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Form

Additional personal particulars
information 1221

About this form Please use a pen, and write neatly in English using BLOCK LETTERS.
This is a supplementary form required to support your visa Tick where applicable 3
application and is to be completed by all applicants who are
18 years of age or over.
Part A – Your details
Important – Please read this information carefully before you
complete this form. Once you have completed this form we 1 Your full name
strongly advise that you keep a copy for your records. (as shown in your passport or travel document)
Family name
Integrity of application
The Department of Immigration and Border Protection Given names
(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. 2 Other names you are, or have been, known by
(including name at birth, previous married names, aliases)
Important information about privacy
Your 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, 3 Name in your own language or script (if applicable)
including sensitive information, is contained in form 1442i
Privacy notice. Form 1442i is available from the department’s
website www.border.gov.au/allforms/ or offices of the
department. You should ensure that you read and understand
form 1442i before completing this form. 4 Name in Chinese Commercial Code Numbers (if applicable)

DAY MONTH YEAR

5 Date of birth
Home page www.border.gov.au
General Telephone 131 881 during business hours 6 Place of birth
enquiry line in Australia to speak to an operator (recorded
information available outside these hours). Suburb and
If you are outside Australia, please contact town/city
your nearest Australian mission. State/province/
region
Country

7 Sex Male Female

8 Relationship status
Married Separated Never married or
been in a de facto
Engaged Divorced
relationship
De facto Widowed

9 Citizenship or nationality (give details of all held)

DAY MONTH YEAR

Date granted

© COMMONWEALTH OF AUSTRALIA, 2015 1221 (Design date 10/15) - Page 1

give details at Part O – Additional details 12 Your proposed residential address in Australia (if known) POSTCODE Part B – Travel details 13 Details from your passport/travel document Passport/travel document number Country of passport/ travel document DAY MONTH YEAR Date of issue Date of expiry Place of issue/ issuing authority 1221 (Design date 10/15) . 2015 . migration agent address or mailbox address is not acceptable as a residential address.Page 2 © COMMONWEALTH OF AUSTRALIA. 10 Your current residential address (this is the place where you currently live) Note: A post office box. Unit/Apartment number Address (include street number and name) Suburb and town/city State/province/ region Country Postal code 11 Your contact details COUNTRY CODE AREA CODE NUMBER Home (            ) (            ) telephone Mobile/cell All email addresses If insufficient space.

been refused entry to. give details of your intended arrival DAY MONTH YEAR Intended date of arrival Flight number or vessel details (if known) DAY MONTH YEAR 19 Intended date of departure © COMMONWEALTH OF AUSTRALIA. visitor. 2015 1221 (Design date 10/15) . social security cards etc)? No Yes Give details Identification number shown Type of identification document Country of issue Name shown on document (if applicable) 15 Have you ever had a visa refused or cancelled by. or been deported from.14 Do you currently have. Place where Your names shown on visa Reason for visit student. any national identity documents or numbers (including birth registration numbers. countries and circumstances (If insufficient space.Page 3 . give details at Part O – Additional details) Type of visa (eg. or have you ever had. give details at Part O – Additional details) 16 Have you previously held an Australian visa? No Yes Give details in chronological order (If insufficient space. business) visa was issued 17 What is the general purpose of your journey/further stay? 18 If you are outside Australia. any country? No Yes Give details of dates.

give details at Part O – Additional details 22 Are you fully funding your trip? No Give details of the person/institution funding your trip Part D – Current employment details Full name 24 Are you currently employed No Give details of how you occupy your time and Name of institution (if applicable) how you support yourself Address POSTCODE Telephone number COUNTRY CODE AREA CODE NUMBER (            ) (            ) Yes Give details of your current employment DAY MONTH YEAR Email address of person/institution Employment commenced Name of employer Yes Address of employer Part C – Details of travelling dependents/ family members POSTCODE Contact telephone 23 Give details of dependents/family members travelling to Australia with you COUNTRY CODE AREA CODE NUMBER (            ) (            ) 1. aunt) Email address (if applicable) Family name Given names Type of business DAY MONTH YEAR Date of birth Occupation/Position Suburb and town/city of birth Detailed job description Country of birth 1221 (Design date 10/15) . partner.Page 4 © COMMONWEALTH OF AUSTRALIA. sister. Relationship to you (eg. aunt) Places of intended stopovers Family name Given names DAY MONTH YEAR Date of birth 21 Give details of any proposed onward locations after your departure from Australia Suburb and town/city of birth Country of birth If insufficient space. 20 Give details of any intended stopovers on your way to Australia 2. Relationship to you (eg. 2015 . partner. sister.

work experience.Page 5 . self employment and periods of unemployment) (If insufficient space. give details at Part O – Additional details) Date from Date to Name and address of employer/business. give details at Part O – Additional details) Date from Date to Full name of Unit/ Country of Country of service Battalion/Brigade Rank Duties deployment DAY MONTH YEAR DAY MONTH YEAR © COMMONWEALTH OF AUSTRALIA. Part E – Employment status in the last 10 years 25 Give details of your employment status in the last 10 years (including internships. 2015 1221 (Design date 10/15) . Type of business/ Your occupation/position/title/duties/ MONTH YEAR MONTH YEAR (Do not use abbreviations) other activities how you spent your time if unemployed Part F – Military service 26 Have you had any military service? No Yes Give details in chronological order (If insufficient space.

give details at Part O – Additional details POSTCODE 1221 (Design date 10/15) . training. Institution and city/campus Given names Qualification Nature of relationship to you Main subjects or duties 31 Current residential address of your contact Year of award (a post office box address is not acceptable as a residential address) If insufficient space. Institution and city/campus Qualification Part H – Details of your contact in Main subjects or duties Australia 30 Do you have contacts in Australia (including your sponsor. the person you will be staying with. 2015 . conferences or seminars you have qualifications attended in the last 2 years 27 Give details of all post secondary qualifications (list your most recent experience first) 1.Page 6 © COMMONWEALTH OF AUSTRALIA. Institution and city/campus Qualification Main subjects or duties Year of award 2. Part G – Education and trade 28 Describe any workshops. Institution and city/campus 29 List all titles and describe any previous academic or research papers you have had published Qualification Main subjects or duties Year of award 3. a family relative or an Year of award educational institution)? No Go to Part I Yes Family name 4. business contacts.

academic. researcher or fellow Go to Part M Part J – Visitor visa 35 Do you intend to do a course of study while in Australia? No Yes Give details Name of course Name of the institution Type of course © COMMONWEALTH OF AUSTRALIA. 2015 1221 (Design date 10/15) .Page 7 .32 Contact’s telephone numbers Part K – Business visa COUNTRY CODE AREA CODE NUMBER Telephone 36 Proposed employment/business activity details (            ) (            ) number Name of employer Mobile All email Address of employment addresses POSTCODE 33 Contact’s current employment details Nature of employment/business activities Name of employer Proposed duties/activities Address of employer POSTCODE 37 Are you attending a conference/seminar in Australia? Type of business No Yes Give full name of conference and (if applicable) attach an Occupation/Position abstract of the conference presentation Duties Part I – Details of your journey to Australia 34 Only complete the section(s) relevant to you If you: 38 Do you intend to inspect and/or negotiate the purchase of any have applied for a equipment during your stay in Australia? Visitor visa Go to Part J No have applied for a Yes Give details Business visa Go to Part K have applied for a Migration visa Go to Part L are a student.

give details below Name of employer Address of employer POSTCODE Type of business Occupation/Position Duties 1221 (Design date 10/15) . 2015 . thesis topic and research to be undertaken) Name of course Name of the institution Type of course 40 Do you intend to work in Australia? No Yes If you have organised your employment.Page 8 © COMMONWEALTH OF AUSTRALIA. Part L – Migration visas Part M – 39 Do you intend to do a course of study while in Australia? Student/Academic/Researcher/Fellows No 41 Give details of your proposed course/field of study in Australia Yes If you have organised your course. give details below (including name of course. give details below Name of employer Address of employer POSTCODE Type of business Occupation/Position Name of the institution Duties Name of supervisor (if applicable) Family name Given names 42 Do you intend to work in Australia? No Yes If you have organised your employment. type of course.

Part N – Additional information 44 Are there any other details you would like taken into consideration? 43 Give details of how you intend to use the knowledge/skills/research obtained once you depart Australia © COMMONWEALTH OF AUSTRALIA. 2015 1221 (Design date 10/15) .Page 9 .

correct and up-to-date in every detail. use and disclose my personal information (including biometric information and other sensitive information) as outlined in form 1442i Privacy notice. 2015 . 46 I declare that: • the information I have supplied in this application is complete. • I have read the information contained in form 1442i Privacy notice. 1221 (Design date 10/15) .Page 10 © COMMONWEALTH OF AUSTRALIA. Signature of applicant - DAY MONTH YEAR Date We strongly advise that you keep a copy of your application and all attachments for your records. • I understand the department may collect. Part O – Additional details 45 Question number Additional information Part P – Declaration WARNING: Giving false or misleading information is a serious offence. • I have read and understood the information supplied to me.