Professional Documents
Culture Documents
Form
80
Important Please read this information carefully before you complete this form. Once you have completed this form we strongly advise that you keep a copy for your records. This form is to be completed in English by applicants for visas for Australia who are 16 years of age or over, as requested by the office processing the application.
Please use a pen, and write neatly in English using BLOCK LETTERS. Tick where applicable I am applying for a visa to travel to Australia as a: migrant temporary resident visitor student refugee/ humanitarian entrant OR I am applying in Australia for: a further temporary stay or visit permanent residence protection
Integrity of application
The Department of Immigration and Citizenship (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.
Note: If your passport/travel document only shows one name, write that name in the Family name box. Family name All given names
Sex Date of birth Place of birth Suburb and Town/City State/Province/ Region Country
Male
DAY MONTH
Female
YEAR
Relationship status Married Date of marriage Engaged De facto Separated Divorced Widowed Never married or been in a de facto relationship Date of intended marriage Date relationship began
DAY
MONTH
YEAR
Are you of Russian descent? No Yes In English, provide your patronymic name
Have you ever been known by other names or spellings of your name? Examples of the types of other names: s cultural or tribal name or s name at birth clan/subclan name s name before or after marriage s preferred name s adoptive or foster name s other spellings of names s alias or pseudonym No Yes Give details in English
Does the passport/travel document at Question 1 show your full name? No What is your full name? Family name Given names
Yes
2. Type of name Did you use the passport/travel document at Question 1 to enter Australia? No Write the number of the document you used to enter Australia Family name Given names
Yes
If more than 2, give details at Part J Additional details Do you ever use a Chinese Commercial Code Number for your names shown in the passport/travel document at Question 1 No Yes Chinese Commercial Code Number (in full)
Have you ever had a different date of birth? No Yes Different date of birth
DAY MONTH YEAR
12 Are you currently, or have you ever been, a citizen of any other
country not already shown at Question 1 or Question 11? No Yes Give details
1. Country How did you gain this citizenship (eg. birth, descent, naturalisation)? When did you have this citizenship? From To (If you still have the citizenship, write Current)
Note: If the passport/travel document only shows one name, write that name in the Family name box. Family name All given names
DAY
MONTH
YEAR
How did you gain this citizenship (eg. birth, descent, naturalisation)? When did you have this citizenship? From To (If you still have the citizenship, write Current) If more than 2, give details at Part J Additional details
DAY
MONTH
YEAR
13 Have you ever renounced any citizenship you have previously held?
Are you, or have you ever been, a citizen of the country of passport/ travel document shown above? No Yes How did you gain this citizenship (eg. birth, descent, naturalisation)? No Yes Give details Country Reason
DAY
MONTH
YEAR
Date of renouncement
1. Country 2. Country
DAY
MONTH
YEAR
DAY
MONTH
YEAR
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 Country of issue Identification number shown (if applicable) Name shown on document
( (
) (
Sex
POSTCODE
Male
DAY MONTH
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. Unit/Apartment number Address (including street number and name)
Sex
Male
DAY MONTH
Female
YEAR
Suburb and Town/City State/Province/ Region Country Postal code Telephone number
AREA CODE ( ) NUMBER
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. Unit/Apartment number Address (including street number and name)
Suburb and Town/City State/Province/ Region Country Postal code Telephone ( ) number Relationship to you (eg. partner, sister, aunt, friend, business contact/sponsor)
AREA CODE NUMBER
32 Is your partner currently, or have they ever been, known by other 25 Sex 26 Date of birth
Date of death (if deceased) Male
DAY MONTH
Female
YEAR
names or spellings of their name? Examples of the types of other names: s cultural or tribal name or s name at birth clan/subclan name s name before or after marriage s preferred name s adoptive or foster name s other spellings of names s alias or pseudonym No Yes Give details in English
1. Country When did your partner have this citizenship? From To (If they still have the citizenship, write Current) 2. Country When did your partner have this citizenship?
DAY MONTH YEAR
Given names
From To (If they still have the citizenship, write Current) If more than 2, give details at Part J Additional details
29 Does your partner ever use a Chinese Commercial Code Number for
names shown at Question 24? No Yes Chinese Commercial Code Number (in full)
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 Country of issue Identification number shown (if applicable) Name shown on document
Yes
Date of birth Country of birth Nationality Relationship to you (eg. partner, sister, friend, business contact)
Departure date Flight number or vessel details (if known) City of departure
DAY
MONTH
YEAR
Date of birth Country of birth Nationality Relationship to you (eg. partner, sister, friend, business contact)
41 Visa details
Type of visa
DAY MONTH YEAR
DAY
MONTH
YEAR
Date to
MONTH YEAR
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 Give details in chronological order (If insufficient space, give details at Part J Additional details) Date to
DAY MONTH YEAR
Date from
DAY MONTH YEAR
Country or countries
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. (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
MONTH YEAR
Date to
MONTH YEAR
Country
Date to
MONTH YEAR
Date to
MONTH YEAR
Country of service
Rank
Duties
Country of deployment
Date to
MONTH YEAR
Course status Completed course Withdrew Currently enrolled Completed course Withdrew Currently enrolled Completed course Withdrew Currently enrolled Completed course Withdrew Currently enrolled
h. Does this parent ever use a Chinese Commercial Code Number? No Yes Chinese Commercial Code Number (in full)
i.
Is this parent of Arabic descent? No Yes In English, write the full name of this parents father
51 Parent
a. Relationship to you (eg. natural parent, step-parent etc) j.
b.
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 of Russian descent? No Yes In English, provide this parents patronymic name
k.
Is this parent currently, or have they ever been, known by other names or spellings of their name? Examples of the types of other names: s cultural or tribal name or s name at birth clan/subclan name s name before or after marriage s preferred name s adoptive or foster name s other spellings of names s alias or pseudonym No Yes Give details in English
c.
Sex
Male
Female
DAY MONTH YEAR
d. Date of birth e. f. Date of death (if deceased) This parents place of birth Suburb and Town/City State/Province/ Region Country g. Is this parent currently, or have they ever been, a citizen of any country? No Yes Give details
1. Country When did this parent have this citizenship? From To (If they still have the citizenship, write Current) 2. Country When did this parent have this citizenship?
DAY MONTH YEAR
l.
Country where this parent lives now If in Australia, write the full address, if not living, write DECEASED
52 Parent
a. Relationship to you (eg. natural parent, step-parent etc)
h. Does this parent ever use a Chinese Commercial Code Number? No Yes Chinese Commercial Code Number (in full)
b.
This parents full name Family name i. All given names including, if applicable, patronymic name (in English), clan and sub-clan names, and middle names Is this parent of Arabic descent? No Yes 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
d. Date of birth e. f. Date of death (if deceased) This parents place of birth Suburb and Town/City State/Province/ Region Country g. Is this parent currently, or have they ever been, a citizen of any country? No Yes Give details k.
Is this parent currently, or have they ever been, known by other names or spellings of their name? Examples of the types of other names: s cultural or tribal name or s name at birth clan/subclan name s name before or after marriage s preferred name s adoptive or foster name s other spellings of names s alias or pseudonym No Yes Give details in English
From To (If they still have the citizenship, write Current) 2. Country When did this parent have this citizenship?
DAY MONTH YEAR
Country where this parent lives now If in Australia, write the full address, if not living, write DECEASED
POSTCODE
i.
Is this person of Arabic descent? No Yes In English, write the full name of this persons fathers father (ie. paternal grandfather)
j.
Is this person of Russian descent? No Yes In English, provide their patronymic name
53 Brother or sister
a. Relationship to you (eg. brother, sister, step-brother, step-sister)
b.
Family name All given names including, if applicable, patronymic name (in English), clan and sub-clan names, and middle names
k.
Is this person currently, or have they ever been, known by other names or spellings of their name? Examples of the types of other names: s cultural or tribal name or s name at birth clan/subclan name s name before or after marriage s preferred name s adoptive or foster name s other spellings of names s alias or pseudonym No
c.
Sex
Male
Female
DAY MONTH YEAR
Yes
d. Date of birth e. f. Date of death (if deceased) Place of birth Suburb and Town/City State/Province/ Region Country g. Is this person currently, or have they ever been, a citizen of any country? No Yes Give details
From To (If they still have the citizenship, write Current) 2. Country When did this person have this citizenship?
DAY MONTH YEAR
l.
Country where this person lives now If in Australia, write the full address, if not living, write DECEASED
POSTCODE
From To (If they still have the citizenship, write Current) h. Does this person ever use a Chinese Commercial Code Number? No Yes Chinese Commercial Code Number (in full)
54 Brother or sister
a. Relationship to you (eg. brother, sister, step-brother, step-sister)
i.
Is this person of Arabic descent? No Yes In English, write the full name of this persons fathers father (ie. paternal grandfather)
b.
Family name All given names including, if applicable, patronymic name (in English), clan and sub-clan names, and middle names
j.
Is this person of Russian descent? No Yes In English, provide their patronymic name
c.
Sex
Male
Female
DAY MONTH YEAR
k.
Is this person currently, or have they ever been, known by other names or spellings of their name? Examples of the types of other names: s cultural or tribal name or s name at birth clan/subclan name s name before or after marriage s preferred name s adoptive or foster name s other spellings of names s alias or pseudonym No Yes Give details in English
d. Date of birth e. f. Date of death (if deceased) Place of birth Suburb and Town/City State/Province/ Region Country g. Is this person currently, or have they ever been, a citizen of any country? No Yes Give details
From To (If they still have the citizenship, write Current) 2. Country When did this person have this citizenship?
DAY MONTH YEAR
From To (If they still have the citizenship, write Current) h. Does this person ever use a Chinese Commercial Code Number? No Yes Chinese Commercial Code Number (in full)
POSTCODE
l.
Country where this person lives now If in Australia, write the full address, if not living, write DECEASED
55 Brother or sister
a. Relationship to you (eg. brother, sister, step-brother, step-sister)
i.
Is this person of Arabic descent? No Yes In English, write the full name of this persons fathers father (ie. paternal grandfather)
b.
Family name All given names including, if applicable, patronymic name (in English), clan and sub-clan names, and middle names
j.
Is this person of Russian descent? No Yes In English, provide their patronymic name
c.
Sex
Male
Female
DAY MONTH YEAR
k.
Is this person currently, or have they ever been, known by other names or spellings of their name? Examples of the types of other names: s cultural or tribal name or s name at birth clan/subclan name s name before or after marriage s preferred name s adoptive or foster name s other spellings of names s alias or pseudonym No Yes Give details in English
d. Date of birth e. f. Date of death (if deceased) Place of birth Suburb and Town/City State/Province/ Region Country g. Is this person currently, or have they ever been, a citizen of any country? No Yes Give details
From To (If they still have the citizenship, write Current) 2. Country When did this person have this citizenship?
DAY MONTH YEAR
From To (If they still have the citizenship, write Current) h. Does this person ever use a Chinese Commercial Code Number? No Yes Chinese Commercial Code Number (in full)
POSTCODE
l.
Country where this person lives now If in Australia, write the full address, if not living, write DECEASED
56 Brother or sister
a. Relationship to you (eg. brother, sister, step-brother, step-sister)
i.
Is this person of Arabic descent? No Yes In English, write the full name of this persons fathers father (ie. paternal grandfather)
b.
Family name All given names including, if applicable, patronymic name (in English), clan and sub-clan names, and middle names
j.
Is this person of Russian descent? No Yes In English, provide their patronymic name
c.
Sex
Male
Female
DAY MONTH YEAR
k.
Is this person currently, or have they ever been, known by other names or spellings of their name? Examples of the types of other names: s cultural or tribal name or s name at birth clan/subclan name s name before or after marriage s preferred name s adoptive or foster name s other spellings of names s alias or pseudonym No Yes Give details in English
d. Date of birth e. f. Date of death (if deceased) Place of birth Suburb and Town/City State/Province/ Region Country g. Is this person currently, or have they ever been, a citizen of any country? No Yes Give details
From To (If they still have the citizenship, write Current) 2. Country When did this person have this citizenship?
DAY MONTH YEAR
From To (If they still have the citizenship, write Current) h. Does this person ever use a Chinese Commercial Code Number? No Yes Chinese Commercial Code Number (in full)
POSTCODE
l.
Country where this person lives now If in Australia, write the full address, if not living, write DECEASED
No
Yes
No
Yes
No No No No No
No
Yes
59 Have you ever had a visa cancelled by, been refused entry to, or
No Yes been deported from, any country? No Yes No Yes Give details of dates, countries and circumstances. If insufficient space, give details at Part J Additional details
No
Yes
No
Yes
Part I Declaration
No Yes WARNING: Giving false or misleading information is a serious offence.
60 I declare that:
No Yes 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. Signature of applicant
DAY MONTH YEAR
Date
We strongly advise that you keep a copy of your application and all attachments for your records.
COMMONWEALTH OF AUSTRALIA, 2013 80 (Design date 07/13) - Page 17