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23-Sep-1984
157A (Design date 07/14a) - Page 8 COMMONWEALTH OF AUSTRALIA, 2014
Your country of usual residence 17
18 Your residential address in your country of usual residence
Note: A post office box address is not acceptable as a residential
address. Failure to give a residential address will result in your
application being invalid.
POSTCODE
19 Your telephone numbers outside Australia
( ) ( )
( ) ( )
COUNTRY CODE AREA CODE NUMBER
Office hours
After hours
20 Your residential address in Australia (if known)
POSTCODE
21 Your telephone numbers in Australia (if known)
(AREA CODE ) Office hours
After hours (AREA CODE )
22 Address for correspondence
POSTCODE
Do you agree to the department communicating with you by fax, email
or other electronic means?
23
Give details
No
Yes
( ) ( )
COUNTRY CODE AREA CODE NUMBER
Fax number
Email address
Details of identity card or identity number issued to you by your
government (if applicable) eg. National identity card.
Note: If you are the holder of multiple identity numbers because you
are a citizen of more than one country, you need to enter the identity
number on the card from the country that you live in.
16
Identity number
Country of issue
Personal/private mobile/cell
Personal/private mobile/cell
Your present country of citizenship 12
Do you hold any other citizenship? 13
Which countries?
No
Yes
Do you have a passport? 15
Details from your passport
No
Yes
Passport number
Country of passport
DAY MONTH YEAR
Date of issue
Date of expiry
Issuing authority/Place of issue as shown in your passport
Preferred language 14
The department may contact you for an interview and may use an
interpreter based on your preferred language.
Other date of birth
Place of birth 10
Town/city
Country
Have you ever used a different date of birth? 9
No
Yes
DAY MONTH YEAR
If insufficient space, attach an additional statement.
11 Relationship status
Married
De facto
Engaged
Divorced
Separated
Widowed
Never married or
been in a de facto
relationship
Date of marriage
Date of intended marriage
(if applicable)
Date cohabitation began
DAY MONTH YEAR
Quang Ngai
Vietnam
30-Nov-2012
Vietnam
VIETNAMESE
VIETNAM
26-Feb-2013
26-Feb-2023
Immigration Department
212166978
Vietnam
Vietnam
308/19 Phan Dinh Phung Street, Quang Ngai City,
Quang Ngai Province
+84986847899
Australia Awards Office Vietnam, Room 502,
Building A, 14-16 Ham Long, Hoan Kiem District,
Hanoi, Vietnam
84 4 3934 6782
thao.dam@australiaawardsvietnam.org
157A (Design date 07/14a) - Page 9 COMMONWEALTH OF AUSTRALIA, 2014
24 Are you applying for a student visa while you are in Australia?
Highest qualification 1.
Name of education provider or training body
Address of education provider or training body
Commencement date
Finish date
Documentation attached? No Yes
No
Yes
Go to Question 27
Go to Question 25
25
Important If you are applying in Australia, you must currently hold a
qualifying visa, or held a certain visa within 28 days from the expiry of
that visa.
Information on qualifying visas and certain visas is available from the
departments website
www.immi.gov.au/students/students/qualifying-visas-for-
student-visa-applications-lodged-australia.htm
Do you currently hold a qualifying visa?
No
Yes
Go to Question 26
Go to Question 28
26 Were you the holder of a certain visa and lodging an application within
28 days from the expiry of that visa?
No
Yes
WARNING: You do not meet the criteria for the grant of
a student visa.
Go to Question 28
27 What date do you intend to arrive in Australia?
Go to Question 29
DAY MONTH YEAR
28 Do you currently hold a student visa?
No
Yes
If you are in Assessment Level 2 or 3 and applying
for a student visa in Australia, you will be required at
Question 49 to provide exceptional reasons why you
should be granted a student visa in Australia.
29 What date do you intend to depart Australia after completing your
course?
DAY MONTH YEAR
30 Provide details of your highest qualification obtained outside Australia,
as well as all other studies and training obtained outside Australia.
You must provide evidence of your study and training, including
academic records, if you are:
in Assessment Level 3; or
in Assessment Level 2 seeking to undertake studies in the
postgraduate research sector.
All other applicants may be requested to provide evidence where
considered necessary.
In certain limited circumstances, you may be requested to provide
copies of any published works written by you.
DAY MONTH YEAR
POSTCODE
Other course undertaken outside Australia 2.
Name of education provider or training body
Address of education provider or training body
Commencement date
Finish date
Documentation attached? No Yes
DAY MONTH YEAR
POSTCODE
Other course undertaken outside Australia 3.
Name of education provider or training body
Address of education provider or training body
Commencement date
Finish date
Documentation attached? No Yes
DAY MONTH YEAR
POSTCODE
Bachelor
University of Transport and Communication
450 Le Van Viet, Tang Nhon Phu Ward, District 9
Ho Chi Minh City, Vietnam
05-Sep-2002
04-Jul-2007
06-Sep-2014
Vietnam
14VN006427HOV028A
6.0
Jan-2008 Sep-2014
HPT Construction and Consulting CO., LTD
42 An Duong Vuong street, Quang Ngai City
Quang Ngai Province, Vietnam.
Company
Technical specialist
350 usd/month
Dddd
157A (Design date 07/14a) - Page 12 COMMONWEALTH OF AUSTRALIA, 2014
37 What is your employment status?
Employed
Details of employer
Retired Date of retirement
Student
Your current course
Name of educational Institution
How long have you been
studying at this institution?
Other Provide details
Unemployed Provide details of your last employment (if applicable)
Address
Name
Telephone
number
Position
you hold
MONTHS YEARS
How long have you been
employed by this employer?
( ) ( )
COUNTRY CODE AREA CODE NUMBER
Have you attached evidence
of your employment details?
No Yes
DAY MONTH YEAR
MONTHS YEARS
Self employed
Details of business
Address
Name
Telephone
number
Position
you hold
MONTHS YEARS
How long have you been
employed by this business?
( ) ( )
COUNTRY CODE AREA CODE NUMBER
Have you attached evidence
of your business details?
No Yes
38 Have you been offered a job for when you return home at the
completion of your course?
No What kind of employment will you be seeking on your
return to your home country?
Yes Name and address of your employer
POSTCODE
Telephone number
( ) ( )
COUNTRY CODE AREA CODE NUMBER
POSTCODE
POSTCODE
Occupation
Salary level (if known)
Documentation attached? No Yes
Vietnamese
02-Aug-1988
Vietnamese
15-Dec-2013
6747330
157A (Design date 07/14a) - Page 20 COMMONWEALTH OF AUSTRALIA, 2014
Character
92
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
No Yes
If you answered Yes to any of the above questions, you must state
who it applies to and give ALL relevant details. If the matter relates to a
criminal conviction, please give the nature of the offence, full details of
sentence and dates of any period of imprisonment or other detention.
If insufficient space, attach an additional statement.
Have you, or any member of your family unit
included in this application, ever:
been convicted of a crime or offence in any
country (including any conviction which is
now removed from official records)?
been charged with any offence that is
currently awaiting legal action?
been acquitted of any criminal offence or
other offence on the grounds of mental
illness, insanity or unsoundness of mind?
been removed or deported from any
country (including Australia)?
left any country to avoid being removed or
deported?
been refused entry to, or a further stay in,
any country (including Australia) on
character grounds?
committed, or been involved in, the
commission of war crimes or crimes
against humanity or human rights?
been involved in any activities that would
represent a risk to Australian national
security?
had any outstanding debts to the Australian
Government or any public authority in
Australia?
been involved in any activity, or been
convicted of any offence, relating to the
illegal movement of people to any country
(including Australia)?
served in a military force or state
sponsored/private militia, undergone any
military/paramilitary training, or been
trained in weapons/explosives use
(however described)?
Health insurance
No
Yes
Important This visa application may not be approved
without adequate health insurance arrangements for all
applicants.
90 Do you and all applicants included in this application hold health
insurance for the duration of your intended stay on a student visa?
91 Please select what health insurance arrangements are in place for all
student visa applicants included in this application:
Overseas
Student Health
Cover (OSHC)
Other health
insurance
arrangements
You must provide evidence of OSHC for
all student visa applicants included in
this application.
Give details
Examples of other forms of acceptable health insurance arrangements
can be found in the information sheet Applying for a student visa,
available from the departments website
www.immi.gov.au/allforms/pdf/applying-student.pdf