Personal details form for character assessment

Form
Personal particulars for assessment

including character assessment
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.
This form is to be completed in English by applicants who are
16 years of age or over, as requested by the office processing the
application.
Please use a pen, and write neatly in English using BLOCK LETTERS.
Tick where applicable 3
If you need more space for any answers, give details at Part T
Additional information
Integrity of application
The 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 refused.
80
Part A Applicant details

1
Important information about privacy

Your personal information is protected by law, including the
Privacy Act 1988. 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 departments website
www.border.gov.au/allforms/ or offices of the department.
You should ensure that you read and understand form 1442i
before completing this form.
Please provide your details as they appear in your official documents.

For example, passport, identity document, travel document, birth
certificate.
Note: If you have one name only, please write it in the Family name
field.
Family name
All given names
Sex
Female
Male
Day
Date of birth
Month
Year
Day, month and year

MUST be provided
Suburb of birth
Town/City of birth
State/Province/Region
Country
Do you ever use a Chinese Commercial Code Number for your names
shown in the passport/travel document at Question 1?
No
Yes
Chinese Commercial Code Number (in full)
Are you of Russian descent?

No
Yes
COMMONWEALTH OF AUSTRALIA, 2015
In English, provide your patronymic name
80 (Design date 10/15) - Page 1
Part B Passport / Travel document

details
Have you been known by any other name(s)? Include:

name at birth
name before or after marriage
adoptive or foster name
alias or pseudonym
cultural or tribal name or

clan/subclan name
preferred name
other spellings of names
No
Yes
Do you have a current passport or travel document?

No
Go to Question 13
Yes
Give details
Passport/travel document number
Give details in English
Type of name
Family name
Country of passport/travel document
Given names
Day
Month
Year
Date of issue
Is this the original issue date?
If more than one name, give details at Part T Additional information
No
Have you ever had a different date of birth to the one shown at
Question1?
No
Yes
Day
Day
Year
Different date of birth
Day
No, I am stateless
Place of issue/issuing authority
Give details
Day
Month
Year
Date you gained this citizenship

Do you hold or have you held citizenship from any other country
(including dual citizenships and all previous citizenships)?
No
Country
How did you gain this citizenship (eg. birth, descent,
naturalisation)?
When did you have this citizenship?

Month
From
Year
Day
Month
Year
to
Note: If you still have the citizenship, write CURRENT.

If more than one country, give details at Part T Additional
information
Do you currently have permanent residency rights in any country other
than those declared in Questions 6 or 7?
No
Yes
List all other countries
Year
Name on the document (if the same as Question 1, write SAME AS

QUESTION 1)
Family name
How did you gain this citizenship (eg. birth, descent,

naturalisation)?
Day
Year
Date of expiry
Given names
Month
Nationality
Yes
Month
Yes
Month
Do you currently have citizenship from any country?
Yes
Give original issue date
10 Do you have any other current passport or travel document?
13 Do you have, or remember, any of the document details?
No
No
Yes
Give details
Yes
Give as much information as possible
Day
Month
Day
Year
Month
Year
Date of issue
Date of issue
Date of expiry
Date of expiry
Nationality
Nationality

QUESTION 1)
Family name

QUESTION 1)
Family name
Given names
Given names
11 Have you ever had any previous passports or travel documents

(including expired, lost or stolen documents)?
No
Go to Part C
Yes
12 What happened to this document (Tick one only)

Expired
Lost/stolen
Other
Give details
Part C Identity documents

14 Do you currently have, or have you ever had, any national identity
documents or numbers (including birth registration numbers, social

security cards etc)?
No
Yes
Give details
Type of identification
document
Country of issue
Identification number
shown (if applicable)
Part D Address and contact details

15 Do you have any email addresses?
16 Do you have current contact telephone numbers?
Note: Include all personal, student and work email addresses. Do not
include migration agent email addresses.
No
Yes
No
Yes
Provide all telephone numbers

Country code
Provide all of your email addresses
Area code
Number
Work
) (
Home
) (
Mobile/cell
Other
17 Your address history for the last 10 years.
Note: If you are applying for a refugee/humanitarian visa, you must provide all addresses for the last 30 years.
Include:
addresses inside and outside Australia
places you resided for study/work
refugee camps
any other place you have resided such as share houses, university residences and temporary accommodation.
Note: Provide your address history in chronological order with no gaps in the timeline. If there are gaps, you must provide an explanation at Part T
Additional information.
Date from
Month
Year
Date to
Month
Full address (house number, street name, suburb, town/city, postcode)
Country
Year
CURRENT
Part E International travel / movements

18 Have you travelled to any country other than Australia in the last 10 years?
Note: If you are applying for a refugee/humanitarian visa, you must provide all visits to any country other than Australia for the last 30 years.
Include:
work or study outside your usual country of residence
holiday/leisure trips
business
military deployment
visits back to your own country.
No
Yes
Give details in chronological order

Date from
Day
Month
Date to
Year
Day
Month
Reason for visit

Year
Country
Part F Employment
19 Give details of all employment and unemployment
Employment includes:
Unemployment includes:
all paid employment
from date of birth up until first employment
self-employment/family business
all gaps/breaks between employment
work experience/internships
all gaps between education.
unpaid employment/volunteer work.
If you are currently retired write CURRENTLY RETIRED in Name of business field and provide details in the Your occupation and duties field.
If you have never worked write your date of birth in the Date from field and NEVER WORKED in the Name of business/company field and provide details in the Your occupation and duties field.
Note: Provide your employment and unemployment history with no gaps in the timeline. If there are gaps, you must provide an explanation at Part T Additional information.
Date from
Month
Year
Date to
Month
Year
Name of business/company
(no abbreviations)
Type of business
(eg. government
department, bakery)
Your occupation and duties

OR
If unemployed/retired/never worked,
provide details of how you occupied your time
and financially supported yourself
Full address of business/company

(Building number, street name, suburb,
town/city, state/province)
(no Post Office box)
Country
CURRENT
Part G Education
20 Give details of all tertiary education and qualifications
Education/qualifications includes:
college/vocational schools
specialist training
university
skill/trade qualifications.
research/thesis
Note: If you are applying for a Refugee and Humanitarian visa, you must provide details of all education and qualifications since birth.
Date from
Month
Year
Date to
Month
Year
Full name of institution

(no abbreviations)
Full name of course or description of research/

Thesis and supervisor details (no abbreviations)
Course status
Completed
Withdrew
Currently enrolled
Completed
Withdrew
Currently enrolled
Completed
Withdrew
Currently enrolled
Completed
Withdrew
Currently enrolled
Completed
Withdrew
Currently enrolled
Completed
Withdrew
Currently enrolled
Completed
Withdrew
Currently enrolled
Completed
Withdrew
Currently enrolled
Campus/address of institution
Country
Part H Proposed travel or further stay

details
21 Are you currently in Australia?
No
Go to Question 25
Yes
Proposed travel
Further stay
22 Why are you travelling to Australia?
25 What is your main reason for remaining in Australia?
Include any relevant dates or events
23 Do you have any proposed or booked travel dates for your journey to
26 List the towns/cities you will visit during your further stay in Australia
Australia?
No
Yes
Give details of proposed arrival in Australia

Day
Month
27 Give details of your arrival in Australia
Year
Day
Arrival date
Month
Year
Arrival date
Flight number or vessel details (if known)
City of arrival
City of arrival
28 Are you applying for a temporary visa?
Give details of countries you will visit on your way to Australia

(write N/A if not applicable)
No
Go to Part I
Yes
29 Do you have any proposed or booked travel for your departure from
Australia?
List the towns/cities you will visit during your time in Australia
No
Yes
Give details
Day
Month
Year
Departure date
24 Are you applying for a temporary visa?
No
Go to Part I
Yes
Give details of proposed final departure from Australia

Day
Month
Year
Departure date
City of departure
Give details of countries you will visit after your departure from Australia
City of departure
Give details of countries you will visit after your departure from Australia
Now go to Part I
Part I Address(es) in Australia

No
Yes
Go to Question 33
Located in Australia
Located outside Australia

31 Do you know any details of the places you will stay during your time in
Australia (eg. hotel, friends, relatives)?
No
Go to Part J
33 Do you have any other addresses in Australia that have not been
declared at Question 17?
No
Yes
Give the residential address and contact numbers

Note: A post office box is not acceptable.
Address (including hotel name and/or unit and building number and
street name)
Go to Part J
Yes
street name)
Suburb and town/city

State or territory
State or territory
Postcode
Office hours
Office hours
(Area code
Mobile/cell
When and in what circumstances did you reside, or stay, at this
address?
Mobile/cell
32 Will you stay at any other address?

No
Postcode
Telephone numbers
Telephone numbers
(Area code
Go to Part J
Yes
street name)
If you have more than one other address in Australia that has not been
declared above or at Question 17, give details at Part T Additional
information.
State or territory
Postcode
Telephone numbers
Office hours
(Area code
Mobile/cell
If you will stay at any other address(es), give details at Part T
Additional information.
Now go to Part J
Part J Australian visa history

No
Yes
Give details of current visa
Type of visa you hold

(eg. visitor, business)
Reason for journey
Name used on entry
Place of visa issue
Arrival date
Day
Month
Year
35 Have you been to Australia before?

No
Yes
Give details of previous visas
Type of visa you held

(eg. visitor, business)
Reason for journey
Name used on entry
Part K Character
36 Have you, or any other person included in this
application, ever:
been charged with any offence that is

currently awaiting legal action?
No
Yes
Place of visa issue
Arrival date
Day
Month
Departure date
Year
Day
Month
Year
served in a military force, police force, state

sponsored/private militia or intelligence
agency (including secret police)?
No
Yes
undergone any military/paramilitary training,

been trained in weapons/explosives or in the
manufacture of chemical/biological products?
No
Yes
been involved in people smuggling or people

trafficking offences?
No
Yes
been convicted of an offence in any country

(including any conviction which is now
removed from official records)?
No
Yes
been the subject of an arrest warrant or

Interpol notice?
been removed, deported or excluded from any

country (including Australia)?
No
Yes
No
Yes
overstayed a visa in any country (including

Australia)?
No
Yes
had any outstanding debts to the Australian

Government or any public authority in
Australia?
No
Yes
been found guilty of a sexually based offence

involving a child (including where no
conviction was recorded)?
No
Yes
been named on a sex offender register?
No
Yes
been acquitted of any offence on the grounds

of unsoundness of mind or insanity?
No
Yes
been found by a court not fit to plead?
No
Yes
been directly or indirectly involved in, or

associated with, activities which would
represent a risk to national security in
Australia or any other country?
No
Yes
been charged with, or indicted for: genocide,

war crimes, crimes against humanity, torture,
slavery, or any other crime that is otherwise of
a serious international concern?
No
Yes
been associated with a person, group or

organisation that has been/is involved in
criminal conduct?
No
Yes
been associated with an organisation engaged

in violence or engaged in acts of violence
(including war, insurgency, freedom fighting,
terrorism, protest) either overseas or in
Australia?
No
Yes
If you answered Yes to any of the questions at Question 36, 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.
Part L Military service

37 Have you undertaken any military service?
Military service includes:
compulsory
conscription
military training
voluntary
professional.
No
Yes
Give details in chronological order

Date from
Day
Month
Date to
Year
Day
Month
Country of service
Year
Part M Employed by intelligence or

security agency
Full name of Unit/

Battalion/Brigade
Country of
deployment
40 Have you ever been excluded, asked to leave, deported or removed from
any country?
officer or an agent of an intelligence or security agency?
No
No
Yes
Give details of dates, countries and circumstances
Give details of organisation, role and dates you served
Part P Citizenship refusals
Part N Visa refusals
41 Have you ever been refused, renounced or rescinded citizenship of any

country?
39 Have you ever been refused a visa to any country?
No
No
Yes
Duties
Part O Deportations
38 Are you currently, or have you been employed as an intelligence
Yes
Rank
Give dates of refusal, countries and circumstances of

refusal
Yes
Give dates of refusal, countries and circumstances of

refusal
Part Q Associated people

42 Do you have a partner?
Partner includes wife, husband, fianc, boyfriend, girlfriend, significant other and de facto.
If widowed you must give details for your deceased partner.
No
Yes
Give details
(If not living, write DECEASED in Country of current residence column)
Relationship to you
Town/City
Family name
Place of birth
Given names
(include patronymic name)
Any other names

(eg. maiden or tribal name)
Sex
M/F
Date of birth
Day
Year
Chinese commercial codes

(If not applicable, write N/A)
Country of current residence

Migrating with you?
(If not living, write DECEASED)
Citizenship(s) and year granted
Country
Month
No
Yes
43 Do you have children?

Children includes biological or adopted, children from a current or previous marriage, all step-children and deceased children.
No
Yes
Give details
Child 1
Relationship to you
Town/City
Family name
Place of birth
Given names
Any other names

Sex
M/F
Date of birth
Day
Year


Migrating with you?
Country
Month
No
Yes
Child 2
Relationship to you
Town/City
Family name
Place of birth
Given names
Country
Any other names

Sex
M/F
Date of birth
Day
Month
Year


Migrating with you?
No
Yes
Child 3
Relationship to you
Town/City
Family name
Place of birth
Given names
Any other names

Sex
M/F
Date of birth
Day
Year


Migrating with you?
Country
Month
No
Yes
Child 4
Relationship to you
Town/City
Family name
Place of birth
Given names
Any other names

Sex
M/F
Date of birth
Day
Year


Migrating with you?
Country
Month
No
Yes
Child 5
Relationship to you
Town/City
Family name
Place of birth
Given names
Any other names

Sex
M/F
Date of birth
Day
Year

Migrating with you?
Country
Month

No
Yes
Child 6
Relationship to you
Town/City
Family name
Place of birth
Given names
Country
Any other names

Sex
M/F
Date of birth
Day
Month
Year


Migrating with you?
No
If more than 6 children, give details at Part T Additional information
Yes
44 Do you know details of your parents?

Parents include biological parents, adopted parents, step parents, legal guardians and deceased parents.
No
Yes
Give details
Parent 1
Relationship to you
Town/City
Family name
Place of birth
Given names
Any other names

Sex
M/F
Date of birth
Day
Year


Migrating with you?
Country
Month
No
Yes
Parent 2
Relationship to you
Town/City
Family name
Place of birth
Given names
Any other names

Sex
M/F
Date of birth
Day
Year


Migrating with you?
Country
Month
No
Yes
Parent 3
Relationship to you
Town/City
Family name
Place of birth
Given names
Any other names

Sex
M/F
Date of birth
Day
Year


Migrating with you?
Country
Month
No
Yes
Parent 4
Relationship to you
Town/City
Family name
Place of birth
Given names
Country
Any other names

Sex
M/F
Date of birth
Day
Month
Year


Migrating with you?
No
Yes
If more than 4 parents, give details at Part T Additional information

45 Do you have siblings?

Siblings include full, half and adopted brothers and sisters.
No
Yes
Give details
Sibling 1
Relationship to you
Town/City
Family name
Place of birth
Given names
Any other names

Sex
M/F
Date of birth
Day
Year

Country
Month
Migrating with you?

No
Yes
Sibling 2
Relationship to you
Town/City
Family name
Place of birth
Given names
Any other names

Sex
M/F
Date of birth
Day
Year

Country
Month
Migrating with you?

No
Yes
Sibling 3
Relationship to you
Town/City
Family name
Place of birth
Given names
Any other names

Sex
M/F
Date of birth
Day
Year

Country
Month
Migrating with you?

No
Yes
Sibling 4
Relationship to you
Town/City
Family name
Place of birth
Given names
Country
Any other names

Sex
M/F
Date of birth
Day
Month
Year

Migrating with you?

No
Yes
Sibling 5
Relationship to you
Town/City
Family name
Place of birth
Given names
Any other names

Sex
M/F
Date of birth
Day
Year

Country
Month
Migrating with you?

No
Yes
If more than 5 siblings, give details at Part T Additional information
46 Other travelling family members
Are there any other family members included in the visa application?
Family members include nieces, nephews, cousins, in-laws, grandparents etc. who are travelling with you
No
Yes
Give details
Family member 1
Relationship to you
Town/City
Family name
Place of birth
Given names
Any other names

Sex
M/F
Date of birth
Day
Year
Country
Month

Family member 2
Relationship to you
Town/City
Family name
Place of birth
Given names
Country
Any other names

Sex
M/F
Date of birth
Day
Month
Year

If more than 2 other family members, give details at Part T Additional information
47 Do you have any personal contacts in Australia?
48 Do you have any other personal contacts in Australia?
Personal contacts include visa sponsors, any relatives, friends, family

members and acquaintances in Australia.
No
Go to Part R
Provide as much information about one of your personal

contacts as possible
Family name
No
Go to Part R
Yes
Give details
Family name
Yes
Given names
Given names
Female
Sex
Male
Relationship to you (eg. partner, sister, aunt, friend)
Female
Sex
Male
Relationship to you (eg. partner, sister, aunt, friend)
Day
Month
Year
Date of birth
Day
Month
Town/City of birth
Year
Date of birth
Town/City of birth
Country
Nationality
Country
Your personal contacts current residential address

Address (including building/unit/house number and street name)
Nationality
Your personal contacts current residential address
Address (including building/unit/house number and street name)
State or territory
Postcode
Telephone numbers
State or territory
Telephone numbers
Office hours
Mobile/cell
(Area code
Postcode
Office hours
Mobile/cell
)
Email address
Give details of all other contacts at Part T Additional information
Email address
(Area code
Part R Sponsoring employer details
WARNING: Giving false or misleading information is a serious offence.
49 Are you being sponsored by, or associated with, a business or

organisation in Australia?
No
Part S Declaration
53 I declare that:
Go to Part S
the information I have supplied in or with this form is complete,

correct and up-to-date in every detail.
I have read and understand 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 notice.
Yes
Give details
Organisation/Business name
Organisation/Business description
Organisation/Business commercial address (including building number

and street name)
Signature of
applicant
Day
Month
Year
Date
We strongly advise that you keep a copy of your application

and all attachments for your records.
State or territory
Postcode

Name of contact person in business/organisation
50 Does the employer/business have any other associated addresses?

No
Yes
Give details
Type of address (eg. head office, factory, retail store)
Address (including building number and street name)
State or territory
Postcode
51 Does the employer/business have an email address?

No
Yes
Give details
52 Does the employer/business have telephone numbers?

No
Yes
List all contact telephone numbers (including area code)
Part T Additional information

54
Question
number
Additional information
If you do not have enough space to give all the necessary information, attach a separate statement to this form with further details

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Form

Personal particulars for assessment

Important Please read this information carefully before you

Part A Applicant details

Important information about privacy

Please provide your details as they appear in your official documents.

All given names

Day, month and year

Chinese Commercial Code Number (in full)

Are you of Russian descent?

COMMONWEALTH OF AUSTRALIA, 2015

In English, provide your patronymic name

80 (Design date 10/15) - Page 1

Part B Passport / Travel document

Have you been known by any other name(s)? Include:

cultural or tribal name or

Do you have a current passport or travel document?

Give details in English

Country of passport/travel document

If more than one name, give details at Part T Additional information

Different date of birth

Place of issue/issuing authority

Date you gained this citizenship

When did you have this citizenship?

Note: If you still have the citizenship, write CURRENT.

List all other countries

80 (Design date 10/15) - Page 2

Name on the document (if the same as Question 1, write SAME AS

How did you gain this citizenship (eg. birth, descent,

Do you currently have citizenship from any country?

Give original issue date

COMMONWEALTH OF AUSTRALIA, 2015

10 Do you have any other current passport or travel document?

13 Do you have, or remember, any of the document details?

Country of passport/travel document

Country of passport/travel document

Place of issue/issuing authority

Place of issue/issuing authority

Name on the document (if the same as Question 1, write SAME AS

Name on the document (if the same as Question 1, write SAME AS

11 Have you ever had any previous passports or travel documents

12 What happened to this document (Tick one only)

Part C Identity documents

documents or numbers (including birth registration numbers, social

COMMONWEALTH OF AUSTRALIA, 2015

80 (Design date 10/15) - Page 3

Part D Address and contact details

16 Do you have current contact telephone numbers?

Provide all telephone numbers

Provide all of your email addresses

17 Your address history for the last 10 years.

Full address (house number, street name, suburb, town/city, postcode)

Part E International travel / movements

Give details in chronological order

80 (Design date 10/15) - Page 4

Reason for visit

COMMONWEALTH OF AUSTRALIA, 2015

Your occupation and duties

Full address of business/company

COMMONWEALTH OF AUSTRALIA, 2015

80 (Design date 10/15) - Page 5

Full name of institution

Full name of course or description of research/