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
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

Type of identification document	Country of issue	Identification number shown (if applicable)

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

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

Question number	Additional information

Personal particulars for assessment including character assessment

Part A – Applicant details

Part B – Passport / Travel document details

Part C – Identity documents

Part D – Address and contact details

Part E – International travel / movements

Part F – Employment

Part G – Education

Part H – Proposed travel or further stay details

Proposed travel

Further stay

Part I – Address(es) in Australia

Located outside Australia

Located in Australia

Part J – Australian visa history

Part K – Character

Part L – Military service

Part M – Employed by intelligence or security agency

Section Break

Part O – Deportations

Part P – Citizenship refusals

Part Q – Associated people

Part R – Sponsoring employer details

Part S – Declaration

Part T – Additional information