80 PDF

Form
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.
Please use a pen, and write neatly in English using BLOCK LETTERS.
This form is to be completed in English by applicants for visas

for Australia who are 16 years of age or over, as requested by the
office processing the application.
I am applying for a visa to travel to Australia as a:
Tick where applicable
3
migrant
temporary resident
visitor
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.
student
refugee/ humanitarian entrant
OR
I am applying in Australia for:
a further temporary stay or visit

permanent residence
protection
About the information you give

The department has authority under the Migration Act 1958
and the Australian Citizenship Act 2007 and other legislation
it administers, to collect personal information to carry out its
functions, including administration of applications for visas for
entry and/or stay in Australia or for citizenship. The information
provided will be used for assessing your eligibility for a visa to
travel to, enter and remain in Australia and for other purposes
relating to the administration of the Migration Act, for example,
to assist migrants with settling in Australia or for ensuring
compliance with the Migration Act.
The information provided might also be disclosed to agencies
who are authorised to receive information relating to adoption,
border control, business skills, citizenship, education, health
assessment, health insurance, health services, law enforcement,
payment of pensions and benefits, taxation, superannuation,
review of decisions and registration of migration agents.
The information form 993i Safeguarding your personal
information, available from offices of the department, gives
details of agencies to which your information might be
disclosed.
Part A Your details

1
Write your name and birth details as shown on your current

passport, birth certificate, family book or travel document
Passport
Other
Type of document
Note: If your passport/travel document only shows one name,

write that name in the Family name box.
Family name
All given
names
Sex
Male
DAY
Female
MONTH
YEAR
Date of birth
Day, month and year

MUST be provided
Place of birth
Suburb and
Town/City
State/Province/
Region
Country
Passport/travel document number
Country of passport/travel document
DAY
MONTH
YEAR
Date of issue
Date of expiry
Nationality
Place of issue/issuing authority
COMMONWEALTH OF AUSTRALIA, 2013
80 (Design date 11/13) - Page 1
Relationship status
Married
DAY
MONTH
YEAR
No
Date of marriage
Engaged
Date of intended marriage
De facto
Date relationship began
Yes
Separated
Widowed
Never married or
been in a de facto
relationship
Have you ever been known by other names or spellings of your name?
No
Does the passport/travel document at Question 1 show your

full name?
No
In English, provide your patronymic name
Examples of the types of other names:

cultural or tribal name or
name at birth
clan/subclan name
name before or after marriage
preferred name
adoptive or foster name
other spellings of names
alias or pseudonym
Divorced
Are you of Russian descent?
Yes
What is your full name?
Give details in English
1. Type of name
Family name
Family name
Given names
Given names
Yes
2. Type of name
Did you use the passport/travel document at Question 1
to enter Australia?
No
Family name
Write the number of the document you used to

enter Australia
Given names
Yes
If more than 2, give details at Part K Additional details

Do you ever use a Chinese Commercial Code Number for your names
shown in the passport/travel document at Question 1
Have you ever had a different date of birth?

No
No
Yes
Chinese Commercial Code Number (in full)
Yes
DAY
MONTH
YEAR
Different date of birth
10 Are you a citizen of the country of passport/travel document at

6
Are you of Arabic descent?
Question 1?
No
No
Yes
In English, write the full name of your fathers father

(ie. your paternal grandfather)
Yes
How did you gain this citizenship (eg. birth, descent,

naturalisation)?
DAY
Date you gained this citizenship
MONTH
YEAR
11 Do you currently have, or have you ever had, other passports/travel

documents not already shown at Question 1?
2. Country
naturalisation)?
No
Yes
Give details as they appear on the other passports/travel

documents (If more than one, give details at Part K
Additional details)
When did you have this citizenship?
Note: If the passport/travel document only shows one name, write

that name in the Family name box.
DAY
MONTH
YEAR
From
To (If you still have the citizenship,
write Current)
Family name
All given
names
13 Have you ever renounced any citizenship you have previously held?
No
Passport/travel document number
Yes
Give details
Country
Country of passport/travel document

DAY
MONTH
Reason
YEAR
Date of issue
DAY
MONTH
YEAR
Date of renouncement
Date of expiry
14 Do you currently have permanent residence rights in any country
Nationality
not already shown at Question 1, Question 11 or Question 12?
Place of issue/issuing authority
No
Yes
Are you, or have you ever been, a citizen of the country of passport/
travel document shown above?
No
Yes

naturalisation)?
Give details
1. Country
2. Country
15 Have you ever been refused citizenship of any country?

No
Yes

DAY
MONTH
YEAR
Give details
1. Country
Reason for refusal
From
To (If you still have the
citizenship, write Current)
DAY
12 Are you currently, or have you ever been, a citizen of any other
MONTH
YEAR
MONTH
YEAR
Date
country not already shown at Question 1 or Question 11?

No
Yes
2. Country
Give details
Reason for refusal
1. Country
naturalisation)?
DAY

From
Date
DAY
MONTH
YEAR
To (If you still have the citizenship,

write Current)
16 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
Identification number shown

(if applicable)
Country of issue
Name shown on document
19 Your current contact numbers (include country code if outside Australia)
17 Your current residential address (this is the place where you

currently live)
Note: A post office box or mailbox address is not acceptable as a
residential address.
Work
) (
Unit/Apartment number
Home
) (
Address (including street number and name)
Mobile/cell
(
) (
COUNTRY CODE
Fax
AREA CODE
NUMBER
Other contact numbers you have

Suburb and
Town/City
State/Province/
Region
Country
) (
) (
20 Address in Australia where you can be contacted or will be staying

Note: A post office box or mailbox address is not acceptable.
Postal code
18 Do you have an e-mail address?

Note: Do not provide the e-mail address of a migration agent.
POSTCODE
No
Yes
Please provide all of your e-mail addresses
21 Contact telephone numbers in Australia (if known)

AREA CODE
NUMBER
Work
Home
Mobile/cell
Other contact numbers
22 Do you have personal contacts in Australia (including business

contacts/sponsor)?
Note: Do not provide the contact details of a migration agent.
2. Family name
Given names
No
Yes
Give details
Sex
Male
1. Family name
DAY
Male
DAY
Female
MONTH
MONTH
YEAR
Date of birth
Place of birth
Suburb and
Town/City
State/Province/
Region
Country
Given names
Sex
Female
YEAR
Date of birth
Place of birth
Suburb and
Town/City
State/Province/
Region
Country
Nationality
Your personal contacts current residential address
Note: A post office box or mailbox address is not acceptable
as a residential address.
Nationality
Your personal contacts current residential address

Note: A post office box or mailbox address is not acceptable
as a residential address.
Suburb and
Town/City
State/Province/
Region
Country
Suburb and
Town/City
State/Province/
Region
Country
Postal code
Telephone
number
Postal code
Relationship to you (eg. partner, sister, aunt, friend,

business contact/sponsor)
Telephone
number
AREA CODE
(
NUMBER
)
E-mail address
AREA CODE
(
NUMBER
)
E-mail address
Relationship to you (eg. partner, sister, aunt, friend,

business contact/sponsor)
Part B Your partners details
30 Is your partner of Arabic descent?
23 Do you currently have a partner?

Note: If you are widowed, you must answer Yes and give details for
your deceased partner.
No
Yes
Go to Part C
No
In English, write the full name of your partners

fathers father (ie. paternal grandfather)
Yes
24 Your partners full name
31 Is your partner of Russian descent?
Family name
No
All given
names
Yes
In English, provide your partners patronymic name
32 Is your partner currently, or have they ever been, known by other

25 Sex
Male
DAY
names or spellings of their name?
Female
MONTH
YEAR
26 Date of birth
Day, month and year

MUST be provided
Date of death
(if deceased)

name at birth
clan/subclan name

preferred name
alias or pseudonym
No
27 Your partners place of birth
Yes
Suburb and
Town/City
State/Province/
Region
Country
1. Type of name
Family name
Given names
28 Is your partner currently, or have they ever been, a citizen of any

country?
No
Yes
Give details
2. Type of name
1. Country
Family name
When did your partner have this citizenship?

DAY
MONTH
YEAR
Given names
From
To (If they still have the
2. Country
When did your partner have this citizenship?
DAY
MONTH
33 Country where your partner lives now
YEAR
From
If in Australia, write the full address, if deceased, write DECEASED
To (If they still have the

29 Does your partner ever use a Chinese Commercial Code Number for
names shown at Question 24?
No
Yes
POSTCODE
34 Does your partner currently have, or have they ever had, any national identity documents
or numbers (including birth registration numbers, social security cards etc)?
No
Yes
Give details
Type of identification document
Identification number shown

(if applicable)
Country of issue
Name shown on document
Part C Travel to Australia

35 Are you planning to travel to Australia with any other person(s) OR
37 Details of proposed arrival in Australia
if you are in Australia did you travel with any other person(s)?
DAY
No
Yes
MONTH
YEAR
Arrival date
Flight number or vessel details (if known)
Give details
1. Family name
City of arrival
Given names
38 Are you applying for a temporary visa?

No
DAY
MONTH
Details of proposed final departure from Australia
Yes
YEAR
DAY
Date of birth
MONTH
YEAR
Departure date
Country of
birth
Nationality
Flight number or vessel details (if known)
Relationship to you (eg. partner, sister, friend, business contact)
City of
departure
39 What is the main reason for going to Australia?

Include details of any dates that are of special significance to
your time in Australia.
2. Family name
Given names
DAY
MONTH
YEAR
Date of birth
Country of
birth
Nationality
Relationship to you (eg. partner, sister, friend, business contact)

Go to Part E
36 Are you currently in Australia?

No
Yes
Go to Part D
Part D Current visa details

NOTE: Only complete this Part if you are currently in Australia
40 Do you currently hold an Australian visa?

Go to Part E
No
Yes
41 Visa details
Type of visa
DAY
MONTH
YEAR
Date of issue
Place of issue
42 Details of your arrival in Australia

DAY
MONTH
YEAR
Arrival date
City of arrival
43 Final date you must leave Australia
DAY
MONTH
YEAR
on this visa
Part E Other information

44 Have you travelled to Australia before?
No
Yes
Give details in chronological order

(If insufficient space, give details at Part K Additional details)
Date from
DAY
MONTH
YEAR
Date to
DAY
MONTH
YEAR
Type of visa (eg. visitor,

student, business)
Place where
visa was issued
Your names shown on visa
45 Have you travelled to any country other than Australia, including any visits back to your
country of citizenship during the past 10 years (including short stays)?
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 (both month and year are required).
No
Yes

Date from
DAY
MONTH
YEAR
Date to
DAY
MONTH
YEAR
Country or countries
Reason for visit
Reason for visit
46 List, in chronological order, the addresses of the places where you have lived during the
last 10 years (including Australia). You must account for every month/year. If you are unable
to provide an address for any period of time please provide an explanation.
Note: If you are applying for a refugee/humanitarian visa you must provide all addresses
for the last 30 years (both month and year are required with no gaps).
Date from
MONTH
YEAR
Date to
MONTH
YEAR
Country
Full address (number, street name, suburb, state/province, region)
47 Give details of all employment including periods of unemployment.

Note: If you are unable to provide details for a period, please provide an
explanation. (If insufficient space, give details at Part K Additional details)
For current or previous periods of unemployment please advise how you
occupied your time and how you supported yourself. Month and year are both
required. If retired, please provide activities. Time gaps are unacceptable.
Date from
MONTH
YEAR
Date to
MONTH
YEAR
Name and address of employer/business.

Do not use abbreviations.
Type of business/
other activities
Your position/title/duties/how you

spent your time if unemployed
48 Have you had any military service?

No
Yes
Date from
DAY
MONTH
YEAR
Date to
DAY
MONTH
YEAR
Country of service
Full name of Unit/

Battalion/Brigade
Rank
Duties
Country of
deployment
49 List all education and qualifications undertaken, including courses completed,

withdrawn or continuing. (If insufficient space, give details at Part K Additional details)
Give details in chronological order.
Date from
MONTH
YEAR
Date to
MONTH
YEAR
Country where
course undertaken
Name and address of institution.

Course of study.
Course status
Completed
course
Withdrew
Currently
enrolled
Completed
course
Withdrew
Currently
enrolled
Completed
course
Withdrew
Currently
enrolled
Completed
course
Withdrew
Currently
enrolled
50 Have you undertaken an academic thesis, dissertation or publication (including

completed, withdrawn or continuing theses, dissertations or publications)?
No
Yes
Give details
Full name of your supervisor

Family name
Given names
Part F About your parents
h. Does this parent ever use a Chinese Commercial Code Number?
Note: You must give details for any person (living or deceased) who
is or was your parent or with whom you have had a parent-like
relationship. This should include, but is not limited to, natural parents,
adoptive parents, surrogate parents, step-parents, foster parents, and/
or guardians.
Provide details of one parent at Question 51 and the other parent at
Question 52. If more than 2, give details at Part K Additional details.
No
Yes
i.
Is this parent of Arabic descent?

No
Yes
51 Parent
a.
Relationship to you (eg. natural parent, step-parent etc)
b.
This parents full name

Family name
j.
In English, write the full name of this parents father
Is this parent of Russian descent?

No
Yes
In English, provide this parents patronymic name
All given names including, if applicable, patronymic name

(in English), clan and sub-clan names, and middle names
k.
Is this parent currently, or have they ever been, known by other names
or spellings of their name?
d. Date of birth

name at birth
clan/subclan name

preferred name
alias or pseudonym
e.
Date of death (if deceased)
No
f.
This parents place of birth
c.
Sex
Male
Female
DAY
MONTH
YEAR
Yes
1. Type of name
Suburb and
Town/City
State/Province/
Region
Family name
Given names
Country
g. Is this parent currently, or have they ever been, a citizen of any
country?
No
2. Type of name
Yes
Give details
Family name
1. Country
When did this parent have this citizenship?
Given names
DAY
MONTH
YEAR
From
To (If they still have the citizenship,
write Current)
l.
2. Country
Country where this parent lives now

If in Australia, write the full address, if not living, write DECEASED

DAY
MONTH
YEAR
From
write Current)
POSTCODE
52 Parent
a.
h. Does this parent ever use a Chinese Commercial Code Number?
Relationship to you (eg. natural parent, step-parent etc)
No
Yes
b.
This parents full name

Family name
i.
Yes
j.
Sex
Male
Female
MONTH
YEAR
f.
This parents place of birth
k.
Suburb and
Town/City
State/Province/
Region
In English, provide this parents patronymic name
Is this parent currently, or have they ever been, known by other names
name at birth
clan/subclan name

preferred name
alias or pseudonym
Country
g. Is this parent currently, or have they ever been, a citizen of any
country?
No
No
Yes
Is this parent of Russian descent?

Yes
d. Date of birth
In English, write the full name of this parents father
No
DAY
e.
Is this parent of Arabic descent?

No

c.
Yes
1. Type of name
Give details
Family name
1. Country
DAY
MONTH
Given names
YEAR
From
write Current)
2. Type of name
2. Country
Family name

DAY
MONTH
YEAR
From
Given names

write Current)
l.
Country where this parent lives now

POSTCODE
Part G About your brothers and sisters
i.
is or was your brother or sister. This should include, but is not limited
to, natural brothers and sisters, adoptive brothers and sisters, stepbrothers and sisters.
Provide details of one brother or sister at Question 53 and the others
at Questions 5456. If more than 4, give details at Part K Additional
details.
No
Yes
j.
53 Brother or sister
In English, write the full name of this persons fathers

father (ie. paternal grandfather)
Is this person of Russian descent?

No
a.
Relationship to you (eg. brother, sister, step-brother, step-sister)
b.
Family name
c.
Is this person of Arabic descent?
Yes
k.
In English, provide their patronymic name
Is this person currently, or have they ever been, known by other names


name at birth
clan/subclan name

preferred name
alias or pseudonym
Sex
No
Male
Female
DAY
MONTH
Yes
YEAR
d. Date of birth
e.
f.
Place of birth
1. Type of name
Family name
Suburb and
Town/City
State/Province/
Region
Given names
Country
2. Type of name
g. Is this person currently, or have they ever been, a citizen of any

country?
Family name
No
Yes
Given names
Give details
1. Country
When did this person have this citizenship?
DAY
MONTH
YEAR
MONTH
YEAR
From
l.
Country where this person lives now


write Current)
2. Country
DAY
POSTCODE
From
write Current)
h. Does this person ever use a Chinese Commercial Code Number?
No
Yes
a.
i.

No
Yes
b.
Family name
j.


No
Yes
c.
Sex
Male
Female
k.
DAY
MONTH
YEAR
d. Date of birth
e.
f.
Place of birth
name at birth
clan/subclan name

preferred name
alias or pseudonym
Suburb and
Town/City
State/Province/
Region
No
Yes
Country
1. Type of name

country?
Family name
No
Yes
Given names
Give details
1. Country
DAY
MONTH
YEAR
From
2. Type of name

write Current)
Family name
Given names
2. Country
DAY
MONTH
YEAR
From
l.

write Current)


No
Yes
POSTCODE
a.
i.

No
Yes
b.
Family name
j.


No
Yes
c.
Sex
Male
Female
k.
DAY
MONTH
YEAR
d. Date of birth
e.
f.
Place of birth
name at birth
clan/subclan name

preferred name
alias or pseudonym
Suburb and
Town/City
State/Province/
Region
No
Yes
Country
1. Type of name

country?
Family name
No
Yes
Given names
Give details
1. Country
DAY
MONTH
YEAR
From
2. Type of name

write Current)
Family name
Given names
2. Country
DAY
MONTH
YEAR
From
l.

write Current)


No
Yes
POSTCODE
a.
i.

No
Yes
b.
Family name
j.


No
Yes
c.
Sex
Male
Female
k.
DAY
MONTH
YEAR
d. Date of birth
e.
f.
Place of birth
name at birth
clan/subclan name

preferred name
alias or pseudonym
Suburb and
Town/City
State/Province/
Region
No
Yes
Country
1. Type of name

country?
Family name
No
Yes
Given names
Give details
1. Country
DAY
MONTH
YEAR
From
2. Type of name

write Current)
Family name
Given names
2. Country
DAY
MONTH
YEAR
From
l.

write Current)


No
Yes
POSTCODE
Part H About your children
i.
is or was your child. This should include, but is not limited to, natural
children, adoptive children, step-children.

No
Yes
Provide details of one child at Question 57 and another at Question 58.

If more than 2, give details at Part K Additional details.
57 Child
a.
Relationship to you (eg. son, daughter)
b.
Family name
j.
Sex
Male

No
Yes
k.

c.
DAY
MONTH
YEAR
f.
Place of birth
No
d. Date of birth

name at birth
clan/subclan name

preferred name
alias or pseudonym
Female
e.

Yes
1. Type of name
Family name
Suburb and
Town/City
State/Province/
Region
Given names
Country
country?
2. Type of name
No
Family name
Yes
Give details
1. Country
Given names

DAY
MONTH
YEAR
From
write Current)
l.

2. Country
DAY
MONTH
YEAR
From
POSTCODE

write Current)
No
Yes
58 Child
a.
i.
Relationship to you (eg. son, daughter)

No
Yes
b.
Family name
j.


No
Yes
c.
Sex
Male
Female
k.
DAY
MONTH
YEAR
d. Date of birth
e.
f.
Place of birth
name at birth
clan/subclan name

preferred name
alias or pseudonym
Suburb and
Town/City
State/Province/
Region
No
Yes
Country
1. Type of name

country?
Family name
No
Yes
Given names
Give details
1. Country
DAY
MONTH
YEAR
From
2. Type of name

write Current)
Family name
Given names
2. Country
DAY
MONTH
YEAR
From
l.

write Current)


No
Yes
POSTCODE
Part I Character details

59 Have you, or any other person included in this
application, ever:
been convicted of a crime or offence in any
country (including any conviction which is
now removed from official records)?
No
Yes
If insufficient space, give details at Part K Additional details
been charged with any offence or have

proceedings against you overseas or in
Australia
No
Yes
been acquitted of any criminal offence or

other offence on the grounds of mental
illness, insanity or unsoundness of mind?
No
Yes
been confined in a prison or psychiatric

institution by order of a court made in
connection with criminal proceedings
overseas or in Australia?
No
Yes
been removed or deported from any country

(including Australia)?
No
Yes
left any country to avoid being removed or

deported (including Australia)?
No
Yes
been refused a visa for Australia or any

other country?
No
Yes
been excluded from or asked to leave any

country (including Australia)?
No
Yes
committed, or been involved in the

commission of war crimes or crimes against
humanity or human rights?
No
Yes
been involved in any activities that would

represent a risk to Australian national
security?
officer or an agent of an intelligence or security agency?

No
Give details of organisation, role and dates you served
61 Have you ever had a visa cancelled by, been refused entry to, or
No
Yes
been deported from, any country?

No
No
Yes
been involved in any activity, or been

convicted of any offence, relating to the
illegal movement of people to any country
(including Australia)?
No
Yes
been associated with or involved in a

program related to the development of
weapons of mass destruction?
No
Yes
been under a probation order, good

behaviour bond, on parole, released on
licence or subject to a periodic detention
overseas or in Australia?
60 Are you currently, or have you been employed as an intelligence
Yes
had any outstanding debts to the Australian

Government or any public authority in
Australia?
been associated with or received training

from an organisation engaged in violence, or
been involved in an act of violence (including
war, insurgency, freedom fighting, terrorism,
protest) overseas or in Australia?
If you answered Yes to any of the questions at Question 59, 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, court details and dates of any period of
imprisonment or other detention.
Yes
Give details of dates, countries and circumstances.

If insufficient space, give details at Part K Additional
details
Part J Declaration
No
Yes
WARNING: Giving false or misleading information is a serious offence.
62 I declare that:
No
Yes
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.
Signature of
applicant
DAY
MONTH
YEAR
Date
We strongly advise that you keep a copy of your application

and all attachments for your records.
Part K Additional details

63
Question number
Additional information
If insufficient space, attach additional details


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Form

Personal particulars for assessment

Important Please read this information carefully before you

This form is to be completed in English by applicants for visas

I am applying for a visa to travel to Australia as a:

Tick where applicable

a further temporary stay or visit

About the information you give

Part A Your details

Write your name and birth details as shown on your current

Note: If your passport/travel document only shows one name,

Day, month and year

COMMONWEALTH OF AUSTRALIA, 2013

80 (Design date 11/13) - Page 1

Date of intended marriage

Date relationship began

Does the passport/travel document at Question 1 show your

In English, provide your patronymic name

Examples of the types of other names:

Are you of Russian descent?

What is your full name?

Give details in English

Write the number of the document you used to

If more than 2, give details at Part K Additional details

Have you ever had a different date of birth?

Chinese Commercial Code Number (in full)

Different date of birth

10 Are you a citizen of the country of passport/travel document at

Are you of Arabic descent?

In English, write the full name of your fathers father

How did you gain this citizenship (eg. birth, descent,

Date you gained this citizenship

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COMMONWEALTH OF AUSTRALIA, 2013

11 Do you currently have, or have you ever had, other passports/travel

Give details as they appear on the other passports/travel

When did you have this citizenship?

Note: If the passport/travel document only shows one name, write

If more than 2, give details at Part K Additional details

Passport/travel document number

Country of passport/travel document

14 Do you currently have permanent residence rights in any country

not already shown at Question 1, Question 11 or Question 12?

Place of issue/issuing authority

How did you gain this citizenship (eg. birth, descent,

15 Have you ever been refused citizenship of any country?

When did you have this citizenship?

country not already shown at Question 1 or Question 11?

Reason for refusal

When did you have this citizenship?

If more than 2, give details at Part K Additional details

To (If you still have the citizenship,

COMMONWEALTH OF AUSTRALIA, 2013

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Type of identification document

Identification number shown

Name shown on document

19 Your current contact numbers (include country code if outside Australia)