Additional personal particulars information

Form

1221

About this form

This 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 records.

Please use a pen, and write neatly in English using BLOCK LETTERS. Tick where applicable

Part A Your details

1
Your full name (as shown in your passport or travel document) Family name Given names

Integrity of application
The Department of Immigration and Citizenship (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.

About the information you give

The department is authorised to collect information provided on this form under Part 2 of the Migration Act 1958 Control of Arrival and Presence of Non-Citizens. The information provided will be used for assessing your eligibility for a visa to travel, enter and remain in Australia and other purposes relating to the administration of the Migration Act, for example, to assist migrants with settling in Australia or for ensuring compliance with the Migration Act. The information provided might also be disclosed to agencies who are authorised to receive information. The information form 993i Safeguarding your personal information, available from offices of the department, gives details of agencies to which your information might be disclosed.

Other names you are, or have been, known by (including name at birth, previous married names, aliases)

Name in your own language or script (if applicable). Please write Chinese names in Chinese Commercial Code Numbers

DAY

MONTH

YEAR

4 5

Date of birth Place of birth Town/City Country

Home page www.immi.gov.au General Telephone 131 881 during business hours enquiry line in Australia to speak to an operator (recorded
information available outside these hours). If you are outside Australia, please contact your nearest Australian mission.

6 7

Sex

Male

Female

Relationship status Married Engaged De facto Separated Divorced Widowed Never married or been in a de facto relationship

Citizenship or nationality (give details of all held)

DAY

MONTH

YEAR

Date granted Place granted

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Your current residential address (a post office box address is not acceptable as a residential address)

Part B Travel details

14 Details from your passport
Passport number Country of passport
DAY MONTH YEAR

POSTCODE

10 Address for correspondence

(if the same as your residential address, write AS ABOVE)

Date of issue Date of expiry Issuing authority/ Place of issue as shown in your passport

POSTCODE

11 Your residential address in Australia (if known)

15 Other travel document details

POSTCODE

12 Your contact details

COUNTRY CODE AREA CODE ( ( ) ) NUMBER

16 Are you applying for a visa to travel to Australia as a:

migrant/refugee visitor OR temporary resident student/academic

Office hours After hours Fax number E-mail addresses

( (

) )

Are you applying for: permanent residency a further temporary stay protection

If insufficient space give details at Question 43

17 Visa subclass you are applying for 13 Do you agree to the department communicating with you by fax, e-mail
or other electronic means? No Yes Fax number E-mail address Give details
COUNTRY CODE ( ) ( AREA CODE ) NUMBER

18 What is the general purpose of your journey/further stay?

19 If you are outside Australia, give details of your intended arrival

DAY MONTH YEAR

Date of arrival Flight/Ship details

20 How long do you intend to stay in Australia?

DAY MONTH YEAR DAY MONTH YEAR

From

to

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21 Give details of each place you intend to stay in Australia, including the
length and purpose of each stay 1. Place you intend to stay Purpose of stay

Part C Employment details

23 Give details of your employment for the last 5 years
(list your most recent experience first)
DAY MONTH YEAR DAY MONTH YEAR

1. From Name of employer

to

DAY

MONTH

YEAR

DAY

MONTH

YEAR

Employers address

From 2. Place you intend to stay

to

POSTCODE

Purpose of stay

Type of business Occupation/Position

DAY

MONTH

YEAR

DAY

MONTH

YEAR

From 3. Place you intend to stay Purpose of stay

to

Duties

DAY

MONTH

YEAR

DAY

MONTH

YEAR

2. From Name of employer

to

DAY

MONTH

YEAR

DAY

MONTH

YEAR

From 4. Place you intend to stay

to

Employers address

POSTCODE

Purpose of stay

Type of business Occupation/Position

DAY

MONTH

YEAR

DAY

MONTH

YEAR

From

to

Duties

If insufficient space give details at Question 43

22 Are you funding your trip?

No Give details of the person/institution funding your trip Full name 3. From Name of employer Name of institution (if applicable) Employers address Address
DAY MONTH YEAR DAY MONTH YEAR

to

POSTCODE POSTCODE

Type of business Occupation/Position Duties

Telephone number
COUNTRY CODE ( ) ( AREA CODE ) NUMBER

Yes

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DAY

MONTH

YEAR

DAY

MONTH

YEAR

3. Institution and city

4. From Name of employer

to

Qualification Employers address Main subjects or duties

POSTCODE

Type of business Occupation/Position

Year of award

4. Institution and city Duties Qualification

If insufficient space give details at Question 43

Main subjects or duties

Part D Education and trade qualifications

24 Give details of all post secondary qualifications
(list your most recent experience first)
1. Institution and city

Year of award

If insufficient space give details at Question 43

25 Describe any workshops, training, conferences or seminars you have

attended in the last 2 years Qualification Main subjects or duties

Year of award

2. Institution and city

Qualification

26 List all titles and describe any previous academic or research papers
you have had published Main subjects or duties

Year of award

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Part E Details of your personal contact in Australia

27 Do you have a personal contact in Australia (eg. your sponsor, the person
you will be staying with, the person funding your holiday, a family relative or an educational institution)? No Yes Go to Part F Family name

Part G Visitor visa

33 Do you intend to do a course of study while in Australia?
No Yes Give details

Name of course Name of the institution

Given names Type of course

28 Date of birth of
personal contact

DAY

MONTH

YEAR

Part H Business visas

34 Intended employment details
Name of employer

29 Current residential address of your personal contact

(a post office box address is not acceptable as a residential address)

Employers address
POSTCODE

30 Personal contacts telephone numbers

COUNTRY CODE AREA CODE ( ( ) ) NUMBER

POSTCODE

Type of business Occupation/Position Duties

Office hours After hours

( (

) )

31 Personal contacts current employment details

Name of employer

Employers address

35 Will your intended business activity in Australia require you to visit more
than one place of work?
POSTCODE

No Yes List the name and location of institutions you will visit during your stay in Australia, the type of business each institution does and the name of your contact at each institution

Type of business Occupation/Position Duties

Part F Details of your journey to Australia

32 Only complete the section(s) relevant to you
If you: have applied for a Visitor visa have applied for a Business visa have applied for a Migration visa are a student, academic, researcher or fellow Go to Part G Go to Part H Go to Part I Go to Part J
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36 Do you intend to inspect and/or negotiate the purchase of any equipment

during your stay in Australia? No Yes Give details

Part I Migration visas

37 Where do you intend to live?
Town/City State/Territory

Part J Student/Academic/Researcher/Fellows
40 Give details of your thesis topic and research to be undertaken

38 Do you intend to do a course of study while in Australia?

No Yes If you have organised your course, give details below Name of course Name of the institution Type of course

39 Do you intend to work in Australia?

No Yes If you have organised your employment, give details below

Name of employer

Employers address

POSTCODE

Type of business Occupation/Position Duties

41 Do you intend to work in Australia?

No Yes If you have organised your employment, give details below

Name of employer

Employers address

POSTCODE

Type of business Occupation/Position Duties

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Part K Additional information

42 Have you ever been denied or refused a visa or entry
to another country? No Yes Give details

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

44 I declare that:
the information I have supplied in this application is complete, correct and up-to-date in every detail; and I have read and understood the information supplied to me.
Signature of applicant
DAY MONTH YEAR

43 Are there any other details you would like taken into consideration?
Question number Additional information

Date

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

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