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Form
80
Important Please read this information carefully before you complete your application. Once you have completed your application we strongly advise that you keep a copy for your records. This form is to be completed in English by applicants for visas for Australia who are 16 years of age or over, as requested by the office processing the application. All questions must be completed.
Write your name and birth details as shown on official documents such as birth certificate, family book, passport or identification document.
Kadwo
Pius Kwame
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.
2 3
Sex
Male
Female
Other names you are, or have been, known by (If insufficient space, give details at Question 37) Family name Given names
Kadwo
Kwame
(a) Write your name in your own language or script. For Russian citizens, include Patronymic name
(c) If you are of Arabic descent, write the full names of your paternal grandfather (ie. your fathers father)
DAY
MONTH
YEAR
For officer This form is designed for completion by applicants and requires attachment of form 80H, internally completed, before despatch for checking purposes.
5 6
08-Aug-1963
Town/city Tikobo No. 2 State/ Province Country
Please use a pen, and write neatly in English using BLOCK LETTERS. Tick where applicable I am applying for a visa to travel to Australia as a: OR I am applying in Australia for:
Ghana
refugee/ humanitarian entrant temporary resident a further temporary stay migrant visitor student permanent residence protection
Relationship status Married Engaged De facto Separated Divorced Widowed Never married or been in a de facto relationship
Ghana
birth
DAY
MONTH
YEAR
08-Aug-1963
11 Are you a dual citizen, or have you held any other citizenship?
No Yes Provide detail including date of citizenship Citizenship Date granted
DAY MONTH YEAR
Manukau, Auckland
New Zealand
Country of residence
POSTAL CODE
2025
New Zealand
Yes
DAY
Kadwo
Amanda Essuman
Male Female
Sex
2. Date Country Reason for refusal (If insufficient space, give details at Question 37)
Other names known by/used before (such as an alias, underline family name used)
Write your partners name in their own language or script. Please also write Chinese names in Chinese commercial code numbers. For Russian citizens, include Patronymic name. If your partner is of Arabic descent, write the full names of their paternal grandfather (ie. their fathers father)
H2009228
(If insufficient space, give details at Question 37)
Ghana
Date of birth (DAY/MONTH/YEAR) Place and country of birth
New Zealand
Is your partner a dual citizen, or have they held any other citizenship? No Yes Provide detail including date of citizenship Citizenship Date granted
DAY MONTH YEAR
Work Home
Country where living now (If not living, write DECEASED) New Zealand
( (
64
) (
09
2777109
Father
Sex Family name Given names Male Female
Mother
Sex Family name Given names Male Female
Papa Kwamekyi
Lucy Anyimah
Other names known by/used before (such as an alias, underline family name used)
Other names known by/used before (such as an alias, underline family name used)
Write your parents name in their own language or script. Please also write Chinese names in Chinese commercial code numbers. For Russian citizens, include Patronymic name. If your parent is of Arabic descent, write the full names of their paternal grandfather (ie. their fathers father)
Write your parents name in their own language or script. Please also write Chinese names in Chinese commercial code numbers. For Russian citizens, include Patronymic name. If your parent is of Arabic descent, write the full names of their paternal grandfather (ie. their fathers father)
Tikobo no 2 , Ghana
Citizenship or nationality (Give details of all held) Citizenship Date granted
DAY MONTH YEAR
Tikobo no 2, Ghana
Citizenship or nationality (Give details of all held) Citizenship Date granted
DAY MONTH YEAR
Country where living now (If not living, write DECEASED) Deceased
Country where living now (If not living, write DECEASED) Ghana
Kwame
John Dickson
Male Female
Kwame
Issac
Male Female
Sex
Sex
Other names known by/used before (such as an alias, underline family name used)
Other names known by/used before (such as an alias, underline family name used)
Write their name in their own language or script. Please also write Chinese names in Chinese commercial code numbers. For Russian citizens, include Patronymic name. If they are of Arabic descent, write the full names of their paternal grandfather (ie. their fathers father)
Write their name in their own language or script. Please also write Chinese names in Chinese commercial code numbers. For Russian citizens, include Patronymic name. If they are of Arabic descent, write the full names of their paternal grandfather (ie. their fathers father)
Tikobo no 2 Ghana
Citizenship or nationality (Give details of all held) Date granted Citizenship DAY MONTH YEAR
Tikobo no 2 Ghana
Citizenship or nationality (Give details of all held) Date granted Citizenship DAY MONTH YEAR
Country where living now (If not living, write DECEASED) Deceased 2. Family name Given names
Country where living now (If not living, write DECEASED) Ghana 4. Family name Given names
Kwame
Grace Afo
Male Female
Kwame
Abraham
Male Female
Sex
Sex
Other names known by/used before (such as an alias, underline family name used)
Other names known by/used before (such as an alias, underline family name used)
Write their name in their own language or script. Please also write Chinese names in Chinese commercial code numbers. For Russian citizens, include Patronymic name. If they are of Arabic descent, write the full names of their paternal grandfather (ie. their fathers father)
Write their name in their own language or script. Please also write Chinese names in Chinese commercial code numbers. For Russian citizens, include Patronymic name. If they are of Arabic descent, write the full names of their paternal grandfather (ie. their fathers father)
Tikobo no 2
Citizenship or nationality (Give details of all held) Date granted Citizenship DAY MONTH YEAR
Tikobo no 2, Ghana
Citizenship or nationality (Give details of all held) Date granted Citizenship DAY MONTH YEAR
Country where living now (If not living, write DECEASED) America
80 (Design date 11/09) - Page 4 COMMONWEALTH OF AUSTRALIA, 2009
Country where living now (If not living, write DECEASED) Ghana
21 Previous addresses of the places where you have lived during the last 10 years (including Australia). You must account for every year.
If you are unable to provide an address for any period of time please provide an explanation. (If insufficient space, give details at Question 37) From
MONTH YEAR MONTH
To
YEAR
Country
present
New Zealand
22 What is your present occupation 23 Give details of your employment history for the entire period since leaving school until now, including periods of unemployment
(If insufficient space, give details at Question 37) From
MONTH YEAR MONTH
To
YEAR
Country
Type of business
Sep-1986
Sep-1999
Mar-2001
09-1998
Dec-2000
Jun-2005
Ghana
Ghana
New Zealand
Motorman
Marine , Eng,
Machinist
May-2008
Jan-2012
New Zealand
Assembly
24 Give details of your education history for the entire period since leaving (high) school (If insufficient space, give details at Question 37)
From
MONTH YEAR MONTH
To
YEAR
Course studied
Aug-1970
07-1980
Basic Edu,
Sep-1980
Aug-1998
Jun-1985
Jun-1999
G.C.E
Marine Eng, Marine . Eng.
25 Give details of all your previous visits to Australia (If none, write N/A. If insufficient space, give details at Question 37)
From
DAY MONTH YEAR DAY
To
MONTH YEAR
Purpose of visit
26 Give details of all visits (including short stays) to countries outside Australia for the last 10 years (If insufficient space, give details at Question 37)
From
DAY MONTH YEAR DAY
To
MONTH YEAR
Country or countries
passport
H2009228
05-Apr-2012
Accra
08-Mar-2007
temporary residence
Date of expiry (DAY/MONTH/YEAR) 07-Mar-2017 Name on passport Family name Given names
Additional periods of stay authorised not applicable after arrival (if applicable) Proposed address in Australia (number, street name, suburb, state)
Kadwo
Pius Kwame
POSTCODE
Go to Question 32
Sex
Male
Female
Place of issue of visa Date of issue of visa (DAY/MONTH/YEAR) Special conditions (if applicable)
NUMBER
Date of birth (DAY/MONTH/YEAR) Relationship to you (eg. family friend, mother) Telephone number 2. Family name Given names
AREA CODE ( )
32 Please answer the following questions about yourself and any other
person included in this application (a) Have you, or any other person included in this application, ever been convicted of, or found guilty of, ANY offences overseas or in Australia (include all traffic offences which went to court, including offences declared in your permanent residence application, and any spent convictions)? No Note: Spent convictions are convictions which are not, under legislation in certain countries, normally required to be disclosed, for example because of the time that has passed since the conviction, or because of a pardon for reasons other than wrongful conviction. Female (b) Have you, or any other person included in this application, ever been confined in a prison or in a psychiatric institution by order of a court made in connection with criminal proceedings overseas or in Australia? No
NUMBER )
Sex
Male
Female
Date of birth (DAY/MONTH/YEAR) Relationship to you (eg. family friend, mother) Telephone number 3. Family name Given names
AREA CODE ( ) NUMBER
Yes
Sex
Male
Date of birth (DAY/MONTH/YEAR) Relationship to you (eg. family friend, mother) Telephone number
AREA CODE (
Yes
(c) Have you, or any other person included in this application, ever committed, or been involved in the commission of war crimes or crimes against humanity or human rights overseas or in Australia? No
Yes
(d) Are you, or any other person included in this application, presently under a probation order, good behaviour bond, on parole, released on licence or subject to periodic detention overseas or in Australia? No (e) Are you, or any other person included in this application, aware of any proceedings pending against you overseas or in Australia for an offence, including proceedings by way of appeal or review? No (f) Have you, or any other person included in this application, ever been involved in any activity, or been convicted of any offence, relating to the illegal movement of people to any country (including Australia)? No (g) Have you, or any other person included in this application, ever been charged with any offence overseas or in Australia that is currently awaiting legal action?
33 Have you ever served in the military, either for your own country or
another country that was not considered mandatory service? No Yes Yes Give details of any periods of military service including name of unit, locations where posted, rank achieved and duties performed
Yes
Yes
(h) Have you, or any other person included in this application, ever been associated with or received training from an organisation engaged in violence, or been involved in an act of violence (including war, insurgency, freedom fighting, terrorism, protest) overseas or in Australia? No (i) Have you, or any other person included in this application, ever been associated with or involved in a program related to the development of weapons of mass destruction?
Yes
No
Yes
If you answered Yes to any of the above questions, give details of all occurrences. Include the following where appropriate: the name of the court; the offence; the name of the terrorist organisation; the nature of the terrorist association; details of terrorist acts; the sentence received; relevant dates; to whom it applies (you or a person included in this application).
Declaration
WARNING: Giving false or misleading information is a serious offence.
36 I hereby declare that the information I have supplied in this form is,
so far as I know or could reasonably find out, correct in every detail. I declare that I have read and understand the information supplied to me. Signature of applicant
DAY MONTH YEAR
Date
We strongly advise that you keep a copy of your application and all attachments for your records.
Additional details
37
Question number Additional information