˜DECEASEDā€™)
Migrating with you?
Town/City State/Province/Region Country
No Yes
Child 4
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted
Country of current residence
(If not living, write ā€˜DECEASEDā€™)
Migrating with you?
Town/City State/Province/Region Country
No Yes
Child 5
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted
Country of current residence
(If not living, write ā€˜DECEASEDā€™)
Migrating with you?
Town/City State/Province/Region Country
No Yes
Child 6
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted
Country of current residence
(If not living, write ā€˜DECEASEDā€™)
Migrating with you?
Town/City State/Province/Region Country
No Yes
If more than 6 children, give details at Part T ā€“ Additional information
80 (Design date 12/14) - Page 13
Ā© COMMONWEALTH OF AUSTRALIA, 2014
45 Do you know details of your parents?
Parents include biological parents, adopted parents, step parents, legal guardians and deceased parents.
No
Yes Give details
(If not living, write ā€˜DECEASEDā€™ in ā€˜Country of current residenceā€™ column)
Parent 1
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted
Country of current residence
(If not living, write ā€˜DECEASEDā€™)
Migrating with you?
Town/City State/Province/Region Country
No Yes
Parent 2
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted
Country of current residence
(If not living, write ā€˜DECEASEDā€™)
Migrating with you?
Town/City State/Province/Region Country
No Yes
Parent 3
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted
Country of current residence
(If not living, write ā€˜DECEASEDā€™)
Migrating with you?
Town/City State/Province/Region Country
No Yes
Parent 4
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted
Country of current residence
(If not living, write ā€˜DECEASEDā€™)
Migrating with you?
Town/City State/Province/Region Country
No Yes
If more than 4 parents, give details at Part T ā€“ Additional information
80 (Design date 12/14) - Page 14 Ā© COMMONWEALTH OF AUSTRALIA, 2014
46 Do you have siblings?
Siblings include full, half and adopted brothers and sisters.
No
Yes Give details
(If not living, write ā€˜DECEASEDā€™ in ā€˜Country of current residenceā€™ column)
Sibling 1
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted Country of current residence Migrating with you?
Town/City State/Province/Region Country
No Yes
Sibling 2
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted Country of current residence Migrating with you?
Town/City State/Province/Region Country
No Yes
Sibling 3
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted Country of current residence Migrating with you?
Town/City State/Province/Region Country
No Yes
Sibling 4
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted Country of current residence Migrating with you?
Town/City State/Province/Region Country
No Yes
80 (Design date 12/14) - Page 15
Ā© COMMONWEALTH OF AUSTRALIA, 2014
Sibling 5
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted Country of current residence Migrating with you?
Town/City State/Province/Region Country
No Yes
If more than 5 siblings, give details at Part T ā€“ Additional information
47 Other travelling family members
Are there any other family members included in the visa application?
Family members include nieces, nephews, cousins, in-laws, grandparents etc. who are travelling with you
No
Yes Give details
Family member 1
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted Country of current residence
Town/City State/Province/Region Country
Family member 2
Relationship to you Family name
Given names
(include patronymic name)
Any other names
(eg. maiden or tribal name)
Sex Date of birth Chinese commercial codes
(If not applicable, write ā€˜N/Aā€™)
M/F Day Month Year
Place of birth
Citizenship(s) and year granted Country of current residence
Town/City State/Province/Region Country
If more than 2 other family members, give details at Part T ā€“ Additional information
80 (Design date 12/14) - Page 16 Ā© COMMONWEALTH OF AUSTRALIA, 2014
48 Do you have any personal contacts in Australia?
Personal contacts include visa sponsors, any relatives, friends, family
members and acquaintances in Australia.
No Go to Part R
Yes Provide as much information about one of your personal
contacts as possible
Family name
Given names
Sex Male Female
Relationship to you (eg. partner, sister, aunt, friend)
Date of birth
Day Month Year
Town/City of birth
State/Province/Region
Country
Nationality
Your personal contactā€™s current residential address
Note: A post office box is not acceptable.
Address (including building/unit/house number and street name)
Suburb and town/city
State or territory Postcode
Telephone numbers
Office hours (Area code )
Mobile/cell
Email address
49 Do you have any other personal contacts in Australia?
No Go to Part R
Yes Give details
Family name
Given names
Sex Male Female
Relationship to you (eg. partner, sister, aunt, friend)
Date of birth
Day Month Year
Town/City of birth
State/Province/Region
Country
Nationality
Your personal contactā€™s current residential address
Note: A post office box is not acceptable.
Address (including building/unit/house number and street name)
Suburb and town/city
State or territory Postcode
Telephone numbers
Office hours (Area code )
Mobile/cell
Email address
Give details of all other contacts at Part T ā€“ Additional information
80 (Design date 12/14) - Page 17
Ā© COMMONWEALTH OF AUSTRALIA, 2014
Part R ā€“ Sponsoring employer details
50 Are you being sponsored by, or associated with, a business or
organisation in Australia?
No Go to Part S
Yes Give details
Organisation/Business name
Organisation/Business description
Organisation/Business commercial address (including building number
and street name)
Suburb and town/city
State or territory Postcode
Name of contact person in business/organisation
51 Does the employer/business have any other associated addresses?
No
Yes Give details
Type of address (eg. head office, factory, retail store)
Address (including building number and street name)
Suburb and town/city
State or territory Postcode
52 Does the employer/business have an email address?
No
Yes Give details
53 Does the employer/business have telephone numbers?
No
Yes List all contact telephone numbers (including area code)
Part S ā€“ Declaration
WARNING: Giving false or misleading information is a serious offence.
54 I declare that:
ā€¢ the information I have supplied in or with this form is complete,
correct and up-to-date in every detail.
ā€¢ I have read and understand the information supplied to me.
ā€¢ I have read the information contained in form 1442i Privacy notice.
ā€¢ 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
applicant
-
Date
Day Month Year
We strongly advise that you keep a copy of your application
and all attachments for your records.
80 (Design date 12/14) - Page 18 Ā© COMMONWEALTH OF AUSTRALIA, 2014
Part T ā€“ Additional information
55 Question
number
Additional information
If you do not have enough space to give all the necessary information, attach a separate statement to this form with further details

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80 - Personal Particulars For Assessment Including Character Assessment

  • 1. 80 (Design date 12/14) - Page 1 Ā© COMMONWEALTH OF AUSTRALIA, 2014 Personal particulars for assessment including character assessment Form 80 Important ā€“ Please read this information carefully before you complete this form. Once you have completed this form we strongly advise that you keep a copy for your records. This form is to be completed in English by applicants who are 16 years of age or over, as requested by the office processing the application. Integrity of application The Department of Immigration and Border Protection (the department) is committed to maintaining the integrity of the visa and citizenship programs. Please be aware that if you provide us with fraudulent documents or claims, this may result in processing delays and possibly your application being refused. Important information about privacy Your personal information is protected by law, including the Privacy Act 1988. Important information about the collection, use and disclosure (to other agencies and third parties, including overseas entities) of your personal information, including sensitive information, is contained in form 1442i Privacy notice. Form 1442i is available from the departmentā€™s website www.immi.gov.au/allforms/ or offices of the department. You should ensure that you read and understand form 1442i before completing this form. Please use a pen, and write neatly in English using BLOCK LETTERS. Tick where applicable 3 If you need more space for any answers, give details at Part T ā€“ Additional information Part A ā€“ Applicant details 1 Please provide your details as they appear in your official documents. For example, passport, identity document, travel document, birth certificate. Note: If you have one name only, please write it in the ā€˜Family nameā€™ field. Family name All given names Sex Male Female Date of birth Day Month Year Day, month and year MUST be provided Suburb of birth Town/City of birth State/Province/Region Country 2 Do you ever use a Chinese Commercial Code Number for your names shown in the passport/travel document at Question 1? No Yes Chinese Commercial Code Number (in full) 3 Are you of Arabic descent? No Yes In English, write the full name of your fatherā€™s father (ie. your paternal grandfather) 4 Are you of Russian descent? No Yes In English, provide your patronymic name
  • 2. 80 (Design date 12/14) - Page 2 Ā© COMMONWEALTH OF AUSTRALIA, 2014 5 Have you been known by any other name(s)? Include: ā€¢ name at birth ā€¢ name before or after marriage ā€¢ adoptive or foster name ā€¢ alias or pseudonym ā€¢ cultural or tribal name or clan/subclan name ā€¢ preferred name ā€¢ other spellings of names No Yes Give details in English Type of name Family name Given names If more than one name, give details at Part T ā€“ Additional information 6 Have you ever had a different date of birth to the one shown at Question 1? No Yes Different date of birth Day Month Year 7 Do you currently have citizenship from any country? No, I am stateless Give details Yes How did you gain this citizenship (eg. birth, descent, naturalisation)? Date you gained this citizenship Day Month Year 8 Do you hold or have you held citizenship from any other country (including dual citizenships and all previous citizenships)? No Yes Country How did you gain this citizenship (eg. birth, descent, naturalisation)? When did you have this citizenship? From Day Month Year to Day Month Year Note: If you still have the citizenship, write ā€˜CURRENTā€™. If more than one country, give details at Part T ā€“ Additional information 9 Do you currently have permanent residency rights in any country other than those declared in Questions 7 or 8? No Yes List all other countries Part B ā€“ Passport / Travel document details 10 Do you have a current passport or travel document? No Go to Question 12 Yes Give details Passport/travel document number Country of passport/travel document Date of issue Day Month Year Is this the original issue date? No Give original issue date Day Month Year Yes Date of expiry Day Month Year Nationality Place of issue/issuing authority Name on the document (if the same as Question 1, write ā€˜SAME AS QUESTION 1ā€™) Family name Given names
  • 3. 80 (Design date 12/14) - Page 3 Ā© COMMONWEALTH OF AUSTRALIA, 2014 11 Do you have any other current passport or travel document? No Yes Give details Passport/travel document number Country of passport/travel document Date of issue Day Month Year Date of expiry Nationality Place of issue/issuing authority Name on the document (if the same as Question 1, write ā€˜SAME AS QUESTION 1ā€™) Family name Given names 12 Have you ever had any previous passports or travel documents (including expired, lost or stolen documents)? No Go to Part C Yes 13 What happened to this document (Tick one only) Expired Lost/stolen Other Give details 14 Do you have, or remember, any of the document details? No Yes Give as much information as possible Passport/travel document number Country of passport/travel document Date of issue Day Month Year Date of expiry Nationality Place of issue/issuing authority Name on the document (if the same as Question 1, write ā€˜SAME AS QUESTION 1ā€™) Family name Given names Part C ā€“ Identity documents 15 Do you currently have, or have you ever had, any national identity documents or numbers (including birth registration numbers, social security cards etc)? No Yes Give details Type of identification document Country of issue Identification number shown (if applicable)
  • 4. 80 (Design date 12/14) - Page 4 Ā© COMMONWEALTH OF AUSTRALIA, 2014 Part D ā€“ Address and contact details 16 Do you have any email addresses? Note: Include all personal, student and work email addresses. Do not include migration agent email addresses. No Yes Provide all of your email addresses 18 Your address history for the last 10 years. Note: If you are applying for a refugee/humanitarian visa, you must provide all addresses for the last 30 years. Include: ā€¢ addresses inside and outside Australia ā€¢ places you resided for study/work ā€¢ refugee camps ā€¢ any other place you have resided such as share houses, university residences and temporary accommodation. Note: Provide your address history in chronological order with no gaps in the timeline. If there are gaps, you must provide an explanation at Part T ā€“ Additional information. Date from Date to Full address (house number, street name, suburb, town/city, postcode) Country Month Year Month Year CURRENT Part E ā€“ International travel / movements 19 Have you travelled to any country other than Australia in the last 10 years? Note: If you are applying for a refugee/humanitarian visa, you must provide all visits to any country other than Australia for the last 30 years. Include: ā€¢ work or study outside your usual country of residence ā€¢ holiday/leisure trips ā€¢ business ā€¢ military deployment ā€¢ visits back to your own country. No Yes Give details in chronological order Date from Date to Reason for visit Country Day Month Year Day Month Year 17 Do you have current contact telephone numbers? No Yes Provide all telephone numbers Work ( ) ( ) Country code Area code Number Home ( ) ( ) Mobile/cell Other
  • 5. 80 (Design date 12/14) - Page 5 Ā© COMMONWEALTH OF AUSTRALIA, 2014 Part F ā€“ Employment 20 Give details of all employment and unemployment since birth Employment includes: ā€¢ all paid employment ā€¢ self-employment/family business ā€¢ work experience/internships ā€¢ unpaid employment/volunteer work. Unemployment includes: ā€¢ from date of birth up until first employment ā€¢ all gaps/breaks between employment ā€¢ all gaps between education. If you are currently retired ā€“ write ā€˜CURRENTLY RETIREDā€™ in ā€˜Name of businessā€™ field and provide details in the ā€˜Your occupation and dutiesā€™ field. If you have never worked ā€“ write your date of birth in the ā€˜Date fromā€™ field and ā€˜NEVER WORKEDā€™ in the ā€˜Name of business/companyā€™ field and provide details in the ā€˜Your occupation and dutiesā€™ field. Note: Provide your employment and unemployment history with no gaps in the timeline. If there are gaps, you must provide an explanation at Part T ā€“ Additional information. Date from Date to Name of business/company (no abbreviations) Type of business (eg. government department, bakery) Your occupation and duties OR If unemployed/retired/never worked, provide details of how you occupied your time and financially supported yourself Full address of business/company (Building number, street name, suburb, town/city, state/province) (no Post Office box) Country Month Year Month Year CURRENT
  • 6. 80 (Design date 12/14) - Page 6 Ā© COMMONWEALTH OF AUSTRALIA, 2014 Part G ā€“ Education 21 Give details of all education and qualifications since birth Education/qualification includes: ā€¢ primary, middle and high school ā€¢ college/vocational schools ā€¢ university ā€¢ research/thesis ā€¢ specialist training ā€¢ skill/trade qualifications. Date from Date to Full name of institution (no abbreviations) Full name of course or description of research/ Thesis and supervisor details (no abbreviations) Course status Campus/address of institution Country Month Year Month Year Completed Withdrew Currently enrolled Completed Withdrew Currently enrolled Completed Withdrew Currently enrolled Completed Withdrew Currently enrolled Completed Withdrew Currently enrolled Completed Withdrew Currently enrolled Completed Withdrew Currently enrolled Completed Withdrew Currently enrolled
  • 7. 80 (Design date 12/14) - Page 7 Ā© COMMONWEALTH OF AUSTRALIA, 2014 Part H ā€“ Proposed travel or further stay details 22 Are you currently in Australia? No Yes Go to Question 26 Proposed travel 23 Why are you travelling to Australia? Include any relevant dates or events 24 Do you have any proposed or booked travel dates for your journey to Australia? No Yes Give details of proposed arrival in Australia Arrival date Day Month Year Flight number or vessel details (if known) City of arrival Give details of countries you will visit on your way to Australia (write ā€˜N/Aā€™ if not applicable) List the towns/cities you will visit during your time in Australia 25 Are you applying for a temporary visa? No Go to Part I Yes Give details of proposed final departure from Australia Departure date Day Month Year Flight number or vessel details (if known) City of departure Give details of countries you will visit after your departure from Australia (write ā€˜N/Aā€™ if not applicable) Now go to Part I Further stay 26 What is your main reason for remaining in Australia? 27 List the towns/cities you will visit during your further stay in Australia 28 Give details of your arrival in Australia Arrival date Day Month Year City of arrival 29 Are you applying for a temporary visa? No Go to Part I Yes 30 Do you have any proposed or booked travel for your departure from Australia? No Yes Give details Departure date Day Month Year Flight number or vessel details (if known) City of departure Give details of countries you will visit after your departure from Australia (write ā€˜N/Aā€™ if not applicable)
  • 8. 80 (Design date 12/14) - Page 8 Ā© COMMONWEALTH OF AUSTRALIA, 2014 Part I ā€“ Address(es) in Australia 31 Are you currently in Australia? No Yes Go to Question 34 Located outside Australia 32 Do you know any details of the places you will stay during your time in Australia (eg. hotel, friends, relatives)? No Go to Part J Yes Give the residential address and contact numbers Note: A post office box is not acceptable. Address (including hotel name and/or unit and building number and street name) Suburb and town/city State or territory Postcode Telephone numbers Office hours (Area code ) Mobile/cell 33 Will you stay at any other address? No Go to Part J Yes Give the residential address and contact numbers Address (including hotel name and/or unit and building number and street name) Suburb and town/city State or territory Postcode Telephone numbers Office hours (Area code ) Mobile/cell If you will stay at any other address(es), give details at Part T ā€“ Additional information. Now go to Part J Located in Australia 34 Do you have any other addresses in Australia that have not been declared at Question 18? No Go to Part J Yes Give the residential address and contact numbers Address (including hotel name and/or unit and building number and street name) Suburb and town/city State or territory Postcode Telephone numbers Office hours (Area code ) Mobile/cell When and in what circumstances did you reside, or stay, at this address? If you have more than one other address in Australia that has not been declared above or at Question 18, give details at Part T ā€“ Additional information.
  • 9. 80 (Design date 12/14) - Page 9 Ā© COMMONWEALTH OF AUSTRALIA, 2014 Part J ā€“ Australian visa history 35 Are you currently in Australia? No Yes Give details of current visa Type of visa you hold (eg. visitor, business) Reason for journey Name used on entry Place of visa issue Arrival date Day Month Year 36 Have you been to Australia before? No Yes Give details of previous visas Type of visa you held (eg. visitor, business) Reason for journey Name used on entry Place of visa issue Arrival date Departure date Day Month Year Day Month Year Part K ā€“ Character 37 Have you, or any other person included in this application, ever: ā€¢ been charged with any offence that is currently awaiting legal action? No Yes ā€¢ been convicted of an offence in any country (including any conviction which is now removed from official records)? No Yes ā€¢ been the subject of an arrest warrant orąø€ Interpol notice? No Yes ā€¢ been found guilty of a sexually based offence involving a child (including where no conviction was recorded)? No Yes ā€¢ been named on a sex offender register? No Yes ā€¢ been acquitted of any offence on the grounds of unsoundness of mind or insanity? No Yes ā€¢ been found by a court not fit to plead? No Yes ā€¢ been directly or indirectly involved in, or associated with, activities which would represent a risk to national security in Australia or any other country? No Yes ā€¢ been charged with, or indicted for: genocide, war crimes, crimes against humanity, torture, slavery, or any other crime that is otherwise of a serious international concern? No Yes ā€¢ been associated with a person, group or organisation that has been/is involved in criminal conduct? No Yes ā€¢ been associated with an organisation engaged in violence or engaged in acts of violence (including war, insurgency, freedom fighting, terrorism, protest) either overseas or in Australia? No Yes ā€¢ served in a military force, police force, state sponsored/private militia or intelligence agency (including secret police)? No Yes ā€¢ undergone any military/paramilitary training, been trained in weapons/explosives or in the manufacture of chemical/biological products? No Yes ā€¢ been involved in people smuggling or people trafficking offences? No Yes ā€¢ been removed, deported or excluded from any country (including Australia)? No Yes ā€¢ overstayed a visa in any country (including Australia)? No Yes ā€¢ had any outstanding debts to the Australian Government or any public authority in Australia? No Yes If you answered ā€˜Yesā€™ to any of the questions at Question 37, you must state who it applies to and give ALL relevant details. If the matter relates to a criminal conviction, please give the nature of the offence, full details of sentence and dates of any period of imprisonment or other detention.
  • 10. 80 (Design date 12/14) - Page 10 Ā© COMMONWEALTH OF AUSTRALIA, 2014 Part L ā€“ Military service 38 Have you undertaken any military service? Military service includes: ā€¢ compulsory ā€¢ conscription ā€¢ military training ā€¢ voluntary ā€¢ professional. No Yes Give details in chronological order Date from Date to Country of service Full name of Unit/ Battalion/Brigade Rank Duties Country of deployment Day Month Year Day Month Year Part M ā€“ Employed by intelligence or security agency 39 Are you currently, or have you been employed as an intelligence officer or an agent of an intelligence or security agency? No Yes Give details of organisation, role and dates you served Part N ā€“ Visa refusals 40 Have you ever been refused a visa to any country? No Yes Give dates of refusal, countries and circumstances of refusal Part O ā€“ Deportations 41 Have you ever been excluded, asked to leave, deported or removed from any country? No Yes Give details of dates, countries and circumstances Part P ā€“ Citizenship refusals 42 Have you ever been refused, renounced or rescinded citizenship of any country? No Yes Give dates of refusal, countries and circumstances of refusal
  • 11. 80 (Design date 12/14) - Page 11 Ā© COMMONWEALTH OF AUSTRALIA, 2014 Part Q ā€“ Associated people 43 Do you have a partner? Partner includes wife, husband, fiancĆ©, boyfriend, girlfriend, significant other and de facto. If widowed you must give details for your deceased partner. No Yes Give details (If not living, write ā€˜DECEASEDā€™ in ā€˜Country of current residenceā€™ column) Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence (If not living, write ā€˜DECEASEDā€™) Migrating with you? Town/City State/Province/Region Country No Yes 44 Do you have children? Children includes biological or adopted, children from a current or previous marriage, all step-children and deceased children. No Yes Give details (If not living, write ā€˜DECEASEDā€™ in ā€˜Country of current residenceā€™ column) Child 1 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence (If not living, write ā€˜DECEASEDā€™) Migrating with you? Town/City State/Province/Region Country No Yes Child 2 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence (If not living, write ā€˜DECEASEDā€™) Migrating with you? Town/City State/Province/Region Country No Yes
  • 12. 80 (Design date 12/14) - Page 12 Ā© COMMONWEALTH OF AUSTRALIA, 2014 Child 3 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence (If not living, write ā€˜DECEASEDā€™) Migrating with you? Town/City State/Province/Region Country No Yes Child 4 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence (If not living, write ā€˜DECEASEDā€™) Migrating with you? Town/City State/Province/Region Country No Yes Child 5 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence (If not living, write ā€˜DECEASEDā€™) Migrating with you? Town/City State/Province/Region Country No Yes Child 6 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence (If not living, write ā€˜DECEASEDā€™) Migrating with you? Town/City State/Province/Region Country No Yes If more than 6 children, give details at Part T ā€“ Additional information
  • 13. 80 (Design date 12/14) - Page 13 Ā© COMMONWEALTH OF AUSTRALIA, 2014 45 Do you know details of your parents? Parents include biological parents, adopted parents, step parents, legal guardians and deceased parents. No Yes Give details (If not living, write ā€˜DECEASEDā€™ in ā€˜Country of current residenceā€™ column) Parent 1 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence (If not living, write ā€˜DECEASEDā€™) Migrating with you? Town/City State/Province/Region Country No Yes Parent 2 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence (If not living, write ā€˜DECEASEDā€™) Migrating with you? Town/City State/Province/Region Country No Yes Parent 3 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence (If not living, write ā€˜DECEASEDā€™) Migrating with you? Town/City State/Province/Region Country No Yes Parent 4 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence (If not living, write ā€˜DECEASEDā€™) Migrating with you? Town/City State/Province/Region Country No Yes If more than 4 parents, give details at Part T ā€“ Additional information
  • 14. 80 (Design date 12/14) - Page 14 Ā© COMMONWEALTH OF AUSTRALIA, 2014 46 Do you have siblings? Siblings include full, half and adopted brothers and sisters. No Yes Give details (If not living, write ā€˜DECEASEDā€™ in ā€˜Country of current residenceā€™ column) Sibling 1 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence Migrating with you? Town/City State/Province/Region Country No Yes Sibling 2 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence Migrating with you? Town/City State/Province/Region Country No Yes Sibling 3 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence Migrating with you? Town/City State/Province/Region Country No Yes Sibling 4 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence Migrating with you? Town/City State/Province/Region Country No Yes
  • 15. 80 (Design date 12/14) - Page 15 Ā© COMMONWEALTH OF AUSTRALIA, 2014 Sibling 5 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence Migrating with you? Town/City State/Province/Region Country No Yes If more than 5 siblings, give details at Part T ā€“ Additional information 47 Other travelling family members Are there any other family members included in the visa application? Family members include nieces, nephews, cousins, in-laws, grandparents etc. who are travelling with you No Yes Give details Family member 1 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence Town/City State/Province/Region Country Family member 2 Relationship to you Family name Given names (include patronymic name) Any other names (eg. maiden or tribal name) Sex Date of birth Chinese commercial codes (If not applicable, write ā€˜N/Aā€™) M/F Day Month Year Place of birth Citizenship(s) and year granted Country of current residence Town/City State/Province/Region Country If more than 2 other family members, give details at Part T ā€“ Additional information
  • 16. 80 (Design date 12/14) - Page 16 Ā© COMMONWEALTH OF AUSTRALIA, 2014 48 Do you have any personal contacts in Australia? Personal contacts include visa sponsors, any relatives, friends, family members and acquaintances in Australia. No Go to Part R Yes Provide as much information about one of your personal contacts as possible Family name Given names Sex Male Female Relationship to you (eg. partner, sister, aunt, friend) Date of birth Day Month Year Town/City of birth State/Province/Region Country Nationality Your personal contactā€™s current residential address Note: A post office box is not acceptable. Address (including building/unit/house number and street name) Suburb and town/city State or territory Postcode Telephone numbers Office hours (Area code ) Mobile/cell Email address 49 Do you have any other personal contacts in Australia? No Go to Part R Yes Give details Family name Given names Sex Male Female Relationship to you (eg. partner, sister, aunt, friend) Date of birth Day Month Year Town/City of birth State/Province/Region Country Nationality Your personal contactā€™s current residential address Note: A post office box is not acceptable. Address (including building/unit/house number and street name) Suburb and town/city State or territory Postcode Telephone numbers Office hours (Area code ) Mobile/cell Email address Give details of all other contacts at Part T ā€“ Additional information
  • 17. 80 (Design date 12/14) - Page 17 Ā© COMMONWEALTH OF AUSTRALIA, 2014 Part R ā€“ Sponsoring employer details 50 Are you being sponsored by, or associated with, a business or organisation in Australia? No Go to Part S Yes Give details Organisation/Business name Organisation/Business description Organisation/Business commercial address (including building number and street name) Suburb and town/city State or territory Postcode Name of contact person in business/organisation 51 Does the employer/business have any other associated addresses? No Yes Give details Type of address (eg. head office, factory, retail store) Address (including building number and street name) Suburb and town/city State or territory Postcode 52 Does the employer/business have an email address? No Yes Give details 53 Does the employer/business have telephone numbers? No Yes List all contact telephone numbers (including area code) Part S ā€“ Declaration WARNING: Giving false or misleading information is a serious offence. 54 I declare that: ā€¢ the information I have supplied in or with this form is complete, correct and up-to-date in every detail. ā€¢ I have read and understand the information supplied to me. ā€¢ I have read the information contained in form 1442i Privacy notice. ā€¢ 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 applicant - Date Day Month Year We strongly advise that you keep a copy of your application and all attachments for your records.
  • 18. 80 (Design date 12/14) - Page 18 Ā© COMMONWEALTH OF AUSTRALIA, 2014 Part T ā€“ Additional information 55 Question number Additional information If you do not have enough space to give all the necessary information, attach a separate statement to this form with further details