Thijan Form 80 Copy

7/27/2019 Thijan Form 80 Copy

1/1880 (Design date 07/13) - Page 1 COMMONWEALTH OF AUSTRALIA, 2013

Personal particulars for assessmentincluding character assessment

Form

80

Important Please read this information carefully before youcomplete 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 for visasfor Australia who are 16 years of age or over, as requested by theoffice processing the application.

Integrity of application

The Department of Immigration and Citizenship (thedepartment) is committed to maintaining the integrity of thevisa and citizenship programs. Please be aware that if youprovide us with fraudulent documents or claims, this mayresult in processing delays and possibly your application beingrefused.

About the information you give

The Department of Immigration and Citizenship (thedepartment) has authority under theMigration Act 1958andtheAustralian Citizenship Act 2007and other legislation itadministers, to collect personal information to carry out itsfunctions, including administration of applications for visas forentry and/or stay in Australia or for citizenship. The informationprovided will be used for assessing your eligibility for a visa totravel to, enter and remain in Australia and for other purposesrelating to the administration of the Migration Act, for example,to assist migrants with settling in Australia or for ensuringcompliance with the Migration Act.

The information provided might also be disclosed to agencieswho are authorised to receive information relating to adoption,border control, business skills, citizenship, education, healthassessment, health insurance, health services, law enforcement,payment of pensions and benefits, taxation, superannuation,review of decisions and registration of migration agents.

The information form 993iSafeguarding your personalinformation, available from offices of the department, givesdetails of agencies to which your information might bedisclosed.

student

refugee/ humanitarian entrant

visitor

migrant

temporary resident

OR

I am applying in Australia for:

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

a further temporary stay or visit

protection

permanent residence

Sex Male Female

Family name

Nationality

Passport/travel document number

All given

names

DAY MONTH YEAR

Date of birth

Tick where applicable

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

Place of birth

Suburb andTown/City

1 Write your name and birth details as shown on your currentpassport, birth certificate, family book or travel document

Passport

Other Type of document

Part A Your details

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

write that name in the Family name box.

Country of passport/travel document

Place of issue/issuing authority

Date of issue

Date of expiry

DAY MONTH YEAR

Day, month and yearMUST be provided

State/Province/Region

Country



3 Does the passport/travel document at Question 1 show yourfull name?

No

No

Yes

Yes

What is your full name?

Write the number of the document you used to

enter Australia

Family name

Given names

4

5

6

9

10

8

Do you ever use a Chinese Commercial Code Number for your names

shown in the passport/travel document at Question 1

Are you of Arabic descent?

Have you ever had a different date of birth?

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

Question 1?

Have you ever been known by other names or spellings of your name?

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

Did you use the passport/travel document at Question 1

to enter Australia?

Chinese Commercial Code Number (in full)

In English, write the full name of your fathers father

(ie. your paternal grandfather)

Give details in English

Different date of birth

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

naturalisation)?

Date you gained this citizenship

Type of name

Type of name

Family name

Family name

Given names

Given names

2.

1.

DAY MONTH YEAR

DAY MONTH YEAR

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

Examples of the types of other names:

s name at birth

s name before or after marriage

s adoptive or foster name

s alias or pseudonym

s cultural or tribal name or

clan/subclan names preferred name

s other spellings of names

2 Relationship status

Married

De facto

Engaged

Divorced

Separated

Widowed

Never married orbeen in a de facto

relationship

Date of marriage

Date of intended marriage

Date relationship began

DAY MONTH YEAR7 Are you of Russian descent?

No

Yes In English, provide your patronymic name



11 12

14

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

documents not already shown at Question 1?

Are you currently, or have you ever been, a citizen of any other

country not already shown at Question 1 or Question 11?

Do you currently have permanent residence rights in any country

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

No No

No

Yes Yes

Yes

Give details as they appear on the other passports/travel

documents (If more than one, give details at Part J

Additional details)

Give details

Give details

Family name

Nationality

Passport/travel document number

All given

names

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

that name in the Family name box.

Country of passport/travel document

Place of issue/issuing authority

Are you, or have you ever been, a citizen of the country of passport/

travel document shown above?

Date of issue

From

From

FromDate of expiry

To (If you still have thecitizenship, write Current)

To (If you still have the citizenship,write Current)

To (If you still have the citizenship,write Current)

DAY MONTH YEAR

DAY MONTH YEAR

DAY MONTH YEAR

DAY MONTH YEAR

No

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

naturalisation)?


naturalisation)?


naturalisation)?

When did you have this citizenship?




Country

Country

Country

Country

1.

1.

2.

2.

13 Have you ever renounced any citizenship you have previously held?

No

Yes Give details

Country

Reason

Date of renouncement

DAY MONTH YEAR



17 Your current residential address (this is the place where youcurrently live)

Note: A post office box or mailbox address is not acceptable as a

residential address.

Unit/Apartment number

Postal code

Address (including street number and name)

16

Country of issueType of identification document Name shown on documentIdentification number shown(if applicable)

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

15 Have you ever been refused citizenship of any country?

No

Yes Give details

Reason for refusal

Reason for refusal

Date

Date

DAY MONTH YEAR

DAY MONTH YEAR

Country

Country

1.

2.


18 Do you have an e-mail address?Note: Do not provide the e-mail address of a migrat ion agent.

No

Yes Please provide all of your e-mail addresses

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

( ) ( )

( ) ( )

COUNTRY CODE AREA CODE

Work

Home

Mobile/cell

( ) ( )

( ) ( )

( ) ( )Fax

Other contact numbers you have

NUMBER

Suburb andTown/City


Country



20 Address in Australia where you can be contacted or will be stayingNote: A post office box or mailbox address is not acceptable.

POSTCODE

21 Contact telephone numbers in Australia (if known)

( )

( )

AREA CODE

Work

Home

Mobile/cell

( )

( )

Other contact numbers

NUMBER

22 Do you have personal contacts in Australia (including businesscontacts/sponsor)?

Note: Do not provide the contact details of a migration agent.

No

Yes Give details

Given names

Family name

Sex Male Female

Date of birth

Relationship to you (eg. partner, sister, aunt, friend,

business contact/sponsor)

( )

AREA CODE NUMBERTelephonenumber

1.


DAY MONTH YEAR

Place of birth

Suburb andTown/City

Nationality


Country

Your personal contacts current residential address

Note: A post office box or mailbox address is not acceptable

as a residential address.


Postal code



Country

Given names

Family name

Sex Male Female

Date of birth

Relationship to you (eg. partner, sister, aunt, friend,

business contact/sponsor)

( )

AREA CODE NUMBERTelephone

number

2.

DAY MONTH YEAR

Place of birth

Nationality


Country

Your personal contacts current residential address

Note: A post office box or mailbox address is not acceptable

as a residential address.


Postal code



Country

Suburb andTown/City

Suburb andTown/City

Suburb andTown/City



27 Your partners place of birth

Family name

All given

names

24 Your partners full name

Part B Your partners details

25

26

Sex Male Female

Date of birth

Date of death(if deceased)

DAY MONTH YEAR

28

23

Is your partner currently, or have they ever been, a citizen of any

country?

Do you currently have a partner?

Note: If you are widowed, you must answer Yes and give details for

your deceased partner.

No

No

Yes

Yes

Give details

From

From

To (If they still have thecitizenship, write Current)

To (If they still have thecitizenship, write Current)

DAY MONTH YEAR

DAY MONTH YEAR

When did your partner have this citizenship?

When did your partner have this citizenship?


Country

Country

1.

2.

29

33

Does your partner ever use a Chinese Commercial Code Number for

names shown at Question 24?

Country where your partner lives now

If in Australia, write the full address, if deceased, write DECEASED

No

Yes Chinese Commercial Code Number (in full)

Go to Part C


Country

32 Is your partner currently, or have they ever been, known by othernames or spellings of their name?

No

Yes Give details in English

Type of name

Type of name

Family name

Family name

Given names

Given names

2.

1.


30 Is your partner of Arabic descent?

No

Yes In English, write the full name of your partners

fathers father (ie. paternal grandfather)


s name at birth





clan/subclan name

s preferred name


In English, provide your partners patronymic name

31 Is your partner of Russian descent?

No

Yes

Day, month and yearMUST be provided

POSTCODE

Suburb andTown/City



34

Country of issueType of identification document Name shown on documentIdentification number shown(if applicable)

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

Details of proposed final departure from Australia

38

39

Are you applying for a temporary visa?

What is the main reason for going to Australia?

Include details of any dates that are of special significance to

your time in Australia.

No

Yes

Part C Travel to Australia

Departure date

Flight number or vessel details (if known)

DAY MONTH YEAR

City ofdeparture

Details of proposed arrival in Australia37

Arrival date

Date of birth

Date of birth

Flight number or vessel details (if known)

Country ofbirth

Country ofbirth

Nationality

Nationality

DAY MONTH YEAR

DAY MONTH YEAR

DAY MONTH YEAR

City of arrival

Go to Part E

35 Are you planning to travel to Australia with any other person(s) ORif you are in Australia did you travel with any other person(s)?

No

Yes Give details

Family name

Family name

Relationship to you (eg. partner, sister, friend, business contact)

Relationship to you (eg. partner, sister, friend, business contact)

Given names

Given names

1.

2.


Go to Part D

36 Are you currently in Australia?

No

Yes



Go to Part E

40 Do you currently hold an Australian visa?

No

Yes

Part D Current visa details

Details of your arrival in Australia

Final date you must leave Australia

on this visa

42

43

Arrival date

Date of issue

DAY MONTH YEAR

DAY MONTH YEAR

DAY MONTH YEAR

City of arrival

NOTE: Only complete this Part if you are currently in Australia

41 Visa details

Type of visa

Place of issue

44 Have you travelled to Australia before?

Give details in chronological order

(If insufficient space, give details at Part J Additional details)



No

No

Yes

Yes

Part E Other information

DAY MONTH YEAR DAY MONTH YEAR

Date from Date toYour names shown on visa

Place wherevisa was issued

Type of visa (eg. visitor,student, business) Reason for visit

45 Have you travelled to any country other than Australia, including any visits back to yourcountry 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).

Country or countries Reason for visitDAY MONTH YEAR DAY MONTH YEAR

Date from Date to



Name and address of employer/business.Do not use abbreviations.

Type of business/other activities

Your position/title/duties/how youspent your time if unemployed

Date from Date to

MONTH YEAR MONTH YEAR

46 List, in chronological order, the addresses of the places where you have lived during thelast 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 Date toCountry Full address (number, street name, suburb, state/province, region)

MONTH YEAR MONTH YEAR

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 J 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.



48

49

Have you had any military service?

List all education and qualifications undertaken, including courses completed,

withdrawn or continuing. (If insufficient space, give details at Part J Additional details)

Give details in chronological order.



No

Yes

RankFull name of Unit/Battalion/BrigadeCountry of service Duties

Country ofdeployment

DAY MONTH YEAR DAY MONTH YEAR

Date from Date to

Name and address of institution.Do not use abbreviations.

Country wherecourse undertaken

Course of study.Do not use abbreviations. Course status

Date from Date toMONTH YEAR MONTH YEAR

Completedcourse

Completedcourse

Completedcourse

Completedcourse

Withdrew

Withdrew

Withdrew

Withdrew

Currentlyenrolled

Currentlyenrolled

Currentlyenrolled

Currentlyenrolled

Have you undertaken an academic thesis, dissertation or publication (including

completed, withdrawn or continuing theses, dissertations or publications)?

Give details

Full name of your supervisor

No

Yes

Family name

50

Given names



51

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 J Additional details.

Relationship to you (eg. natural parent, step-parent etc)

Country where this parent lives nowIf in Australia, write the full address, if not living, write DECEASED

Part F About your parents

This parents place of birth

Sex Male Female

Date of birth

DAY MONTH YEAR

Is this parent currently, or have they ever been, a citizen of any

country?

Yes Give details

From

From

To (If they still have the citizenship,write Current)


DAY MONTH YEAR

DAY MONTH YEAR

No

When did this parent have this citizenship?


Country

Country

1.

a.

l.

i.

k.

b.

c.

d.

e.

f.

g.

2.

Is this parent of Arabic descent?

In English, write the full name of this parents father

No

No

Yes

Parent

This parents full name

Family name

All given names including, if applicable, patronymic name

(in English), clan and sub-clan names, and middle names

Is this parent currently, or have they ever been, known by other names

or spellings of their name?

No Yes Give details in English

Type of name

Type of name

Family name

Family name

Given names

Given names

h. Does this parent ever use a Chinese Commercial Code Number?


2.

1.

Date of death (if deceased)

Examples of the types of other names:s name at birth





clan/subclan name

s preferred name


j.

In English, provide this parents patronymic name

Is this parent of Russian descent?

No

Yes

POSTCODE

Suburb andTown/City


Country



52

Relationship to you (eg. natural parent, step-parent etc)

Country where this parent lives nowIf in Australia, write the full address, if not living, write DECEASED

This parents place of birth

Sex Male Female

Date of birth

DAY MONTH YEAR

Is this parent currently, or have they ever been, a citizen of any

country?

Yes Give details

From

From



DAY MONTH YEAR

DAY MONTH YEAR

No



Country

Country

1.

a.

l.

i.

k.

b.

c.

d.

e.

f.

g.

2.

Is this parent of Arabic descent?

In English, write the full name of this parents father

No

No

Yes

Parent

This parents full name

Family name



Is this parent currently, or have they ever been, known by other names


No Yes Give details in English

Type of name

Type of name

Family name

Family name

Given names

Given names

h. Does this parent ever use a Chinese Commercial Code Number?


2.

1.


Examples of the types of other names:s name at birth





clan/subclan name

s preferred name


j.

In English, provide this parents patronymic name

Is this parent of Russian descent?

No

Yes

POSTCODE

Suburb andTown/City


Country



53

Relationship to you (eg. brother, sister, step-brother, step-sister)

Country where this person lives nowIf in Australia, write the full address, if not living, write DECEASED

Part G About your brothers and sisters

Place of birth

Sex Male Female

Date of birth

DAY MONTH YEAR

Is this person currently, or have they ever been, a citizen of any

country?

Yes Give details

From

From

To (If they still have the citizenship,

write Current)


DAY MONTH YEAR

DAY MONTH YEAR

No

When did this person have this citizenship?


Country

Country

1.

a.

l.

i.

k.b.

c.

d.

e.

f.

g.

2.

Is this person of Arabic descent?

In English, write the full name of this persons fathers

father (ie. paternal grandfather)

No

Yes

Brother or sister

Family name



Is this person currently, or have they ever been, known by other names


No


Type of name

Type of name

Family name

Family name

Given names

Given names

2.

1.


Note: You must give details for any person (living or deceased) who

is or was your brother or sister. This should include, but is not limited

to, natural brothers and sisters, adoptive brothers and sisters, step-

brothers 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 J Additional

details.

No

h. Does this person ever use a Chinese Commercial Code Number?



s name at birth





clan/subclan name

s preferred name


j.

In English, provide their patronymic name

Is this person of Russian descent?

NoYes

POSTCODE

Suburb andTown/City


Country



54



Place of birth

Sex Male Female

Date of birth

DAY MONTH YEAR


country?

Yes Give details

From

From



DAY MONTH YEAR

DAY MONTH YEAR

No



Country

Country

1.

a.

l.

i.

k.

b.

c.

d.

e.

f.

g.

2.




No

Yes

Brother or sister

Family name





No


Type of name

Type of name

Family name

Family name

Given names

Given names

2.

1.


No




s name at birth





clan/subclan name

s preferred name


j.



NoYes

POSTCODE

Suburb andTown/City


Country



55



Place of birth

Sex Male Female

Date of birth

DAY MONTH YEAR


country?

Yes Give details

From

From



DAY MONTH YEAR

DAY MONTH YEAR

No



Country

Country

1.

a.

l.

i.

k.

b.

c.

d.

e.

f.

g.

2.




No

Yes

Brother or sister

Family name





No


Type of name

Type of name

Family name

Family name

Given names

Given names

2.

1.


No




s name at birth





clan/subclan name

s preferred name


j.



NoYes

POSTCODE

Suburb andTown/City


Country



56



Place of birth

Sex Male Female

Date of birth

DAY MONTH YEAR


country?

Yes Give details

From

From



DAY MONTH YEAR

DAY MONTH YEAR

No



Country

Country

1.

a.

l.

i.

k.

b.

c.

d.

e.

f.

g.

2.




No

Yes

Brother or sister

Family name





No


Type of name

Type of name

Family name

Family name

Given names

Given names

2.

1.


No




s name at birth





clan/subclan name

s preferred name


j.



NoYes

POSTCODE

Suburb andTown/City


Country



57

No Yes

No Yes

No Yes

No Yes

No Yes

No Yes

No Yes

No Yes

No Yes

No Yes

No Yes

If you answered Yes to any of the questions at Question 57, 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.

If insufficient space, give details at Part J Additional details

Have you, or any other person included in this

application, ever:

s been convicted of a crime or offence in any

country (including any conviction which is

now removed from official records)?

s been charged with any offence or have

proceedings against you overseas or in

Australia

s been acquitted of any criminal offence or

other offence on the grounds of mental

illness, insanity or unsoundness of mind?

s been confined in a prison or psychiatric

institution by order of a court made in

connection with criminal proceedings

overseas or in Australia?

s been removed or deported from any country

(including Australia)?

s left any country to avoid being removed or

deported (including Australia)?

s been refused a visa for Australia or any

other country?

s been excluded from or asked to leave any

country (including Australia)?

s committed, or been involved in the

commission of war crimes or crimes against

humanity or human rights?

s been involved in any activities that would

represent a risk to Australian national

security?

s

had any outstanding debts to the AustralianGovernment or any public authority in

Australia?

s been involved in any activity, or been

convicted of any offence, relating to the

illegal movement of people to any country

(including Australia)?

s been associated with or involved in a

program related to the development of

weapons of mass destruction?

s 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?

s been under a probation order, good

behaviour bond, on parole, released on

licence or subject to a periodic detention

overseas or in Australia?

No Yes

Part H Character details

No Yes

Signature of

applicant

Date

DAY MONTH YEAR

We strongly advise that you keep a copy of your application

and all attachments for your records.

60

Part I Declaration

I declare that:

s the information I have supplied in or with this form is complete,

correct and up-to-date in every detail.

s I have read and understand the information supplied to me.

WARNING: Giving false or misleading information is a serious offence.

58

59

Are you currently, or have you been employed as an intelligence

officer or an agent of an intelligence or security agency?

Have you ever had a visa cancelled by, been refused entry to, or

been deported from, any country?

No

No

Yes

Yes

Give details of organisation, role and dates you served

Give details of dates, countries and circumstances.

If insufficient space, give details at Part J Additional

details

No Yes

No Yes


18/18

61

Part J Additional details

Question number Additional information

If insufficient space attach additional details

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