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 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.
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 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 Year
Day, 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 issue
Identification 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) Country
Month 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 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
Month 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 travel
22 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 stay
25 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 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
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 Australia
33 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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 birth
Citizenship(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 – Declaration
WARNING: 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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