Thisisasupplementaryformrequiredtosupportyourvisaapplicationandistobecompletedbyallapplicantswhoare18yearsofageorover.
Important–Pleasereadthisinformationcarefullybeforeyoucompletethisform.Onceyouhavecompletedthisformwestronglyadvisethatyoukeepacopyforyourrecords.
Integrityofapplication
TheDepartmentofImmigrationandBorderProtection
(thedepartment)iscommittedtomaintainingtheintegrityofthevisaandcitizenshipprograms.Pleasebeawarethatifyouprovideuswithfraudulentdocumentsorclaims,thismayresultinprocessingdelaysandpossiblyyourapplicationbeingrefused.
Importantinformationaboutprivacy
Yourpersonalinformationisprotectedbylaw,includingthePrivacyAct1988.Importantinformationaboutthecollection,useanddisclosure(tootheragenciesandthirdparties,includingoverseasentities)ofyourpersonalinformation,includingsensitiveinformation,iscontainedinform1442iPrivacynotice.Form1442iisavailablefromthedepartment’swebsite.au/allforms/orofficesofthe
department.Youshouldensurethatyoureadandunderstand
form1442ibeforecompletingthisform.
Tickwhereapplicable
Pleaseuseapen,andwriteneatlyinEnglishusingBLOCKLETTERS.PartA–Yourdetails
.au
Telephone131881duringbusinesshoursinAustraliatospeaktoanoperator(recorded
informationavailableoutsidethesehours).IfyouareoutsideAustralia,pleasecontactyournearestAustralianmission.
HomepageGeneral
enquirylineFamilynameGivennames
1
3
Yourfullname
(asshowninyourpassportortraveldocument)Nameinyourownlanguageorscript
(ifapplicable)
2
Othernamesyouare,orhavebeen,knownby
(includingnameatbirth,previousmarriednames,aliases)
Male
Female
6
Placeofbirth5Dateofbirth
7Sex8
Relationshipstatus
MarriedDefacto
Engaged
DivorcedSeparated
Widowed
relationship
9
Citizenshipornationality(givedetailsofallheld)
Dategranted
4
NameinChineseCommercialCodeNumbers
Country
State/province/
region
Suburband
town/city
11Yourcontactdetails
HometelephoneMobile/cellAllemail
addresses
Ifinsufficientspace,givedetailsatPartO–Additionaldetails
12
YourproposedresidentialaddressinAustralia(ifknown)
Passport/traveldocumentnumber13Detailsfromyourpassport/traveldocument
Placeofissue/issuingauthority
DateofissueDateofexpiryPartB–Traveldetails
Countryofpassport/traveldocument
10Yourcurrentresidentialaddress(thisistheplacewhereyoucurrentlylive)
Note:Apostofficebox,migrationagentaddressormailboxaddressisnotacceptableasaresidentialaddress.Unit/Apartmentnumber