Personal particulars for assessment including character assessment

Part A – Applicant details

Please provide your details as they appear in your official documents. For example, passport, identity document, travel document, birth certificate

Family name

Note: If you have one name only, please write it in the ‘Family name’ field.

All given names

Sex

Male
Female
Indeterminate / Intersex / Unspecified

Date of birth

Day

Month

Year

Day, month and year MUST be provided

Suburb of birth

Town/City of birth

State/Province/Region

Address

Country

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)

Are you of Russian descent?

No
Yes

In English, provide your patronymic name

Have you been known by any other name(s)? Include: • name at birth • name before or after marriage • adoptive or foster name • alias or pseudonym • cultural or tribal name or clan/subclan name • preferred name • other spellings of names

No
Yes

Type of name

Family name

Given names

If more than one name, give details at Part T – Additional information

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

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

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 ‘CURRENT’. If more than one country, give details at Part T – Additional information

Do you currently have permanent residency rights in any country other than those declared in Questions 6 or 7?

No
Yes

List all other countries

Part B – Passport / Travel document details

Do you have a current passport or travel document?

No
Yes

Passport/travel document number

Country of passport/travel document

Date of issue

Day

Month

Year

Is this the original issue date?

No
Yes

Give original issue date

Day

Month

Year

Date of expiry

Day

Month

Year

Nationality

Place of issue/issuing authority

Family name

Given names

Do you have any other current passport or travel document?

No
Yes

Passport/travel document number

Country of passport/travel document

Date of issue

Day

Month

Year

Date of expiry

Day

Month

Year

Nationality

Place of issue/issuing authority

Family name

Given names

Have you ever had any previous passports or travel documents (including expired, lost or stolen documents)?

No
Yes

What happened to this document (Tick one only)

Expired
Lost/stolen
Other

Give details

Do you have, or remember, any of the document details?

No
Yes

Passport/travel document number

Country of passport/travel document

Date of issue

Day

Month

Year

Date of expiry

Day

Month

Year

Nationality

Place of issue/issuing authority

Family name

Given names

Part C – Identity documents

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)

Part D – Address and contact details

Do you have any email addresses?

No
Yes

Note: Include all personal, student and work email addresses. Do not include migration agent email addresses.

Primary

Other

Do you have current contact telephone numbers?

No
Yes

Work

Home

Mobile/cell

Other

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: • addresses inside and outside Australia • places you resided for study/work • refugee camps • 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 – Additional information.

Date From	Date To	Address	Actions

There are no Entries.

Part E – International travel / movements

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: • work or study outside your usual country of residence • holiday/leisure trips • business • military deployment • visits back to your own country

No
Yes

Give details in chronological order

Date From	Date To	Address	Actions

There are no Entries.

Part F – Employment

Give details of all employment and unemployment Employment includes: • all paid employment • self-employment/family business • work experience/internships • unpaid employment/volunteer work. Unemployment includes: • from date of birth up until first employment • all gaps/breaks between employment • all gaps between education. If you are currently retired – write ‘CURRENTLY RETIRED’ in ‘Name of business’ field and provide details in the ‘Your occupation and duties’ field. If you have never worked – write your date of birth in the ‘Date from’ field and ‘NEVER WORKED’ in the ‘Name of business/company’ field and provide details in the ‘Your occupation and duties’ 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 – Additional information.

Date from	Date to	Name of business/company	Employer address	Type of business	Occupation	Actions

There are no Entries.

Part G – Education

0 Give details of all tertiary education and qualifications Education/qualifications includes: • college/vocational schools • university • research/thesis • specialist training • skill/trade qualifications. Note: If you are applying for a Refugee and Humanitarian visa, you must provide details of all education and qualifications since birth

Date from	Date to	Full name of institution	Full name of course or description of research	Course status	Campus/address of institution	Actions

There are no Entries.

Part H – Proposed travel or further stay details

Are you currently in Australia?

No
Yes

Proposed travel

Why are you travelling to Australia? Include any relevant dates or events

Do you have any proposed or booked travel dates for your journey to Australia?

No
Yes

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 ‘N/A’ if not applicable)

List the towns/cities you will visit during your time in Australia

Are you applying for a temporary visa?

No
Yes

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 ‘N/A’ if not applicable)

Further stay

What is your main reason for remaining in Australia?

List the towns/cities you will visit during your further stay in Australia

Give details of your arrival in Australia

Arrival date

Day

Month

Yar

City of arrival

Are you applying for a temporary visa?

No
Yes

Do you have any proposed or booked travel for your departure from Australia?

No
Yes

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 ‘N/A’ if not applicable)

Part I – Address(es) in Australia

Are you currently in Australia?

No
Yes

Located outside Australia

Do you know any details of the places you will stay during your time in Australia (eg. hotel, friends, relatives)?

No
Yes

Give the residential address and contact numbers Note: A post office box is not acceptable.

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Office hours

Mobile/cell

Will you stay at any other address?

No
Yes

Address (including hotel name and/or unit and building number and street name)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Office hours

Mobile/cell

If you will stay at any other address(es), give details at Part T – Additional information.

Located in Australia

Do you have any other addresses in Australia that have not been declared at Question 17?

No
Yes

Give the residential address and contact numbers Address (including hotel name and/or unit and building number and street name)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Office hours

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 17, give details at Part T – Additional information.

Part J – Australian visa history

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

Have you been to Australia before?

No
Yes

Have you been to Australia before?

Type of visa you held (eg. visitor, business)	Reason for journey	Name used on entry	Place of visa issue	Arrival date	Departure date

Part K – Character

Have you, or any other person included in this application, ever:

been charged with any offence that is currently awaiting legal action?

No
Yes

been convicted of an offence in any country (including any conviction which is now removed from official records)?

No
Yes

been charged or convicted of family or domestic violence offences or similar related offences?

No
Yes

been the subject of a domestic or family violence order, or any other order, of a tribunal or court or other similar authority, for the personal protection of another person?

No
Yes

been the subject of an arrest warrant or Interpol notice?

No
Yes

been found guilty of a sexually based offence involving a child (including where no conviction was recorded)?

No
Yes

been named on a sex offender register?

No
Yes

been acquitted of any offence on the grounds of unsoundness of mind or insanity?

No
Yes

been found by a court not fit to plead?

No
Yes

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

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

been associated with a person, group or organisation that has been/is involved in criminal conduct?

No
Yes

• 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

• served in a military force, police force, state sponsored/private militia or intelligence agency (including secret police)?

No
Yes

• undergone any military/paramilitary training, been trained in weapons/explosives or in the manufacture of chemical/biological products?

No
Yes

been involved in people smuggling or people trafficking offences?

No
Yes

been removed, deported or excluded from any country (including Australia)?

No
Yes

overstayed a visa in any country (including Australia)?

No
Yes

had any outstanding debts to the Australian Government or any public authority in Australia?

No
Yes

If you answered ‘Yes’ to any question at Question 36, give details, including the date of the charge, the outcome and any penalty imposed. Also attach court documents (for example sentencing remarks or court transcripts). Where relevant, provide a copy of all declared orders (for example, any domestic or family violence orders, child protection orders, or orders that prohibit the applicant from having contact with another person for their personal protection). You are only requested to declare an order where the applicant is the respondent or subject of the order. You are not asked to declare an order where the applicant is the person requiring personal protection.

Part L – Military service

Have you undertaken any military service? Military service includes: • compulsory • conscription • military training • voluntary • professional.

No
Yes

Give reasons

Give details in chronological order

Date from	Date to	Country of service	Full name of Unit/ Battalion/Brigade and Unit ID number	Rank	Duties	Country of deployment	Actions

There are no Entries.

Part M – Employed by intelligence or security agency

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

Section Break

Have you ever been refused a visa to any country?

No
Yes

Give dates of refusal, countries and circumstances of refusal

Part O – Deportations

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 – Citizenship refusals

Have you ever been refused, renounced or rescinded citizenship of any country?

No
Yes

Give dates of refusal, countries and circumstances of refusa

Part Q – Associated people

Do you have a partner? Partner includes wife, husband, fiancé, 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 ‘DECEASED’ in ‘Country of current residence’ column)

Relationship to you	Family name	Given names (include patronymic name)	Any other names (eg. maiden or tribal name)	Sex	Date	Chinese commercial codes	Place of birth	Citizenship(s) and year granted	Country of current residence (If not living, write ‘DECEASED’)	Migrating with you?	Actions

There are no Entries.

Do you have children? Children includes biological or adopted, children from a current or previous marriage, all step-children and deceased children.

No
Yes

children

Relationship to you	Family name	Given names (include patronymic name)	Any other names (eg. maiden or tribal name)	Sex	Date	Chinese commercial codes	Place of birth	Citizenship(s) and year granted	Country of current residence (If not living, write ‘DECEASED’)	Migrating with you?	Actions

There are no Entries.

Do you know details of your parents? Parents include biological parents, adopted parents, step parents, legal guardians and deceased parents

No
Yes

parents

Relationship to you	Family name	Given names (include patronymic name)	Any other names (eg. maiden or tribal name)	Sex	Date	Chinese commercial codes	Place of birth	Citizenship(s) and year granted	Country of current residence (If not living, write ‘DECEASED’)	Migrating with you?	Actions

There are no Entries.

Do you have siblings? Siblings include full, half and adopted brothers and sisters.

No
Yes

Sibling

Relationship to you	Family name	Given names (include patronymic name)	Any other names (eg. maiden or tribal name)	Sex	Date	Chinese commercial codes	Place of birth	Citizenship(s) and year granted	Country of current residence (If not living, write ‘DECEASED’)	Migrating with you?	Actions

There are no Entries.

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

Family member

Relationship to you	Family name	Given names (include patronymic name)	Any other names (eg. maiden or tribal name)	Sex	Date	Chinese commercial codes	Place of birth	Citizenship(s) and year granted	Country of current residence (If not living, write ‘DECEASED’)	Migrating with you?	Actions

There are no Entries.

Do you have any personal contacts in Australia? Personal contacts include visa sponsors, any relatives, friends, family members and acquaintances in Australia.

No
Yes

Provide as much information about one of your personal contacts as possible

Family name Given names

Sex

Male
Female
Indeterminate / Intersex / Unspecified

Relationship to you (eg. partner, sister, aunt, friend)

Date

Day

Month

Year

Town/City of birth

Nationality

Your personal contact’s current residential address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Note: A post office box is not acceptable. Address (including building/unit/house number and street name)

Telephone numbers

Mobile/cell

Email

Do you have any other personal contacts in Australia?

No
Yes

Provide as much information about one of your personal contacts as possible

Family name Given names

Sex

Male
Female
Indeterminate / Intersex / Unspecified

Relationship to you (eg. partner, sister, aunt, friend)

Date of birth

Day

Month

Year

Town/City of birth

State/Province/Region

Nationality

Your personal contact’s current residential address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Note: A post office box is not acceptable. Address (including building/unit/house number and street name)

Telephone numbers

Mobile/cell

Email address

Give details of all other contacts at Part T – Additional information

Part R – Sponsoring employer details

Are you being sponsored by, or associated with, a business or organisation in Australia?

No
Yes

Organisation/Business name

Organisation/Business description

Organisation/Business commercial address (including building number and street name)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of contact person in business/organisation

Does the employer/business have an email address?

No
Yes

Give details

Does the employer/business have telephone numbers?

No
Yes

List all contact telephone numbers (including area code)

Part S – Declaration

WARNING: Giving false or misleading information is a serious offence.

I declare that: • the information I have supplied in or with this form is complete, correct and up-to-date in every detail. • I have read and understand the information supplied to me. • I have read the information contained in form 1442i Privacy notice. • I understand the Department may collect, use and disclose my personal information (including biometric information and other sensitive information) as outlined in form 1442i Privacy notice.

Signature of applicant

Date

Day

Month

Year

We strongly advise that you keep a copy of your application and all attachments for your records.

Part T – Additional information

Question number	Additional information

Agent Email