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Personal particulars for character assessment

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.

Family name Given names

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

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 for 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 relating to adoption, border control, business skills, citizenship, education, health assessment, health insurance, health services, law enforcement, payment of pensions and benefits, taxation, superannuation, review of decisions and registration of migration agents. 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.

(a) Write your name in your own language or script. For Russian citizens, include Patronymic name

(b) Your name in Chinese commercial code numbers (if applicable)

(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

Date of birth Place of birth

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

What is your current citizenship?

Ghana

How was your citizenship acquired? (eg. birth, descent, naturalisation)

birth

COMMONWEALTH OF AUSTRALIA, 2009

80 (Design date 11/09) - Page 1

DAY

MONTH

YEAR

10 When was your citizenship granted?

08-Aug-1963

17 Your current residential address (Not a post office box address)


550 Great South Road

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

18 About your PARTNER


For the purposes of this form, the term partner means a legally married husband or wife, or a partner in a de facto relationship (including same-sex partners), or an intended spouse. If you do not have a partner, write N/A and go to Question 19. Family name Given names

12 Have you ever been refused citizenship of another country?


No 1. Date Country Reason for refusal
DAY MONTH YEAR

Yes
DAY

Provide details below


MONTH YEAR

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)

13 Details of all passports ever issued to you


Passport number Country of issue

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

14 Details of any identity documents, social security cards, or any alien


registration numbers you currently use or have used in the past Type or document Number Country

What is your partners current citizenship?

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

(If insufficient space, give details at Question 37)

15 Your e-mail addresses


paapius@yahoo.com
(If insufficient space, give details at Question 37)

16 Your telephone numbers


COUNTRY CODE AREA CODE ) ( ) NUMBER

Work Home

Country where living now (If not living, write DECEASED) New Zealand

( (

64

) (

09

2777109

Mobile/cell 64-2102311969 Fax Other


( ( ) ( ) ( ) )

Contact telephone if in Australia


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COMMONWEALTH OF AUSTRALIA, 2009

19 About your PARENTS


Note: You must complete details for any person who is or was your parent or with whom you have had a parent-like relationship with. This should include, but is not limited to, natural parents, adoptive parents, IVF parents, surrogate parents, step-parents, foster parents, and/or guardians. (If insufficient space, give details at Question 37) Relationship to you (eg. natural parent, step-parent etc) Relationship to you (eg. natural parent, step-parent etc)

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)

Date of birth (DAY/MONTH/YEAR) Place and country of birth

Date of birth (DAY/MONTH/YEAR) Place and country of birth

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

COMMONWEALTH OF AUSTRALIA, 2009

80 (Design date 11/09) - Page 3

20 About your BROTHERS and/or SISTERS


(If you have more than 4 brothers and/or sisters, give details at Question 37) 1. Family name Given names

Kwame
John Dickson
Male Female

3. Family name Given names

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)

Date of birth (DAY/MONTH/YEAR) Place and country of birth

Date of birth (DAY/MONTH/YEAR) Place and country of birth

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)

Date of birth (DAY/MONTH/YEAR) Place and country of birth

Date of birth (DAY/MONTH/YEAR) Place and country of birth

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

Address (number, street name, suburb, state/province, country)

present

New Zealand

6/20 Spring Street, Onehunga, Auckland 1061

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

Name and address of employer

Country

Type of business

Your occupation/ position

Sep-1986
Sep-1999
Mar-2001

09-1998
Dec-2000
Jun-2005

Ocean Fisheries . Ltd.Box 8415 Tema


PaaPius Shipping ,Box 114 Tema
Parker Hannifin NZ Ltd.

Ghana
Ghana
New Zealand

Motorman
Marine , Eng,
Machinist

May-2008

Jan-2012

Parker Hannifin Nz Ltd

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

Name and address of institution (include country)

Course studied

Course completed or withdrawn

Aug-1970

07-1980

L\A primary and middle school. Tikobo no 2, Ghana

Basic Edu,

Sep-1980
Aug-1998

Jun-1985
Jun-1999

Half Assini Sec . Half Assini Ghana


Regional Maritime Academy Box1115 Accra . Ghana

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

Type of entry (visitor, student, temporary resident)

Place where visa was issued

Name used on entry

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

Reason for visit

COMMONWEALTH OF AUSTRALIA, 2009

80 (Design date 11/09) - Page 5

27 Your current travel document details (eg. passport, travel authority,


documentary visa) Type or travel document Number Place of issue Date of issue (DAY/MONTH/YEAR)

30 Details of intended visit to Australia


Date of arrival or proposed arrival (DAY/MONTH/YEAR) Place of proposed arrival Period of time permitted to remain in Australia as authorised on arrival 5 years Purpose of journey

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

28 Details of contacts in Australia


1. Family name Given names

Go to Question 32

31 Visa details (of initial arrival)


Type of visa Visa number V <

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 ( )

Place of arrival Date of arrival (DAY/MONTH/YEAR)

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

29 Where are you currently located?


Outside Australia In Australia Go to Question 30 Go to Question 31

(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

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COMMONWEALTH OF AUSTRALIA, 2009

(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

34 Are you currently, or have you been employed as an intelligence officer


No Yes or an agent of an intelligence or security agency? No Yes Give details of organisation, role and dates where you served

(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

35 Have you ever been denied or refused a visa or entry


to another country? No Yes Give details

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.

(If insufficient space, give details at Question 37)


COMMONWEALTH OF AUSTRALIA, 2009 80 (Design date 11/09) - Page 7

Additional details
37
Question number Additional information

(If insufficient space, attach additional details)


80 (Design date 11/09) - Page 8 COMMONWEALTH OF AUSTRALIA, 2009