Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Yes Describe the precise biological relationship Yes Describe the precise biological relationship
COUSIN SON
Yes Describe the precise biological relationship Yes Describe the precise biological relationship
SON
Country Country
Citizenship Citizenship
If stateless, write your previous country of citizenship If stateless, write your previous country of citizenship
Relationship status Relationship status
Married legally Engaged Widowed Married legally Engaged Widowed
Married by De facto Never married or Married by De facto Never married or
tradition/custom Separated been in a de facto tradition/custom Separated been in a de facto
relationship relationship
Married religiously Divorced Married religiously Divorced
Relationship to Relationship to
main applicant main applicant
Is this person biologically related to the main applicant? Is this person biologically related to the main applicant?
No Explain how they are related to the main applicant No Explain how they are related to the main applicant
Yes Describe the precise biological relationship Yes Describe the precise biological relationship
If you need more space, please attach a separate page with the details
Attach evidence of identity of each person included in this application
(eg. certified copies of birth certificates, marriage certificates,
passport, national identity card)
9 Have you or any other person included in this visa application Given names
previously been legally married, in a de facto relationship or in a Previous partner’s full name
customary/traditional/religious marriage that is not legally recognised?
No
Day Month Year
Yes Give details of each person below
Dates of
Note: Include partners who you are divorced or separated relationship From
from or who are missing or deceased.
To
1. Family name How did the relationship end?
Given names
Previous partner’s full name Names of all children from this previous relationship
To If you need more space, please attach a separate page with the details
How did the relationship end? Attach a certified copy of previous marriage/divorce documents or
death certificate (if applicable/available)
Names of all children from this previous relationship 10 Do you or any other person included in this application have children
from a previous marriage/relationship, including customary/traditional
marriage?
No
Yes Do they have sole custody of any children under 18 years of
age who are included in this application?
To
How did the relationship end?
Date of birth
1. Family name
Relationship
Given names to you
Full name of biological father
Day Month Year
Date of birth
Relationship Full name of biological mother
to you
Full name of biological father
Whereabouts of biological parents
(if deceased or unknown, please state)
Full name of biological mother
2. Family name
Given names
Day Month Year
Date of birth
Relationship
to you
Full name of biological father
Postal code
2. Family name
Given names
2. Family name
Day Month Year
Given names
Day Month Year
Relationship
to you 3. Family name
Reason they are not applying with you
Given names
Day Month Year
Date of birth
Relationship
to you
If you need more space, please attach a separate page with the details
Last contact (when, where and how you were separated)
Postal code
If you need more space, please attach a separate page with the details
If you need more space, please attach a separate page listing further names
© COMMONWEALTH OF AUSTRALIA, 2018 842 (Design date 02/18) - Page 13
15 Relatives of main applicant’s PARTNER
Give details of ALL YOUR PARTNER’s parents, brothers and sisters and non-dependent children, including children your partner has had with other partners.
You must include half, step and adopted relatives. If any person listed below is not biologically related to your partner, you must clearly indicate this.
Note: You must list ALL YOUR PARTNER’s relatives, whether they are living, deceased, or their whereabouts are unknown. If any relative is deceased or
missing/whereabouts unknown, then you must write ‘DECEASED’ or ‘UNKNOWN’ in the ‘Country where they are now living’ column.
Relationship Status in ‘Relationship status’ codes
Relationship
Sex Date of birth to main Country where they country of N = Never married or been in a
Name status Place and country of birth applicant are now living residence de facto relationship
(use codes
on right) (use codes (use codes M = Married legally
M/F Day Month Year on right) on right)
E = Engaged to be married
Your partner’s parents Select Select Select S = Separated
F = In a de facto relationship
ABDOLKHADER SAEDI M 13/07/1955 M IRAN PB PASS AWAY C D = Divorced
SEDIGHEH DASHTEBAN F 10/12/1963 M IRAN PB IRAN C W = Widowed
MT = Married by tradition/custom
Your partner’s mother’s maiden name MR = Married religiously
SEDIGHEH
‘Relationship to main applicant’
Your partner’s brothers and sisters Select Select Select codes
PB = Parent – Biological
AREZO SAEDI F 21/07/1981 M TEHRAN,IRAN SB IRAN C PA = Parent – Adoptive
SAEDEH SAEDI F 28/10/1985 N TEHRAN,IRAN SB IRAN C PS = Parent – Step
PO = Parent – Other
SAED SAEDI M 1/021987 M SHIRAZ,IRAN SB IRAN C (attach explanation)
SB = Sibling – Biological (full)
SA = Sibling – Adoptive
SS = Sibling – Step
SO = Sibling – Other
(attach explanation)
CB = Child – Biological
CA = Child – Adoptive
CS = Child – Step
CO = Child – Other
(attach explanation)
If you need more space, please attach a separate page listing further names
842 (Design date 02/18) - Page 14 © COMMONWEALTH OF AUSTRALIA, 2018
Part E – Links to Australia
16 Has any person included in this application ever applied for an Australian visa (permanent or temporary) before?
No
Yes Give details
If you need more space, please attach a separate page with the details
17 Do you or your partner have any relatives NOT INCLUDED IN THIS VISA APPLICATION who have current Australian visa applications under consideration?
No
Yes Give details
If you need more space, please attach a separate page with the details
18 Is any person included in this application being proposed (on form 681 or form 1417) for entry to Australia by a person or organisation in Australia?
No
Yes Give details of your proposer or Approved Proposing Organisation (in case of a Community Support Program application)
Family name SEATON
Contact person
Relationship of the
proposer to you FRIEND AND COLLEAGUE THROUGH CHURCH W
Note: Proposers in the Global Special Humanitarian (subclass 202) program must complete form 681 Refugee and Special Humanitarian
Proposal and lodge both form 681 and this form (form 842) together. There is no charge for lodging or processing form 681.
Note: APOs under the Community Support Program must complete form 1417 Community Support Program Proposal by Approved Proposing
Organisation and lodge both form 1417 and this form (form 842) together. For charges associated with lodging and processing form 1417, refer
to the Visa Pricing Table www.homeaffairs.gov.au/trav/visa/fees
These forms are available from the Department’s website www.homeaffairs.gov.au
Given names
Attach a completed form 681 Refugee and Special Humanitarian Proposal to this application (there is no charge
for lodging or processing form 681)
Your proposer should complete form 681 for lodgement with this visa application. Form 681 is available from
any office of the Department, or from the Department’s website www.homeaffairs.gov.au
Attach a certified copy of the immediate family member’s Australian visa label or visa grant letter and evidence
of the relationship (eg. marriage certificate, birth certificate) if available
Provide details of humanitarian claims at Part G, Questions 25 – 37
1. Ahmad Moghimi 14 /08/1984 TR 6 Parer way RoxburghPark 3064 vic Ahmad Brother
2. Hanan Davoudi 28/12/1990 TR 6 Parer way RoxburghPark 3064 vic Hanan Brother’s wife
3. Ghazal Moghimi 31/08/2009 TR 6 Parer way RoxburghPark 3064 vic Ghazal Nephew
4. Amjad Moghimi 27/01/2014 TR 6 Parer way RoxburghPark 3064 vic Amjad Nephew
5.
If you need more space, please attach a separate page with the details
21 Do any people included in this application have any other past or present links to Australia?
No
Yes Indicate the types of links and give details
Links: Education Employment Business Friend Other
Details
Does this person have a travel or identity document? Country of issue INDONESIA
No Attach a statement explaining what happened Day Month Year
to your documents
Date of issue
Yes Give details
Select
Type of document Date of expiry
P
(use codes below)
Issuing authority/place of issue as shown in passport (or other document)
Passport number 26875444
(or document number)
Date of expiry 19/05/2018 Does this person have a travel or identity document?
No Attach a statement explaining what happened
Issuing authority/place of issue as shown in passport (or other document)
to your documents
Yes Give details
Select
Type of document
(use codes below)
Passport number
(or document number)
Country of issue
Day Month Year
Date of issue
Date of expiry
Issuing authority/place of issue as shown in passport (or other document)
‘Type of document’ codes
P = Passport
UN = UN Convention travel document or Titre de voyage
A = Alien/Asylum Registration Card
CI = Certificate or document of identity
S = Seafarer identity document
NIC = National identity card
Country of issue
Day Month Year
Date of issue
Date of expiry
Issuing authority/place of issue as shown in passport (or other document)
A7 Given names
Country of issue
Day Month Year
Date of issue
Date of expiry
Issuing authority/place of issue as shown in passport (or other document)
If you need more space, please attach a separate page with the details
Attach certified copies of the travel documents and identity
documents, if available
If you need more space, please attach a separate page with the details
24 For EACH person included in this application list every address where they have lived during the last 10 years
Date you started to live
Given names of people included in this application
Address where you are living now at this address
who live at this address (if all, write ‘ALL’)
Day Month Year
5. From
To
Town Country
25 For ALL the people included in this application list the ethnic group to which they belong, their religion and any political party/group to which they belong
Membership of political party/group
Given names Ethnic group or clan Religion (if any)
(if any)
Other applicants
A2 KHADIJEH SAEDI PERSIAN CHRISTIAN
A5
A6
A7
If you need more space, please attach a separate page with the details
© COMMONWEALTH OF AUSTRALIA, 2018 842 (Design date 02/18) - Page 21
26 What is the name of the country you fear living in or returning to?
IRAN
28 Why do you fear living in or returning to the country you listed at Question 26?
Your answer should pay special attention to what happened to you, not the general situation in that country.
I believe that my family and I will be in great danger if we return to Iran, because My political activities as an Ahwazi
mean that if we returned, we would be in great danger.
After Iran’s revolution in 1978, minority groups including Arab tribes were not allowed to freely practice cultural
traditions or speak Arabic.
I consider these to be basic human rights and so I have spoken out about this as an Arab in Iran, in particular in Ahwaz.
I have fought for our right to speak our mother tongue (which is Arabic for official duties), the right to wear our
traditional clothing in public, and the right of freedom to vote. Currently, Arabs in Iran are not allowed these rights. In
Ahwaz, I ran a mobile phone shop at Golestan Boulevard 30, opposite Chamran University in Ahwaz. My business
cards were in Arabic as well as Persian, my shop featured Arabic decorations and I wore Arabic clothing. One day, a
customer of mine named Haj Mohamad Sobhani, who was chief of staff of Khuzestan province police, warned me that I
should remove the Arabic writing on my business cards, remove the Arabic decorations from my shop and stop wearing
Arabic clothing or I would face serious trouble. I had already seen Arabic shopkeepers forced by the government to
close their businesses because of the false belief that these shopkeepers were somehow a threat to national security.
The government often falsely accused these people of being rebels against the state. The warning I received made me
more determined to speak out against the oppression, cruelty and injustice carried out by the Iranian regime against
minority groups like Ahwazi.
I joined the Ahwazi Democratic Popular Front and produced some videos and reports on the oppression faced by the
Ahwazi for the Jebhe of Democratic Mardomi Ahwaz’s website in the hope that they would highlight our suffering for the
rest of the world and show how we have been oppressed by the Iranian authoritarian regime. I also began teaching
Arabic to young Arabic Ahwazi who were afraid of learning it in case they were bullied or punished by the government.
This continued until January 2013 when my family was woken from sleep by a knock at the door of our home at Ilia
Complex, Moin Zade alley, Ladan 3 Street, Ahwaz at around 5.30am. Upon answering the door I saw around eight
people, who asked my name and showed me a seizure warrant which they did not let me read. They searched my
home, finding and confiscating three books (one about Sunni religion ,another about Khuzestan’s history, and an Arabic
language dictionary.) They also confiscated a broken PC. They then took me from my home by force. They blindfolded
me and refused to say where they were taking me, instead saying “We have some questions that we want to ask
you.”When we arrived at this unknown destination I was still blindfolded. When they finally removed the blindfold they
forced me to sign a paper that called for me to behave well in detention. They then moved me to a small room, roughly
2m x 3m, and held me there for 17 days. On the 18th day they took me to Kianpars Inqilab court, alleging that I was a
member of the rebel group Ahwazi Democratic Popular Front (ADPF) and had made and spread propaganda against
the Iranian government. This is a common allegation made by the Iranian regime towards Ahwazis. I denied the
allegations for fear of being harmed and was released on bail after my father’s brother paid 1,050,000,000 Rials. He
supplied his house’s certificate to ensure my release. Two days after my release, two friends of mine named Adel Atabi
and Said Cheldavi, who had helped me broadcast some of my announcements via social media, were arrested by the
authorities.
When this happened I met with my friend Javad Treiry, who is a lawyer (+98916 311 6702). He advised that I should
have freedom of movement while on bail but that there was no guarantee and it was possible that I could be
interrogated by the government if I tried to travel via the airport. This was a problem for me as I often needed to travel
to Dubai to buy mobiles to sell in my store and I was worried that if I did not have freedom to travel I would not be able
to continue my livelihood successfully. Following my arrest I also felt very insecure about simply living in Iran, so I
decided to leave with my family and my younger brother, Ahmad. I put my trust in God and luckily we were able to
leave the country from Shiraz airport on Monday second of jun2013 We flew to Qatar and then Jakarta, Indonesia,
arriving on 3rd June 2013.
My experience of being persecuted, having my family home ransacked, being abducted and detained and then taken to
court means that I am very fearful of returning to Iran because I could face more of the same or even worse. The safety
of my family is very important and it is for this reason that we cannot return.
If you need more space, please attach a separate page with the details
30 What do you believe may happen to you, or the people included in your application, if you were to return to or continue living in that country?
You should give full details of what you think may happen to you and reasons why that would happen
I am absolutely certain that harm would come to us. Our experience before we fled Iran was enough to tell me that we
were already in grave danger due to our religious and political beliefs. I believe that if I returned to Iran, I would again
be abducted and jailed. I could be tortured, my family could also be hurt. I also believe that there is a very strong
chance that our lives would actually be at risk and we could be murdered. My family and I are deeply distressed at the
thought of this and so we absolutely cannot return under any circumstances. My wife and children mean everything to
me and I would never knowingly put them in such danger. We are terrified that if we are made to return to Iran, we will
be harmed or killed.
If you need more space, please attach a separate page with the details
31 Who do you think may harm or mistreat you if you continue living in or go back to that country?
It is widely known and accepted that the Iranian government has been capturing and secretly executing Ahwazi Arab
activists, and this is supported by an April 2015 Amnesty International report. The treatment that my family and I
received before we fled Iran indicates that the Iranian authoritarian regime was already taking steps to harm us. There
is no doubt in my mind that if we returned to Iran, the government would not protect us but would instead go out of its to
If you need more space, please attach a separate page with the details
© COMMONWEALTH OF AUSTRALIA, 2018 842 (Design date 02/18) - Page 23
32 Do you think the authorities of that country can and will protect you if you continue living in or return to that country?
No Please explain why
Yes BECAUSE OUR PROBLEM IS WITH GOVERNMENT
33 Did you travel through, or stay, in any other countries before arriving in the country where you are now living?
No
Yes Give details including length of stay and dates
Date
Country From To
Day Month Year Day Month Year
34 Has this application been lodged because the United Nations High Commissioner for Refugees (UNHCR) referred you to Australia for resettlement?
No
Yes Attach a full copy of your UNHCR Resettlement Registration Form (RRF)
35 Has any person included in this application served in a military organisation (army/airforce/navy) or in a paramilitary organisation?
No
Yes Give details
If you need more space, please attach a separate page with the details
Attach certified copies of any discharge papers if available
1. From
To
2. From
To
3. From
To
4. From
To
5. From
To
6. From
To
If you need more space, please attach a separate page with the details
37 If selected for an interview about your application, will you need an interpreter?
No
Yes Which language(s)?
ARABIC OR FARSI
If you are selected for an interview we will advise you if you are required to provide your own interpreter
A1 Main applicant
To
From
To
From
To
From
To
Other applicants
A2 Name KHADIJEH SAEDI
From
To
From
To
From
To
From
To
A3 Name
From
To
From
To
From
To
A4 Name
From
To
From
To
From
To
A5 Name
From
To
From
To
From
To
From
To
A6 Name
From
To
From
To
From
To
From
To
A7 Name
From
To
From
To
From
To
From
To
Name
From
To
From
To
From
To
Name
From
To
From
To
From
To
If you need more space, please attach a separate page with the details
© COMMONWEALTH OF AUSTRALIA, 2018 842 (Design date 02/18) - Page 27
Part I – Language and education
39 For EACH person included in this application, give details of their language Select
How well this person
Given names Main language spoken Other languages spoken speaks English
(insert code from below)
A5
A6
A7
If you need more space, please attach a separate page with the details
40 For EACH person included in this application, give details of their education
Highest educational
Primary school Secondary school Post-secondary education qualification obtained
Given names
(eg. school certificate, electrician
Day Month Year Day Month Year Day Month Year certificate, BA, PhD)
To 09/07/2017 To To
To To To
To To To
To To To
To To To
To To To
To To To
If you need more space, please attach a separate page with the details
English language codes
1 = Very well (eg. can speak English with little hesitation and few errors in most situations)
2 = Well (eg. can speak English well enough to deal with basic social and work situations)
3 = Not well (eg. can speak only a little English)
4 = Not at all
Part K – Character
42 Has any person included in this application ever:
• been charged with any offence that is
currently awaiting legal action? 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? 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
If you need more space, please attach a separate page with the details
• 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
• 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 removed, deported or excluded from any
country (including Australia)? No Yes
• overstayed a visa in any country (including
Australia)? No Yes
44 Is the person an agent registered with the Office of the Migration Agents
Registration Authority (Office of the MARA)?
No
Yes Go to Part M
46 Did you pay the person/agent and/or give a gift for this assistance?
No
Yes
Signature of
dependent
applicant ✍
Name
Signature of
dependent
applicant ✍
Name
Signature of
dependent
applicant ✍
Name
Date
Signature
or mark
✍
Day Month Year
Date
Signature
or mark
✍
Day Month Year
Date
Signature
or mark
✍
Day Month Year
Date
Signature
Warning: The Migration Act contains a power to cancel a visa if a or mark of
person has made an incorrect statement in relation to their
application. If it is determined that you have concealed information,
applicant ✍
Day Month Year
such as an offence, your application to enter Australia may be
refused. If you have already been granted a visa and it is Date 24 05 2019
subsequently discovered that you have concealed information, such
as an offence, your visa will be liable to cancellation and you may be Signature
refused entry to Australia. In the event that you have already entered or mark of
partner
Australia your visa will be liable to cancellation and, if cancelled, you
may be detained and removed from Australia. (if applicable) ✍
Day Month Year
Date 23 05 2019
50 This declaration must be signed by you (the main applicant) and ALL
persons aged 18 or over included in this application.
Signatures of persons aged 18 years or over who are included in this
I declare that:
application (if applicable)
• the information I have supplied on and with this form is complete,
correct and up-to-date in every detail.
Signature
• I did not marry or enter a de facto relationship to become eligible for
or mark
entry to Australia. ✍
• I understand that if I have given false or misleading information, my Day Month Year
application may be refused, or, if a visa has been granted, the visa
may be cancelled and I could be removed from Australia. Date
• I understand that if I am granted a visa, any person not included in
this application will not have automatic right of entry to Australia by Signature
way of this application. or mark
• I undertake to inform the Australian Government of any material ✍
changes to my circumstances while my application is being Day Month Year
considered, or before I am immigration cleared. Date
(Note: Your visa may be cancelled and you could be removed if you
do not advise of changes in circumstances).
• I authorise the Australian Government to make any enquiries Signature
necessary to determine my eligibility for entry to Australia, and to use or mark
any information supplied in this application for that purpose. ✍
Day Month Year
• I understand that unless my qualifications have already been
recognised by an Australian assessing authority before my departure, Date
they may not be recognised after my arrival.
• I understand that it is my personal responsibility to assess my own
Signature
employment prospects in Australia and acknowledge that labour
or mark
market conditions there can vary significantly from time to time and
between regions.
✍
Day Month Year
• I understand that grant of a visa provides no guarantee of
employment once in Australia. Date
• I have read the information contained in form 1442i Privacy notice.
• I understand the Department may collect, use and disclose my Signature
personal information (including biometric information and other or mark
sensitive information) as outlined in form 1442i Privacy notice. ✍
• I understand that information collected in the visa process may be Day Month Year
disclosed to other agencies and contracted service providers for the Date
purposes of evaluating my settlement needs and providing
settlement support.
For applicants applying in the Community Support Program: Signature
or mark
• I understand that my Approved Proposing Organisation will be
lodging this application on my behalf.
✍
Day Month Year
• I understand that the information that I provide in this form may be
shared with my Approved Proposing Organisation and that my Date
Approved Proposing Organisation may also share this information
with any Supporting Community Organisations it works with in order We strongly advise that you keep a copy of your application
to provide services to help me settle in Australia. and all attachments for your records.
Important: If your circumstances change after you lodge this application (eg. you change your address, marry or become engaged to be married, or have
a baby), you must notify the office where you lodge this application. If your application is supported by a proposal form 681 Refugee and special
humanitarian proposal or form 1417 Community Support Program Proposal by Approved Proposing Organisations and your proposer’s circumstances
change after you have lodged this application, you should also notify the office where you lodge this application.
© COMMONWEALTH OF AUSTRALIA, 2018 842 (Design date 02/18) - Page 33
Part Q – Document checklist Question Document Attached?
Q22 Certified* copies of travel documents and/or
This checklist is provided to help you submit a complete, decision-ready identity cards held by any person included in
application. If you do not have any of the requested documents (originals this application (if available)
or certified* copies) listed below, please provide an explanation as to
OR
why you no longer have these documents.
A statement explaining why you have no
travel/identity documents
UNDER NO CIRCUMSTANCES SHOULD YOU SUBMIT FALSE
DOCUMENTS Q24 Certified* copies of any visas/residence
permits held by any person included in this
51 Have you attached the following documents? application (if available)