te. Australian Government Department of Immigration ‘and Border Protection Personal particulars for assessment including character assessment 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, Impoctant information about the collection, use and disclosure (fo other agencies and third parties, including, overseas entities) of your personal information, including sensitive information, is contained in form 1442i Privacy notice, Form 14121 is available from the department’s website www.berder.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. Tekh applcabl [7] Ifyou neod more space fr any answers, give deals at Part 7— ‘Aadtional information Part A — Applicant details Please provide your deals as they appear in your oficial documents. For example, passport, identity document, travel document, birth caticate Note: If you fave one name ony, please vite inthe ‘Family name” field Family name RANABHAT — CrETEY All given names [PRAKASH | eae Sex Malo KZ] Female [J] aaa ae oaeerven [01 703/49 86] Bsr ‘Suburb of birth BHATK HO A-o/ Townvaiy of ith [BAT KHOLA J ‘State/Provinoe/Ragion SYANGIA = _| Country NEPAL Do you ever use a Chinese Commercial Code Number for your names shown in the passportravel document at Question 1? wo 2) Yes [Ib chinese Conner Cod unter fi Onin santor8 Paw‘Have you been known by any other namets)? include: © name at birth ‘© cultura or tribal name or Part B — Passport / Travel document details ‘name before or after mariage _erVsubclan name + sintectarene 7 Seite ate scat pater ola? eee eed No [Jp Goto question 13 wo YZ ves [VIP Give details ‘Yes [Jp Give details in English _ Passport/travel document number Type of name O56 06488 emmy name Country of passportvavel document - NEPAL ‘Shen names ay Merve Datweotisue —[[ / 07/2011 | this the original issue date? ne at Pat T-) ‘No [_]) Give original issue dato ‘amore than one rae, give deta at Part T—Actonal information ene ave you ever had a ferent date of bith tothe one shown at ft ‘Question 1? veal] tio ZI ey Wort) Yar “Day thar Yes [_]> pitferent date of birth Date of expiry 12. 107/202) Do yeu curently have clizeship rom any cout? Natonlty NEPA LES Wo, tam states [_]p Gh das Place of fssuerissuing authority KATHMANDD ‘Yes 7]> How did you gain this citizenship (eg. birth, descent, nnaturalisation)? [Nem e (BIRM) Name on the document (the same as Question 1, vnite ‘SAME AS QUESTION 1) faniyrane E VESTION Given names Day Mentha Date you gained tis citzenship [Op /02- JIL Do you hold or have you hel ciizenship fom anyother country (cluding dual ctizenships and al previous cizenships}? No Yes (]> Country How did you gain this ctzanship fg, birth, descont, naturaisation? When did you have this citizenship? Day Month Year Day Maher. From / 7. lof 7 7 ] te: you st hav the ienship, wit CURRENT: ‘tore than one country, give detals at Part T — Adina information Do you currently have permanent residency rights in any country other than those declared in Questions 6 7? No ‘Yes ["]P List all other countries 7 eeTY Doyou have any ether current passport or Wave document’ (be Doytes, 6 ees, Oe cee No No CJ Yes []) Give details Yes [])- Give as much information as possible Pessportrave document number Passpottravel document numba I L County of passpertravel document Country of passport doctent ‘Daye ar Voth ear Date ofissue Led Date ofissve Date of expiry aan Date of xpity Zt Nabonatty Nationality Pace of ssueissuing authaity Place of ssuefisuing autonty t ‘Narne onthe document (the same as Question 1, vite ‘SAME AS ‘QUESTION 1) Family name Name on the document (ithe same as Question 1, write ‘SAME AS (QUESTION) amity name. Sven names Ghen names i 11 Have you ever had ary previous passport or travel documents (including expired, lost o stolen docurnents)? No i> GotoPartc ves L] 12. What happened to tis document (Tick one on) Expired ] Lost/stolen [_] other [_]> Give details Part C — Identity documents 14 Doyeu curenty have, or have you ever had, any national entity documents or numbers (niucng birth exstaton numbers, sci secu cards et? no Yes V1 Give details ‘Type of identification " Identification number document Socatey of ea) ‘shown (if applicable) lermzensyrf | NEPAL | 060 //6F beim am 098 -Ps15 Part D — Address and contact details Do you have any ema adkesses? 16 Do youhave current contact telephone numbers? ‘Note: Include all personal, stucent and work email addresses. Do not wo [] include migration agent email aosoes. Yes ZI Provide all tephone numbers _Coumbycoe Ancoie Mabe Work je PRAKASNCHETRY 01() GNAEL i o CoM Mobilcll other ‘Your actress history for the last 10 years. ‘Note: If you are applying for a refugoe/huranitaian visa, you must provide all addresses for the last 90 years. Include addresses inside and outside Australia © places you resided for study/vork refugee camps * any other place you have resided such as share houses, university residences and temporary aocomamadaton \Note: Provide your adress history in chronological ordor with no gas in the timeline. If there are gaps, you must provide an explanation at Pat T— ‘Aaktional information Data from | _Deto to Full address (house number, street name, suburb, town/city, postoodk) ] Country et oe aT | 00K A. DEC /2ory, CURRENT Vie. - 3033 - T ania oi pec 83 AkMUR _sTREEr | Aus Tea se) Boy * [Gown cea vic- 3083 = (feo.//2 (guns. --RATMA GAR, TAWDT NEAL Goer CHT TWAN — @ BiIATKr LA 01, BrfATKAGA NEAL PEB/0§ (FBI YANG SA . D-8e, FresT FLooR , PAN NAGA INDTA 68/06 [FBG eT 110092 omiaTs| Part E — International travel / movements ve you raed to any cour oler than usr in the ast 10 yar? Note your apn fo arefugotumanitaian visa you must provide al vss to any cour oe than Atala fr the lst 90 years. Include: work orstuty ouside your usual country of rexdence hholidayfeisure trips business ‘military deployment vis back to your oom cory. no Yes [_]) Give details in chronological order Date from Date to Reason for visit Country aha ee ee loy Peao0t ix Rel 0 | L7LBY WG BACHELoK pegece | INDEA 77 [ “719 Fart k ~ Employment ive dots ofall employment and unemployment Employment incices: «all pad employment «+ sal-ampoymentfamiy business + work perenceintastips © unpaid employment lunes work Unemployment includes: © fom date of birth up until fist employment © al gaps/breaks between employment © al gaps between edtcaton, If you are curently retired ~ write ‘CURRENTLY RETIRED in ‘Name of business" fed and provide details in the Your occupation and duties fed If you have never worked — write your date of birt inthe ‘Date from field and "NEVER WORKED’ the ‘Name of business/company’ field and provide deals in the "Your occupation and duties’ field Note; Provide your employment and unemployment history with no Gaps in the timeline there are gaps, you must provide an explanation at Part T~ Additonal information. Deore | eee fot re ee Lacaneneieen lane of bsinesscompary : iting rune, sbet rae, sub vers |iten te] ODEs Soeterd nberd | roti clea to esa! yr ro ‘nso ony ‘and ancl supported youl LS 7 " corner | DAN Ine ks CLEANIN CLEANER Darnirheas Fact ity Meesgennt —___ fIAW!2° 4 # Pry Lrg Avs LA. (321, Quen se LNerth Melbowne VjeZosh hiuG-/201s| pec/20is TENNIS AustALTA| tr SupP ORT | rr SoPPORT (CASVAL) | Meygouene CARE Me Fok TENTS _lowwMpre Bovkewee® | AustkALTA AUSTEALSA | _ Me LBouRNE PARK /MELBovQne _ _ ECT OOO — be hy Dol 15 ACK Poop Sekvied| GeaM MEM BER comer BoukkE uly /20l4tsep 20 ifes PETALETY | RuSEL IT AUsT@LTA __ MECBoURNE ; VEC~$000 ° / / — / / Scrnamcamer usm 218 eins 1019-sFAL G — Laucation 20 Give details ofall tertiary education and qualifications Education/qualification includes: © collage/ocational schools © university © researchithasis © specialist training * sklitrade qualifications. ote: I you ere apriyng for a Refugee and Humanitarian visa, you must provide deals ofall education and qualifications sine birth [oat | Tis oe ee eral oer MowAsH PhobessronAaL Yeak | cwviiZ| 3222 BovkKe 37 | Pr 08 Rape SHTONAL “IN_ICE wee Ol er Bove AvsTeAles Ee | PATHWAY $ a Currently enralled ("] vice [jou 7302.0 vv 20H LA TRE MASTERS oF Soni sl enty ko J RGBOEY | "UNSER SITY Ter wei 1 pezve MOUS [ke A Curent ervoled (I) MELBOURNE. VEC BBG Joes Gun/poxf MAMA KISH T ACHE LOR OF Completed MI) De crs Coa. Pee net AVANAND GINECRING- woe Ol uwsveessry SeckeTgar | 121A ae Um gveRsity ’ Gurenty ened CI] Lorry, HARYANA - 124 00 pi 7 _ Completed (7) vito CI] ie - — Currently enrolled [J] iz F y a — ‘compoted [1] - withdrew (| | _ _ : Curent enalled I] , 7 | a Completed [_] | i wom CI] _ 2 Curent erred CI a / / Gorpted _ Withdrow [7] | current ervaled I} _ yi 7, L Completed J] : witetow _{ currently envlled 3) peo havd Scan OEPart H — Proposed travet or furtiver stay details ‘re you cunt in Asai? No Yes [ |b Goto Question 25 Proposed travel Why are you raving to Australia? Include any relevant dates or events Do you have any propose or booked travel dates for your journey to ‘stale? No O Yes []b Give details of proposed arrival in Australia ay Month Yar Arrival date: Jo Fight ruber or vessel deta kno) City of ania Give deals of counties you wl vst on your way to Australia (inte WA’ not applicable) ee Listthe townsctes you wil vist during your tine in Australia LE one ‘re you aplying fora temporary visa? No [_]> Goto Part! ‘Yes [_]> Give details of proposed final departure from Australia ‘ay Moth Yor Departredate [7 / Flight number or vessel dtl kno) City of departure ive details of courts you wil ist after your departure from Australia (iit N/A if not appicable) D> Now go to Part a Further stay ‘What is your main reason for remaining in Austell? WoRK 10 PvusTearA LUstthe townslles you wl vit during your further stay in ustraa LMecBogne Give deta of your ativan Australia Day Monty Year aviveldate (09 OF Poy Ciyofanival | AE ¢ BOOLN E ‘Ave you applying for a ternporary visa? No W|> Goto Part! ve ‘Do you have any proposed or booked travel for your departure from Australia? oO Yes (|) Givedetaits ay With Yor Departredae [7 / Fight number or vessel dts fn) City of departure Give details of counties you wil vist after your departure from Australia (ite WA é not apoicabe) eopeignatena9 Po?Part I — Address(es) in Australia 0A you cuenty in Ausra? No ves (ZIp Goto auestion 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 [_]> Goto Parts Yes [7] Give the residential address and contact numbers ‘Note: A post ofice box is not acceptable. Address (including hotel name and/or unit and building number and stot name) State or tentory Telephone numbers Office hours Postcode waco) Mobitefcol ‘Wil you stay at any oer acess? No L]> Goto Parts Yes [_]> Give the residential across and contact numbers Adres including hotel name and/or wit and building numbor and Suburb and townveiy State ortenitory Postoode Telephone numbers [aca Office hows Motie/cel I you wil stay at ny other address(es). ive deta at Part T— Addhional information, D> Now go to Part J ES Located in Australia Do yuu have any other acess in usta that have not been declared at Question 177 No WJ]> Goto Parts Yes [_]> Give the residential address and contact numbers ‘Address (ncding hotel name and/or unit and building number and street name) eee eee eee — Suburb and tounvcity State orteitory | Telephone numbers Offoehous [eacace Posteade Mobie/cel ‘When and in what cicumstances did you reside, or stay, at this address? you have more than one other address in Australia that has not been declared above or at Question 17, give details at Part T~ Aditonal informationPart J - Australian visa history ‘re you crenty in Australia? no O] Yes 7]> Give details of curent visa Type of ca you hold ‘ “val da (og. visitor, business) Reason for journey ‘Name used on entry Place of visa issue Tae es a 485 | STUDY —|PRAKAIN RANABHAT CEI Mcyg OU Rwel of UF 20/2 Have you been to Austala before? No Yes [7]>- Give details of previous visas ‘Type of visa you held : ‘Artval date Departure date] (09. visitor, business) ‘Reason for journey: ‘Name used on entry Place of visa issue cays oe oa |r 1 yt sod | ] a7 cr | = ] v7 rat | Part K — Character ‘= served in a military force, police force, state ‘sponsored/private militia or intelligence Hae ua her en elute tis eile pplication, eer: . any itary tal sa been trained in weapons/easivs rin the ig eae a te eM wo manufacture of chenicaological products? to 7) Yes [] ‘been imvolved in people smuging or pople ‘been comctedof an offence in any county king offence {eluting any concn wich i nw a? wi) vO emmoved from oficial records}? No WM) Yes () © been removed, (epated or excluded from any 4 eo + boon the subject ofan arrest warrant or Sass a “ Interpol notice? No] Yes 0 ‘© overstayed a visa in any country (neluding a + been ound uly of say teed ofence 2? WX) vO imohing a child fecucng where no “ax enycustanding debs to the Australian ccomction was recorded}? No [W] Yes Government or any public authority in ‘Astaia? oY] vee 2] + beennamedonasextlenerreite? to] Yes D] 1 ae ; you answered "Yes! fo any ofthe questions at Question 36, you must * bemaautlfayctemeen team (-] safle bang tot os he nt cs rao neane) to criminal comiction, please give the nature ofthe offence ful details ‘been found by a court not fit to plead? No ves 1) ‘of sentence and dates of any period of imprisonment or other detention. '® been directly or indirectly involved in, oF assorited with aces which would ‘represent a risk to national security in ‘Australia or any other country? WoW) Yes C] ‘© been charged with, or indicted for: genocide, sear crimes, imes agent human, ota, slavery, or any other crime that is otherwise of a serious international concer? wi) ves © been associated with a person, group or ‘organisation that has beenvis involved in criminal conduct? No 4 Yes (] ‘© been associated with an organisation engaged in violence or engaged in acts of violence {eclucng war, insurgncy,feedom fighting, terrorism, protest) either overseas or in LL ‘sta? No] Yes connanvea cr usMAL, 26 Sion 008 FaePart L - Military service 37 Have you undertaken any military sonice? Miltary serves incl © compuisory © vduntary * consctipion «professional try ang » Z Yes [__|P Give details in chronological order Date from Date to Cee Fal nar of Unit aa a County of See Tot see® | atalonsigae | deployment a7 v0 _ a7 y7 | a0 yo Part M — Employed by intelligence or securily agency 38 Are you currently, o hae you boen employed as an inttigence fier gr an agent of an inteligence or seculy agency? No Yes [_]> Give details of organisation, role and dates you served Part 0 — Deportations 40 Have you ever boen excluded, asked to leave, deported or removed from any country? No Ves [D> Gh dae of tes, conti ad eunstanss Part N - Visa refusals 39 Have you ver boon refed a vist any cour? No M] ves [| Give dates of refusal, countries and circumstances of refusal Part P — Citizenship refusals 41 Have you oer boon refused, renounced or rescind citzenship of any county? no A Yes [> Give dates of refusal, countries and circumstances of pinchesFart Y — Associated people Do you have @ partner? Partner includes wit, husband, fiancé, boytiend, gitriend, significant other and de facto I widowed you must give details fo your deceased parier wo C Yoo SLIP civ datas (not ving, vite DECEASED’ in ‘County of curent residence’ column) Date of birth Given names Any other names Sex Chinese commercial codes amumeaeees ee ae {elu ptenyie rane (ea. madenor tba rame) ip ‘ia Yar] _ rat epotcal, wits WA) WEFE SHARNA NAMSTA é 21969) Place of bith County of curent residence | yay Cltzerstips) and year granted ; | Migrating wth you? Trani Tate Promos ogion Tony lene Anat ring, te DECEASED) | HeTavpa_|MAKAWANpOR| NEPAL AusT@ACTA tol) wo Do you have children? Children includes biological or adopted chitrn rom acurtent or previous mariage, al step- Provide as much information about one of your personal contacts as possible Family name Given names Given names Sex ‘Male [] Female [_] Relationship to you fg, partner, sister, aut fend) sex Wale] Female [] Relationship to you eg. pare, sister, aunt end) oy Mert) Yr Date of inh Z Nort oe “TounCiy of ith _ Date of bint ZT Ssat/Proincafecien Toure oft [ [ StateProvinoe Region country rh Country [Ee Your personal contact’ cuent residential adress Note: A post office baxis not acceptable | ‘Your personal coritact's current residential address: ‘Note: A post office box is not acceptable. ‘Address (including building/unit/house number and street name) Adress (nctuding buildng/univhouse number and stroet name) Sabu aed tvty - - Suburb and tony Stat or tory [ ]Pesteade [ “lephonenumbero State otetory Prstcode oficotous [teas Telephone numbers Mobiiot oficetaus [peace Eales Mebilfot Email address Give details of al other contacts at Part T— Akitional informationPart R — Sponsoring employer details 49 Axe you being sponsored by, or associated with, a business or oxganistion in Australia? No Zi GotoPans Yes [_]b Give detais OrgarisatonBusiness name Organsation/Business description Organisation/Business commercial address (including building number and street name) Part S— Declaration WARNING: Giving false or misteacng information is a serious offence. 1 declare that * the information | have supoid in or with this form is complete, correct and up-to-date in evry detail = [have read and understand te information supplied to me ‘have read the information contained in form 14421 Privacy notice. = understand the department may collect, use and asclose my ‘persona information including biometric information and other sensitive information) as outlined inform 14421 Privacy notice. ‘Signature of applicant |, pe Day Month Year oat [IF 702-/2-276 | ‘Suburb and towncity oy on Name of contact parson in business/rganisation 50 _Doos the omployertusinss have anyother associated across? No Yes [_]b Give detais Type of ads eg, head office, factory, retail store) ‘Aakiress (including building number and street name) Suburb and tounicity 51 Doss the emplyerbusinss have an emai adress? no Yes C1) Give detais 52 Does the employerbusines hae leone numbers? No [] ‘Yes [| List ll contact telephone numbers (including area code) We strongly advise that you keep a copy of your application and all attachments for your records. Oem aie tons Font