1221 (Design date 10/15) - Page 1© COMMONWEALTH OF AUSTRALIA, 2015
Additional personal particulars
information
Form
1221
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.
3
Tick where applicable
Please use a pen, and write neatly in English using BLOCK LETTERS.
Part A – Your details
www.border.gov.au
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.
Home page
General
enquiry line
Family name
Given names
1
3
Your full name
(as shown in your passport or travel document)
Name in your own language or script (if applicable)
2
Other names you are, or have been, known by
(including name at birth, previous married names, aliases)
Male Female
6
Place of birth
5
Date of birth
DAY MONTH YEAR
7
Sex
8
Relationship status
Married
De facto
Engaged Divorced
Separated
Widowed
Never married or
been in a de facto
relationship
9
Citizenship or nationality (give details of all held)
Date granted
DAY MONTH YEAR
4
Name in Chinese Commercial Code Numbers (if applicable)
Country
State/province/
region
Suburb and
town/city
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11
Your contact details
Home
telephone
Mobile/cell
All email
addresses
If insufficient space, give details at Part O –
Additional details
12
POSTCODE
Your proposed residential address in Australia (if known)
Passport/travel
document number
13
Details from your passport/travel document
Place of issue/
issuing authority
Date of issue
Date of expiry
Part B – Travel details
Country of passport/
travel document
DAY MONTH YEAR
( ) ( )
COUNTRY CODE AREA CODE NUMBER
10
Your current residential address (this is the place where you currently live)
Note: A post office box, migration agent address or mailbox address is
not acceptable as a residential address.
Unit/Apartment number
Postal code
Address (include street number and name)
Country
State/province/
region
Suburb and
town/city
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15
Have you ever had a visa refused or cancelled by, been refused entry to, or been deported from, any country?
Give details of dates, countries and circumstances
(If insufficient space, give details at Part O – Additional details)
Give details in chronological order
(If insufficient space, give details at Part O – Additional details)
No
Yes
Have you previously held an Australian visa?
16
Type of visa (eg. visitor,
student, business)
Place where
visa was issued
Your names shown on visa Reason for visit
Give details
No
Yes
Do you currently have, or have you ever had, any national identity documents or numbers
(including birth registration numbers, social security cards etc)?
14
Type of identification document Country of issue
Identification number shown
(if applicable)
Name shown on document
17
What is the general purpose of your journey/further stay?
18
If you are outside Australia, give details of your intended arrival
Intended date of arrival
DAY MONTH YEAR
Flight number
or vessel details
(if known)
19
Intended date of departure
DAY MONTH YEAR
No
Yes
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20
Give details of any intended stopovers on your way to Australia
Places of intended stopovers
21
Give details of any proposed onward locations after your departure
from Australia
22
Are you fully funding your trip?
No
Yes
Give details of the person/institution funding your trip
Full name
Name of institution (if applicable)
POSTCODE
( ) ( )
COUNTRY CODE AREA CODE NUMBER
Address
Telephone number
Email address of person/institution
Part C – Details of travelling dependents/
family members
23
Give details of dependents/family members travelling to Australia with you
Given names
Family name
Date of birth
Relationship to you (eg. partner, sister, aunt)
1.
Suburb and
town/city of
birth
Country of birth
DAY MONTH YEAR
Part D – Current employment details
Employment commenced
DAY MONTH YEAR
Name of employer
Address of employer
( ) ( )
COUNTRY CODE AREA CODE NUMBER
Contact telephone
Email address (if applicable)
Type of business
Occupation/Position
Detailed job description
24
Are you currently employed
Give details of your current employment
Yes
Given names
Family name
Date of birth
Relationship to you (eg. partner, sister, aunt)
2.
Country of birth
DAY MONTH YEAR
If insufficient space, give details at Part O – Additional details
No
Give details of how you occupy your time and
how you support yourself
Suburb and
town/city of
birth
POSTCODE
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Name and address of employer/business.
(Do not use abbreviations)
Type of business/
other activities
Your occupation/position/title/duties/
how you spent your time if unemployed
Date from Date to
MONTH YEAR MONTH YEAR
25
Give details of your employment status in the last 10 years (including internships, work experience, self employment and periods of unemployment)
(If insufficient space, give details at Part O – Additional details)
Part F – Military service
26
Have you had any military service?
Give details in chronological order
(If insufficient space, give details at Part O – Additional details)
No
Yes
Rank
Full name of Unit/
Battalion/Brigade
Country of service
Duties
Country of
deployment
DAY MONTH YEAR DAY MONTH YEAR
Date from Date to
Part E – Employment status in the last 10 years
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Part G – Education and trade
qualifications
27
Give details of all post secondary qualifications
(list your most recent experience first)
Institution and city/campus1.
Year of award
Qualification
Main subjects or duties
Institution and city/campus2.
Year of award
Qualification
Main subjects or duties
Institution and city/campus3.
Year of award
Qualification
Main subjects or duties
Institution and city/campus4.
Year of award
Qualification
Main subjects or duties
If insufficient space, give details at Part O – Additional details
28
Describe any workshops, training, conferences or seminars you have
attended in the last 2 years
29
List all titles and describe any previous academic or research papers
you have had published
Part H – Details of your contact in
Australia
30
Do you have contacts in Australia (including your sponsor, business
contacts, the person you will be staying with, a family relative or an
educational institution)?
No
Yes
Go to Part I
Family name
Given names
Nature of relationship to you
31
POSTCODE
Current residential address of your contact
(a post office box address is not acceptable as a residential address)
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34
Part I – Details of your journey to Australia
Only complete the section(s) relevant to you
If you:
have applied for a
Visitor visa
have applied for a
Business visa
have applied for a
Migration visa
are a student, academic,
researcher or fellow
Go to Part J
Go to Part K
Go to Part L
Go to Part M
35
37
Part J – Visitor visa
Do you intend to do a course of study while in Australia?
Are you attending a conference/seminar in Australia?
No
Yes
Give details
Name of course
Name of the institution
Type of course
32
Contact’s telephone numbers
Telephone
number
Mobile
( ) ( )
COUNTRY CODE AREA CODE NUMBER
33
Contact’s current employment details
Name of employer
POSTCODE
Address of employer
Type of business
Occupation/Position
Duties
36
Proposed employment/business activity details
Name of employer
POSTCODE
Address of employment
Nature of employment/business activities
Proposed duties/activities
Part K – Business visa
No
Yes
Give full name of conference and (if applicable) attach an
abstract of the conference presentation
38
Do you intend to inspect and/or negotiate the purchase of any
equipment during your stay in Australia?
No
Yes
Give details
All email
addresses
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41
40
42
Part M –
Student/Academic/Researcher/Fellows
Give details of your proposed course/field of study in Australia
(including name of course, type of course, thesis topic and research to
be undertaken)
Do you intend to work in Australia?
Do you intend to work in Australia?
Name of employer
Name of employer
Address of employer
Address of employer
Type of business
Type of business
Occupation/Position
Occupation/Position
Duties
Duties
POSTCODE
POSTCODE
39
Part L – Migration visas
Do you intend to do a course of study while in Australia?
No
No
No
Yes
Yes
Yes
If you have organised your course, give details below
If you have organised your employment, give details below
If you have organised your employment, give details below
Name of course
Name of the institution
Type of course
Family name
Given names
Name of supervisor (if applicable)
Name of the institution
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Part N – Additional information
43
Give details of how you intend to use the knowledge/skills/research
obtained once you depart Australia
44
Are there any other details you would like taken into consideration?
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46
Part P – Declaration
I declare that:
the information I have supplied in this application is complete,
correct and up-to-date in every detail.
I have read and understood 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.
WARNING: Giving false or misleading information is a serious offence.
Part O – Additional details
Question number Additional information
45
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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