1221 - Additional personal particulars information

1 1221 (Design date 10/15) - Page 1 COMMONWEALTH OF AUSTRALIA, 2015 Additional personal particulars informationForm1221 About this formThis is a supplementary form required to support your visa application and is to be completed by all applicants who are 18 years of age or over. Important 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 of applicationThe 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 information about privacyYour personal information is protected by law, including the Privacy Act 1988.

2 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 department s website or offices of the department. You should ensure that you read and understand form 1442i before completing this where applicablePlease use a pen, and write neatly in English using BLOCK A Your 131 881 during business hours in Australia to speak to an operator (recorded information available outside these hours). If you are outside Australia, please contact your nearest Australian mission. Home pageGeneral enquiry lineFamily nameGiven names13 Your full name (as shown in your passport or travel document)Name in your own language or script (if applicable)2 Other names you are, or have been, known by (including name at birth, previous married names, aliases)MaleFemale6 Place of birth5 Date of birthDAYMONTHYEAR7 Sex8 Relationship statusMarriedDe factoEngagedDivorcedSeparatedWidowedNeve r married or been in a de facto relationship9 Citizenship or nationality (give details of all held)Date grantedDAYMONTHYEAR4 Name in Chinese Commercial Code Numbers (if applicable)CountryState/province/regionS uburb and town/city1221 (Design date 10/15)

3 - Page 2 COMMONWEALTH OF AUSTRALIA, 201511 Your contact detailsHome telephoneMobile/cellAll email addressesIf insufficient space, give details at Part O Additional details12 POSTCODEYour proposed residential address in Australia (if known)Passport/travel document number13 Details from your passport/travel documentPlace of issue/issuing authorityDate of issueDate of expiryPart B Travel detailsCountry of passport/travel documentDAYMONTHYEAR( )( )COUNTRY CODEAREA CODENUMBER10 Your current residential address (this is the place where you currently live) Note: A post office box, migration agent address or mailbox address is not acceptable as a residential address. Unit/Apartment numberPostal codeAddress (include street number and name)CountryState/province/regionSuburb and town/city1221 (Design date 10/15) - Page 3 COMMONWEALTH OF AUSTRALIA, 201515 Have you ever had a visa refused or cancelled by, been refused entry to, or been deported from, any country?

4 Give details of dates, countries and circumstances (If insufficient space, give details at Part O Additional details)Give details in chronological order (If insufficient space, give details at Part O Additional details)NoYesHave you previously held an Australian visa?16 Type of visa (eg. visitor, student, business)Place where visa was issuedYour names shown on visaReason for visitGive detailsNoYesDo you currently have, or have you ever had, any national identity documents or numbers (including birth registration numbers, social security cards etc)?14 Type of identification documentCountry of issueIdentification number shown (if applicable)Name shown on document17 What is the general purpose of your journey/further stay?18If you are outside Australia, give details of your intended arrivalIntended date of arrivalDAYMONTHYEARF light number or vessel details (if known)19 Intended date of departureDAYMONTHYEARNoYes1221 (Design date 10/15) - Page 4 COMMONWEALTH OF AUSTRALIA, 201520 Give details of any intended stopovers on your way to AustraliaPlaces of intended stopovers21 Give details of any proposed onward locations after your departure from Australia22 Are you fully funding your trip?

5 NoYesGive details of the person/institution funding your tripFull nameName of institution (if applicable)POSTCODE( )( )COUNTRY CODEAREA CODENUMBERA ddressTelephone numberEmail address of person/institutionPart C Details of travelling dependents/family members23 Give details of dependents/family members travelling to Australia with youGiven namesFamily nameDate of birthRelationship to you (eg. partner, sister, aunt) and town/city of birthCountry of birthDAYMONTHYEARPart D Current employment detailsEmployment commencedDAYMONTHYEARName of employerAddress of employer( )( )COUNTRY CODEAREA CODENUMBERC ontact telephoneEmail address (if applicable)Type of businessOccupation/PositionDetailed job description24 Are you currently employedGive details of your current employmentYesGiven namesFamily nameDate of birthRelationship to you (eg.)

6 Partner, sister, aunt) of birthDAYMONTHYEARIf insufficient space, give details at Part O Additional detailsNoGive details of how you occupy your time and how you support yourselfSuburb and town/city of birthPOSTCODE1221 (Design date 10/15) - Page 5 COMMONWEALTH OF AUSTRALIA, 2015 Name and address of employer/business. (Do not use abbreviations)Type of business/ other activitiesYour occupation/position/title/duties/how you spent your time if unemployedDate fromDate toMONTHYEARMONTHYEAR25 Give details of your employment status in the last 10 years (including internships, work experience, self employment and periods of unemployment) (If insufficient space, give details at Part O Additional details)Part F Military service26 Have you had any military service? Give details in chronological order (If insufficient space, give details at Part O Additional details)NoYesRankFull name of Unit/ Battalion/BrigadeCountry of serviceDutiesCountry of deploymentDAYMONTHYEARDAYMONTHYEARDate fromDate toPart E Employment status in the last 10 years1221 (Design date 10/15) - Page 6 COMMONWEALTH OF AUSTRALIA, 2015 Part G Education and trade qualifications27 Give details of all post secondary qualifications (list your most recent experience first)

7 Institution and of awardQualificationMain subjects or dutiesInstitution and of awardQualificationMain subjects or dutiesInstitution and of awardQualificationMain subjects or dutiesInstitution and of awardQualificationMain subjects or dutiesIf insufficient space, give details at Part O Additional details28 Describe any workshops, training, conferences or seminars you have attended in the last 2 years29 List all titles and describe any previous academic or research papers you have had publishedPart H Details of your contact in Australia30Do you have contacts in Australia (including your sponsor, business contacts, the person you will be staying with, a family relative or an educational institution)?NoYesGo to Part IFamily nameGiven namesNature of relationship to you31 POSTCODEC urrent residential address of your contact (a post office box address is not acceptable as a residential address)1221 (Design date 10/15) - Page 7 COMMONWEALTH OF AUSTRALIA, 201534 Part I Details of your journey to AustraliaOnly complete the section(s) relevant to youIf you:have applied for a Visitor visahave applied for a Business visahave applied for a Migration visaare a student, academic, researcher or fellowGo to Part JGo to Part KGo to Part LGo to Part M3537 Part J Visitor visaDo you intend to do a course of study while in Australia?

8 Are you attending a conference/seminar in Australia?NoYesGive detailsName of courseName of the institutionType of course32 Contact s telephone numbersTelephone numberMobile( )( )COUNTRY CODEAREA CODENUMBER33 Contact s current employment detailsName of employerPOSTCODEA ddress of employerType of businessOccupation/PositionDuties36 Proposed employment/business activity detailsName of employerPOSTCODEA ddress of employmentNature of employment/business activitiesProposed duties/activitiesPart K Business visaNoYesGive full name of conference and (if applicable) attach an abstract of the conference presentation38Do you intend to inspect and/or negotiate the purchase of any equipment during your stay in Australia? NoYesGive detailsAll email addresses1221 (Design date 10/15) - Page 8 COMMONWEALTH OF AUSTRALIA, 2015414042 Part M Student/Academic/Researcher/FellowsGive details of your proposed course/field of study in Australia (including name of course, type of course, thesis topic and research to be undertaken)Do you intend to work in Australia?

9 Do you intend to work in Australia?Name of employerName of employerAddress of employerAddress of employerType of businessType of businessOccupation/PositionOccupation/Po sitionDutiesDutiesPOSTCODEPOSTCODE39 Part L Migration visasDo you intend to do a course of study while in Australia? NoNoNoYesYesYesIf you have organised your course, give details belowIf you have organised your employment, give details belowIf you have organised your employment, give details belowName of courseName of the institutionType of courseFamily nameGiven namesName of supervisor (if applicable)Name of the institution1221 (Design date 10/15) - Page 9 COMMONWEALTH OF AUSTRALIA, 2015 Part N Additional information43 Give details of how you intend to use the knowledge/skills/research obtained once you depart Australia44 Are there any other details you would like taken into consideration?

10 1221 (Design date 10/15) - Page 10 COMMONWEALTH OF AUSTRALIA, 201546 Part P DeclarationI declare that: the information I have supplied in this application is complete, correct and up-to-date in every detail. I have read and understood 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 : Giving false or misleading information is a serious O Additional detailsQuestion numberAdditional information45 Signature of applicantDateDAYMONTHYEARWe strongly advise that you keep a copy of your application and all attachments for your