1221 (Design date 10/15) - Page 1© COMMONWEALTH OF AUSTRALIA, 2015
Additional personal particulars
About this form
This is a supplementary form required to support your visa
application and is to be completed by all applicants who are
18 years of age or over.
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.
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.
Tick where applicable
Please use a pen, and write neatly in English using BLOCK LETTERS.
Part A – Your details
Telephone 131 881 during business hours
in Australia to speak to an operator (recorded
information available outside these hours).
If you are outside Australia, please contact
your nearest Australian mission.
Your full name
(as shown in your passport or travel document)
Name in your own language or script (if applicable)
Other names you are, or have been, known by
(including name at birth, previous married names, aliases)
Place of birth
Date of birth
DAY MONTH YEAR
Never married or
been in a de facto
Citizenship or nationality (give details of all held)
DAY MONTH YEAR
Name in Chinese Commercial Code Numbers (if applicable)