thijan form 80 copy
TRANSCRIPT
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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
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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
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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)?
How did you gain this citizenship (eg. birth, descent,
naturalisation)?
How did you gain this citizenship (eg. birth, descent,
naturalisation)?
When did you have this citizenship?
When did you have this citizenship?
When did you have this citizenship?
If more than 2, give details at Part J Additional details
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
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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.
If more than 2, give details at Part J Additional details
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
State/Province/Region
Country
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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.
If more than 2, give details at Part J Additional details
DAY MONTH YEAR
Place of birth
Suburb andTown/City
Nationality
State/Province/Region
Country
Your personal contacts current residential address
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)
State/Province/Region
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
State/Province/Region
Country
Your personal contacts current residential address
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)
State/Province/Region
Country
Suburb andTown/City
Suburb andTown/City
Suburb andTown/City
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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?
If more than 2, give details at Part J Additional details
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
State/Province/Region
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.
If more than 2, give details at Part J Additional details
30 Is your partner of Arabic descent?
No
Yes In English, write the full name of your partners
fathers father (ie. paternal grandfather)
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 name
s preferred name
s other spellings of names
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
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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.
If more than 2, give details at Part J Additional details
Go to Part D
36 Are you currently in Australia?
No
Yes
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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)
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
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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.
(If insufficient space, give details at Part J Additional details)
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.
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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.
Give details in chronological order
(If insufficient space, give details at Part J Additional details)
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
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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)
To (If they still have the citizenship,write Current)
DAY MONTH YEAR
DAY MONTH YEAR
No
When did this parent have this citizenship?
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?
Yes Chinese Commercial Code Number (in full)
2.
1.
Date of death (if deceased)
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 name
s preferred name
s other spellings of names
j.
In English, provide this parents patronymic name
Is this parent of Russian descent?
No
Yes
POSTCODE
Suburb andTown/City
State/Province/Region
Country
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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
To (If they still have the citizenship,write Current)
To (If they still have the citizenship,write Current)
DAY MONTH YEAR
DAY MONTH YEAR
No
When did this parent have this citizenship?
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?
Yes Chinese Commercial Code Number (in full)
2.
1.
Date of death (if deceased)
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 name
s preferred name
s other spellings of names
j.
In English, provide this parents patronymic name
Is this parent of Russian descent?
No
Yes
POSTCODE
Suburb andTown/City
State/Province/Region
Country
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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)
To (If they still have the citizenship,write Current)
DAY MONTH YEAR
DAY MONTH YEAR
No
When did this person have this citizenship?
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
All given names including, if applicable, patronymic name
(in English), clan and sub-clan names, and middle names
Is this person 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
2.
1.
Date of death (if deceased)
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?
Yes Chinese Commercial Code Number (in full)
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 name
s preferred name
s other spellings of names
j.
In English, provide their patronymic name
Is this person of Russian descent?
NoYes
POSTCODE
Suburb andTown/City
State/Province/Region
Country
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54
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
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)
To (If they still have the citizenship,write Current)
DAY MONTH YEAR
DAY MONTH YEAR
No
When did this person have this citizenship?
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
All given names including, if applicable, patronymic name
(in English), clan and sub-clan names, and middle names
Is this person 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
2.
1.
Date of death (if deceased)
No
h. Does this person ever use a Chinese Commercial Code Number?
Yes Chinese Commercial Code Number (in full)
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 name
s preferred name
s other spellings of names
j.
In English, provide their patronymic name
Is this person of Russian descent?
NoYes
POSTCODE
Suburb andTown/City
State/Province/Region
Country
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55
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
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)
To (If they still have the citizenship,write Current)
DAY MONTH YEAR
DAY MONTH YEAR
No
When did this person have this citizenship?
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
All given names including, if applicable, patronymic name
(in English), clan and sub-clan names, and middle names
Is this person 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
2.
1.
Date of death (if deceased)
No
h. Does this person ever use a Chinese Commercial Code Number?
Yes Chinese Commercial Code Number (in full)
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 name
s preferred name
s other spellings of names
j.
In English, provide their patronymic name
Is this person of Russian descent?
NoYes
POSTCODE
Suburb andTown/City
State/Province/Region
Country
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56
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
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)
To (If they still have the citizenship,write Current)
DAY MONTH YEAR
DAY MONTH YEAR
No
When did this person have this citizenship?
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
All given names including, if applicable, patronymic name
(in English), clan and sub-clan names, and middle names
Is this person 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
2.
1.
Date of death (if deceased)
No
h. Does this person ever use a Chinese Commercial Code Number?
Yes Chinese Commercial Code Number (in full)
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 name
s preferred name
s other spellings of names
j.
In English, provide their patronymic name
Is this person of Russian descent?
NoYes
POSTCODE
Suburb andTown/City
State/Province/Region
Country
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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
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61
Part J Additional details
Question number Additional information
If insufficient space attach additional details