1221 - Additional personal particulars information

1221 (Design date 03/14) - © COMMONWEALTH OF AUSTRALIA, 2014

Additional personal particulars information

Form

1221

About this formThis 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 applicationThe 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 privacyYour 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.immi.gov.au/allforms/ or offices of the department. You should ensure that you read and understand form 1442i before completing this form.

3Tick where applicable

Please use a pen, and write neatly in English using BLOCK LETTERS.

Part A – Your details

www.immi.gov.auTelephone 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 birthDAY 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 grantedDAY MONTH YEAR

4 Name in Chinese Commercial Code Numbers (if applicable)

Country

State/province/region

Suburb and town/city


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


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 arrivalDAY MONTH YEAR

Flight number or vessel details (if known)

19 Intended date of departureDAY MONTH YEAR

No

Yes


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

( ) ( )


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 birthCountry of birth

DAY MONTH YEAR

Part D – Current employment details

Employment commencedDAY MONTH YEAR

Name of employer

Address of employer

( ) ( )


Contact telephone

Email address (if applicable)

Type of business

Occupation/Position

Detailed job description

24 Are you currently employed

Give details of your current employmentYes

Given names

Family name

Date of birth

Relationship to you (eg. partner, sister, aunt)2.

Country of birth

DAY MONTH YEAR


No Give details of how you occupy your time and how you support yourself

Suburb and town/city of birth

POSTCODE


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 toMONTH 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

RankFull name of Unit/ Battalion/BrigadeCountry 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


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


Year of award

Qualification



Year of award

Qualification



Year of award

Qualification



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)


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

( ) ( )


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


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


Type of course

Family name

Given names

Name of supervisor (if applicable)



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?


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 information45

Signature of applicant

DateDAY MONTH YEAR

We strongly advise that you keep a copy of your application and all attachments for your records.

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1221 - Additional personal particulars information

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