80 (Design date 10/15) - Page 1© COMMONWEALTH OF AUSTRALIA, 2015

Personal particulars for assessment including character assessment

Form

80

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.

Integrity of applicationThe 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.

Important information about privacyYour 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 department’s 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 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

Part A – Applicant details

1 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 Male Female

Date of birth

Day Month YearDay, month and year MUST be provided

Suburb of birth

Town/City of birth

State/Province/Region

Country

2 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)

3 Are you of Russian descent?

No

Yes In English, provide your patronymic name

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4 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 Give details in English

Type of name

Family name

Given names

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

5 Have you ever had a different date of birth to the one shown at Question 1?

No

Yes Different date of birth

Day Month Year

6 Do you currently have citizenship from any country?

No, I am stateless Give details

Yes How did you gain this citizenship (eg. birth, descent, naturalisation)?

Date you gained this citizenship

Day Month Year

7 Do you hold or have you held citizenship from any other country (including dual citizenships and all previous citizenships)?

No

Yes Country

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

When did you have this citizenship?

From

Day Month Year

to

Day Month Year

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

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

8 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

Part B – Passport / Travel document details

9 Do you have a current passport or travel document?

No Go to Question 13

Yes Give details

Passport/travel document number

Country of passport/travel document

Date of issue

Day Month Year

Is this the original issue date?

No Give original issue date

Day Month Year

Yes

Date of expiry

Day Month Year

Nationality

Place of issue/issuing authority

Name on the document (if the same as Question 1, write ‘SAME AS QUESTION 1’)

Family name

Given names

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

No

Yes Give details

Passport/travel document number

Country of passport/travel document

Date of issue

Day Month Year

Date of expiry

Nationality

Place of issue/issuing authority

Name on the document (if the same as Question 1, write ‘SAME AS QUESTION 1’)

Family name

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

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

No

Yes Give as much information as possible

Passport/travel document number

Country of passport/travel document

Date of issue

Day Month Year

Date of expiry

Nationality

Place of issue/issuing authority

Name on the document (if the same as Question 1, write ‘SAME AS QUESTION 1’)

Family name

Given names

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 issueIdentification number shown (if applicable)

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Part D – Address and contact details

15 Do you have any email addresses?

Note: Include all personal, student and work email addresses. Do not include migration agent email addresses.

No

Yes Provide all of your email addresses

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 Date to Full address (house number, street name, suburb, town/city, postcode) CountryMonth Year Month 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 Date to Reason for visit Country Day Month Year Day Month Year

16 Do you have current contact telephone numbers?

No

Yes Provide all telephone numbers

Work ( ) ( )

Country code Area code Number

Home ( ) ( )

Mobile/cell

Other

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Part F – Employment

19 Give details of all employment and unemployment

Employment includes:• all paid employment• self-employment/family business• work experience/internships• unpaid employment/volunteer work.

Unemployment includes:• from date of birth up until first employment• all gaps/breaks between employment• all gaps between education.

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 Date to

Name of business/company (no abbreviations)

Type of business (eg. government

department, bakery)

Your occupation and dutiesOR

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)

CountryMonth Year Month Year

CURRENT

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Part G – Education

20 Give details of all tertiary education and qualifications

Education/qualifications includes:• college/vocational schools

• university

• research/thesis

• specialist training

• skill/trade qualifications.

Note: If you are applying for a Refugee and Humanitarian visa, you must provide details of all education and qualifications since birth.

Date from Date to Full name of institution (no abbreviations)

Full name of course or description of research/ Thesis and supervisor details (no abbreviations) Course status Campus/address of institution Country

Month Year Month Year

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

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Part H – Proposed travel or further stay details

21 Are you currently in Australia?

No

Yes Go to Question 25

Proposed travel22 Why are you travelling to Australia?

Include any relevant dates or events

23 Do you have any proposed or booked travel dates for your journey to Australia?

No

Yes Give details of proposed arrival in Australia

Arrival date

Day Month Year

Flight number or vessel details (if known)

City of arrival

Give details of countries you will visit on your way to Australia (write ‘N/A’ if not applicable)

List the towns/cities you will visit during your time in Australia

24 Are you applying for a temporary visa?

No Go to Part I

Yes Give details of proposed final departure from Australia

Departure date

Day Month Year

Flight number or vessel details (if known)

City of departure

Give details of countries you will visit after your departure from Australia (write ‘N/A’ if not applicable)

Now go to Part I

Further stay25 What is your main reason for remaining in Australia?

26 List the towns/cities you will visit during your further stay in Australia

27 Give details of your arrival in Australia

Arrival date

Day Month Year

City of arrival

28 Are you applying for a temporary visa?

No Go to Part I

Yes

29 Do you have any proposed or booked travel for your departure from Australia?

No

Yes Give details

Departure date

Day Month Year

Flight number or vessel details (if known)

City of departure

Give details of countries you will visit after your departure from Australia (write ‘N/A’ if not applicable)

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Part I – Address(es) in Australia

30 Are you currently in Australia?

No Yes Go to Question 33

Located outside Australia31 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

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)

Suburb and town/city

State or territory Postcode

Telephone numbers

Office hours (Area code )

Mobile/cell

32 Will you stay at any other address?

No Go to Part J

Yes Give the residential address and contact numbers

Address (including hotel name and/or unit and building number and street name)

Suburb and town/city

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

Located in Australia33 Do you have any other addresses in Australia that have not been

declared at Question 17?

No Go to Part J

Yes Give the residential address and contact numbers

Address (including hotel name and/or unit and building number and street name)

Suburb and town/city

State or territory Postcode

Telephone numbers

Office hours (Area code )

Mobile/cell

When and in what circumstances did you reside, or stay, at this address?

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.

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Part J – Australian visa history

34 Are you currently in Australia?

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 Place of visa issue

Arrival date Departure date Day Month Year Day Month Year

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

• 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

• 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

• had any outstanding debts to the Australian Government or any public authority 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.

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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 Date to Country of service Full name of Unit/ Battalion/Brigade Rank Duties Country of

deployment Day Month Year Day Month Year

Part M – Employed by intelligence or security agency

38 Are you currently, or have you been employed as an intelligence officer or an agent of an intelligence or security agency?

No

Yes Give details of organisation, role and dates you served

Part N – Visa refusals

39 Have you ever been refused a visa to any country?

No

Yes Give dates of refusal, countries and circumstances of refusal

Part O – Deportations

40 Have you ever been excluded, asked to leave, deported or removed from any country?

No

Yes Give details of dates, countries and circumstances

Part P – Citizenship refusals

41 Have you ever been refused, renounced or rescinded citizenship of any country?

No

Yes Give dates of refusal, countries and circumstances of refusal

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Part Q – Associated people

42 Do you have a partner?

Partner includes wife, husband, fiancé, 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 Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted

Country of current residence (If not living, write ‘DECEASED’) Migrating with you?

Town/City State/Province/Region Country

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

(If not living, write ‘DECEASED’ in ‘Country of current residence’ column)

Child 1

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted

Country of current residence (If not living, write ‘DECEASED’) Migrating with you?

Town/City State/Province/Region Country

No Yes

Child 2

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted

Country of current residence (If not living, write ‘DECEASED’) Migrating with you?

Town/City State/Province/Region Country

No Yes

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Child 3

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted

Country of current residence (If not living, write ‘DECEASED’) Migrating with you?

Town/City State/Province/Region Country

No Yes

Child 4

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted

Country of current residence (If not living, write ‘DECEASED’) Migrating with you?

Town/City State/Province/Region Country

No Yes

Child 5

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted

Country of current residence (If not living, write ‘DECEASED’) Migrating with you?

Town/City State/Province/Region Country

No Yes

Child 6

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted

Country of current residence (If not living, write ‘DECEASED’) Migrating with you?

Town/City State/Province/Region Country

No Yes

If more than 6 children, give details at Part T – Additional information

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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 (If not living, write ‘DECEASED’ in ‘Country of current residence’ column)

Parent 1

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted

Country of current residence (If not living, write ‘DECEASED’) Migrating with you?

Town/City State/Province/Region Country

No Yes

Parent 2

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted

Country of current residence (If not living, write ‘DECEASED’) Migrating with you?

Town/City State/Province/Region Country

No Yes

Parent 3

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted

Country of current residence (If not living, write ‘DECEASED’) Migrating with you?

Town/City State/Province/Region Country

No Yes

Parent 4

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted

Country of current residence (If not living, write ‘DECEASED’) Migrating with you?

Town/City State/Province/Region Country

No Yes

If more than 4 parents, give details at Part T – Additional information

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45 Do you have siblings?

Siblings include full, half and adopted brothers and sisters.

No

Yes Give details (If not living, write ‘DECEASED’ in ‘Country of current residence’ column)

Sibling 1

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted Country of current residence Migrating with you?

Town/City State/Province/Region Country

No Yes

Sibling 2

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted Country of current residence Migrating with you?

Town/City State/Province/Region Country

No Yes

Sibling 3

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted Country of current residence Migrating with you?

Town/City State/Province/Region Country

No Yes

Sibling 4

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted Country of current residence Migrating with you?

Town/City State/Province/Region Country

No Yes

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Sibling 5

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted Country of current residence Migrating with you?

Town/City State/Province/Region Country

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 Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted Country of current residence

Town/City State/Province/Region Country

Family member 2

Relationship to you Family name Given names (include patronymic name)

Any other names (eg. maiden or tribal name)

Sex Date of birth Chinese commercial codes (If not applicable, write ‘N/A’)M/F Day Month Year

Place of birthCitizenship(s) and year granted Country of current residence

Town/City State/Province/Region Country

If more than 2 other family members, give details at Part T – Additional information

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47 Do you have any personal contacts in Australia?

Personal contacts include visa sponsors, any relatives, friends, family members and acquaintances in Australia.

No Go to Part R

Yes Provide as much information about one of your personal contacts as possible

Family name

Given names

Sex Male Female

Relationship to you (eg. partner, sister, aunt, friend)

Date of birth

Day Month Year

Town/City of birth

State/Province/Region

Country

Nationality

Your personal contact’s current residential address Note: A post office box is not acceptable.

Address (including building/unit/house number and street name)

Suburb and town/city

State or territory Postcode

Telephone numbers

Office hours (Area code )

Mobile/cell

Email address

48 Do you have any other personal contacts in Australia?

No Go to Part R

Yes Give details

Family name

Given names

Sex Male Female

Relationship to you (eg. partner, sister, aunt, friend)

Date of birth

Day Month Year

Town/City of birth

State/Province/Region

Country

Nationality

Your personal contact’s current residential address Note: A post office box is not acceptable.

Address (including building/unit/house number and street name)

Suburb and town/city

State or territory Postcode

Telephone numbers

Office hours (Area code )

Mobile/cell

Email address

Give details of all other contacts at Part T – Additional information

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Part R – Sponsoring employer details

49 Are you being sponsored by, or associated with, a business or organisation in Australia?

No Go to Part S

Yes Give details

Organisation/Business name

Organisation/Business description

Organisation/Business commercial address (including building number and street name)

Suburb and town/city

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)

Suburb and town/city

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 S – DeclarationWARNING: Giving false or misleading information is a serious offence.

53 I declare that:

• 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.

Signature of applicant -

Date

Day Month Year

We strongly advise that you keep a copy of your application and all attachments for your records.

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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