Form

Personal particulars for

character assessment 80

Important – Please read this information carefully before you Write your name and birth details as shown on official documents such
complete your application. Once you have completed your as birth certificate, family book, passport or identification document.
application we strongly advise that you keep a copy for your
records. 1 Family name
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 Given names
the office processing the application. All questions must be
completed.

Integrity of application
2 Sex Male Female
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 3 Other names you are, or have been, known by
provide us with fraudulent documents or claims, this may (If insufficient space, give details at Question 37)
result in processing delays and possibly your application being
Family name
refused.
Given names
About the information you give
The department is authorised to collect information provided
on this form under Part 2 of the Migration Act 1958 ‘Control of
Arrival and Presence of Non-Citizens’. The information provided
will be used for assessing your eligibility for a visa to travel, 4 (a) Write your name in your own language or script. For Russian
enter and remain in Australia and for other purposes relating to citizens, include Patronymic name
the administration of the Migration Act, for example, to assist
migrants with settling in Australia or for ensuring compliance
with the Migration Act.
The information provided might also be disclosed to agencies (b) Your name in Chinese commercial code numbers (if applicable)
who are authorised to receive information relating to adoption,
border control, business skills, citizenship, education, health
assessment, health insurance, health services, law enforcement,
payment of pensions and benefits, taxation, superannuation, (c) If you are of Arabic descent, write the full names of your paternal
review of decisions and registration of migration agents.
grandfather (ie. your father’s father)
The information form 993i Safeguarding your personal
information, available from offices of the department, gives
details of agencies to which your information might be
disclosed.
DAY MONTH YEAR

5 Date of birth
For officer — This form is designed for completion by
applicants and requires attachment of form 80H, internally
completed, before despatch for checking purposes. 6 Place of birth Town/city
State/
Province
Please use a pen, and write neatly in English using BLOCK LETTERS. Country

Tick where applicable ✓

7 Relationship status
Married Separated Never married or
I am applying for refugee/ migrant been in a de facto
a visa to travel to humanitarian entrant Engaged Divorced
visitor relationship
Australia as a: temporary De facto Widowed
student
resident
OR
8 What is your current citizenship?
I am applying a further permanent
in Australia for: temporary stay residence
protection
9 How was your citizenship acquired? (eg. birth, descent, naturalisation)

© COMMONWEALTH OF AUSTRALIA, 2009 80 (Design date 11/09) - Page 1

 DAY MONTH YEAR
17 Your current residential address (Not a post office box address)
10 When was your citizenship granted?

11 Are you a dual citizen, or have you held any other citizenship?
POSTAL CODE
No Yes Provide detail including date of citizenship
Date granted Country of residence
Citizenship DAY MONTH YEAR

18 About your PARTNER

For the purposes of this form, the term ‘partner’ means a legally
married husband or wife, or a partner in a de facto relationship
12 Have you ever been refused citizenship of another country? (including same-sex partners), or an intended spouse. If you do not
No Yes Provide details below have a partner, write ‘N/A’ and go to Question 19.
DAY MONTH YEAR Family name
1. Date
Given names
Country
Reason for
refusal Sex Male Female
Other names known by/used before (such as an alias, underline family
DAY MONTH YEAR
name used)
2. Date

Country
Reason for
refusal Write your partner’s name in their own language or script. Please
also write Chinese names in Chinese commercial code numbers.
(If insufficient space, give details at Question 37) For Russian citizens, include Patronymic name. If your partner is of
Arabic descent, write the full names of their paternal grandfather
13 Details of all passports ever issued to you (ie. their father’s father)
Passport number Country of issue

Date of birth (DAY/MONTH/YEAR)

(If insufficient space, give details at Question 37) Place and country of birth

14 Details of any identity documents, social security cards, or any alien

registration numbers you currently use or have used in the past What is your partner’s current citizenship?

Type or document Number Country

Is your partner a dual citizen, or have they held any other citizenship?
No
Yes Provide detail including date of citizenship
(If insufficient space, give details at Question 37) Date granted
Citizenship DAY MONTH YEAR

15 Your e-mail addresses

(If insufficient space, give details at Question 37)

16 Your telephone numbers Country where living now
COUNTRY CODE AREA CODE NUMBER
(If not living, write ‘DECEASED’)
Work ( ) ( )

Home ( ) ( )

Mobile/cell

Fax ( ) ( )

Other ( ) ( )

Contact telephone
( )
if in Australia

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19 About your PARENTS
Note: You must complete details for any person who is or was your
parent or with whom you have had a parent-like relationship with. This
should include, but is not limited to, natural parents, adoptive parents,
IVF parents, surrogate parents, step-parents, foster parents, and/or
guardians.
(If insufficient space, give details at Question 37)

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

Sex Male Female Sex Male Female

Family name Family name

Given names Given names

Other names known by/used before (such as an alias, underline family Other names known by/used before (such as an alias, underline family
name used) name used)

Write your parent’s name in their own language or script. Please
also write Chinese names in Chinese commercial code numbers.
For Russian citizens, include Patronymic name. If your parent is of
Arabic descent, write the full names of their paternal grandfather
(ie. their father’s father)
Write your parent’s name in their own language or script. Please
also write Chinese names in Chinese commercial code numbers.
For Russian citizens, include Patronymic name. If your parent is of
Arabic descent, write the full names of their paternal grandfather
(ie. their father’s father)

Date of birth (DAY/MONTH/YEAR) Date of birth (DAY/MONTH/YEAR)

Place and country of birth Place and country of birth

Citizenship or nationality (Give details of all held) Citizenship or nationality (Give details of all held)
Date granted Date granted
Citizenship DAY MONTH YEAR Citizenship DAY MONTH YEAR

Country where living now Country where living now

(If not living, write ‘DECEASED’) (If not living, write ‘DECEASED’)

© COMMONWEALTH OF AUSTRALIA, 2009 80 (Design date 11/09) - Page 3

 20 About your BROTHERS and/or SISTERS
(If you have more than 4 brothers and/or sisters, give details at
Question 37)

1. Family name 3. Family name

Given names Given names

Sex Male Female Sex Male Female

Other names known by/used before (such as an alias, underline Other names known by/used before (such as an alias, underline
family name used) family name used)

Write their name in their own language or script. Please also
write Chinese names in Chinese commercial code numbers. For
Russian citizens, include Patronymic name. If they are of Arabic
descent, write the full names of their paternal grandfather
(ie. their father’s father)
Write their name in their own language or script. Please also
write Chinese names in Chinese commercial code numbers. For
Russian citizens, include Patronymic name. If they are of Arabic
descent, write the full names of their paternal grandfather
(ie. their father’s father)

Date of birth (DAY/MONTH/YEAR) Date of birth (DAY/MONTH/YEAR)

Place and country of birth Place and country of birth

Citizenship or nationality (Give details of all held) Citizenship or nationality (Give details of all held)
Date granted Date granted
Citizenship DAY MONTH YEAR Citizenship DAY MONTH YEAR

Country where living now Country where living now

(If not living, write ‘DECEASED’) (If not living, write ‘DECEASED’)

2. Family name 4. Family name

Given names Given names

Sex Male Female Sex Male Female

Other names known by/used before (such as an alias, underline Other names known by/used before (such as an alias, underline
family name used) family name used)

Write their name in their own language or script. Please also
write Chinese names in Chinese commercial code numbers. For
Russian citizens, include Patronymic name. If they are of Arabic
descent, write the full names of their paternal grandfather
(ie. their father’s father)
Write their name in their own language or script. Please also
write Chinese names in Chinese commercial code numbers. For
Russian citizens, include Patronymic name. If they are of Arabic
descent, write the full names of their paternal grandfather
(ie. their father’s father)

Date of birth (DAY/MONTH/YEAR) Date of birth (DAY/MONTH/YEAR)

Place and country of birth Place and country of birth

Citizenship or nationality (Give details of all held) Citizenship or nationality (Give details of all held)
Date granted Date granted
Citizenship DAY MONTH YEAR Citizenship DAY MONTH YEAR

Country where living now Country where living now

(If not living, write ‘DECEASED’) (If not living, write ‘DECEASED’)

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21 Previous addresses of the places where you have lived during the last 10 years (including Australia). You must account for every year.
If you are unable to provide an address for any period of time please provide an explanation. (If insufficient space, give details at Question 37)
From To Country Address (number, street name, suburb, state/province, country)
MONTH YEAR MONTH YEAR

22 What is your present occupation

23 Give details of your employment history for the entire period since leaving school until now, including periods of unemployment
(If insufficient space, give details at Question 37)
From To Name and address of employer Country Type of business Your occupation/
MONTH YEAR MONTH YEAR position

24 Give details of your education history for the entire period since leaving (high) school (If insufficient space, give details at Question 37)
From To Name and address of institution (include country) Course studied Course completed or
MONTH YEAR MONTH YEAR withdrawn

25 Give details of all your previous visits to Australia (If none, write ‘N/A’. If insufficient space, give details at Question 37)
Type of entry
From To (visitor, student, Place where visa Name used on entry Purpose of visit
DAY MONTH YEAR DAY MONTH YEAR temporary resident) was issued

26 Give details of all visits (including short stays) to countries outside Australia for the last 10 years (If insufficient space, give details at Question 37)
From To Country or countries Reason for visit
DAY MONTH YEAR DAY MONTH YEAR

© COMMONWEALTH OF AUSTRALIA, 2009 80 (Design date 11/09) - Page 5

 27 Your current travel document details (eg. passport, travel authority, 30 Details of intended visit to Australia
documentary visa) Date of arrival or proposed
Type or travel document arrival (DAY/MONTH/YEAR)

Number Place of proposed arrival

Period of time permitted to remain
Place of issue in Australia as authorised on arrival
Date of issue (DAY/MONTH/YEAR) Purpose of journey

Date of expiry (DAY/MONTH/YEAR) Additional periods of stay authorised

after arrival (if applicable)
Name on passport
Proposed address in Australia (number, street name, suburb, state)
Family name

Given names

POSTCODE

28 Details of contacts in Australia Go to Question 32

1. Family name 31 Visa details (of initial arrival)

Given names Type of visa

Visa number V <

Sex Male Female Place of issue of visa
Date of birth (DAY/MONTH/YEAR) Date of issue of visa (DAY/MONTH/YEAR)
Relationship to you
(eg. family friend, mother) Special conditions
(if applicable)
AREA CODE NUMBER
Telephone
number ( )
Place of arrival

Date of arrival (DAY/MONTH/YEAR)

2. Family name

Given names 32 Please answer the following questions about yourself and any other
person included in this application
(a) Have you, or any other person included in
Sex Male Female this application, ever been convicted of, or
Date of birth (DAY/MONTH/YEAR) found guilty of, ANY offences overseas or in
Australia (include all traffic offences which
Relationship to you went to court, including offences declared
(eg. family friend, mother) in your permanent residence application,
Telephone
AREA CODE NUMBER and any ‘spent’ convictions)? No Yes
number ( )
Note: ‘Spent’ convictions are convictions
which are not, under legislation in certain
3. Family name countries, normally required to be disclosed,
for example because of the time that has
Given names passed since the conviction, or because of
a pardon for reasons other than wrongful
conviction.
Sex Male Female (b) Have you, or any other person included in
Date of birth (DAY/MONTH/YEAR) this application, ever been confined in a
prison or in a psychiatric institution by order
Relationship to you of a court made in connection with criminal
(eg. family friend, mother) proceedings overseas or in Australia? No Yes
AREA CODE NUMBER
Telephone (c) Have you, or any other person included in
number ( )
this application, ever committed, or been
involved in the commission of war crimes
29 Where are you currently located? or crimes against humanity or human rights
Outside Australia Go to Question 30 overseas or in Australia? No Yes

In Australia Go to Question 31

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(d) Are you, or any other person included in 33 Have you ever served in the military, either for your own country or
this application, presently under a probation another country that was not considered mandatory service?
order, good behaviour bond, on parole, No
released on licence or subject to periodic
detention overseas or in Australia? No Yes Yes Give details of any periods of military service including
name of unit, locations where posted, rank achieved
(e) Are you, or any other person included in and duties performed
this application, aware of any proceedings
pending against you overseas or in Australia
for an offence, including proceedings by
way of appeal or review? No Yes
(f) Have you, or any other person included in
this application, ever been involved in any
activity, or been convicted of any offence,
relating to the illegal movement of people to
any country (including Australia)? No Yes
(g) Have you, or any other person included in
this application, ever been charged with 34 Are you currently, or have you been employed as an intelligence officer
any offence overseas or in Australia that is or an agent of an intelligence or security agency?
currently awaiting legal action? No Yes
No
(h) Have you, or any other person included in
this application, ever been associated with Yes Give details of organisation, role and dates where you
or received training from an organisation served
engaged in violence, or been involved in an
act of violence (including war, insurgency,
freedom fighting, terrorism, protest)
overseas or in Australia? No Yes
(i) Have you, or any other person included
in this application, ever been associated
with or involved in a program related to
the development of weapons of mass 35 Have you ever been denied or refused a visa or entry
destruction? No Yes to another country?
If you answered ‘Yes’ to any of the above questions, No
give details of all occurrences. Yes Give details
Include the following where appropriate:
• the name of the court;
• the offence;
• the name of the terrorist organisation;
• the nature of the terrorist association; Declaration
• details of terrorist acts;
• the sentence received; WARNING: Giving false or misleading information is a serious offence.
• relevant dates; 36 I hereby declare that the information I have supplied in this form is,
• to whom it applies (you or a person included in this application). so far as I know or could reasonably find out, correct in every detail.
I declare that 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.

(If insufficient space, give details at Question 37)

© COMMONWEALTH OF AUSTRALIA, 2009 80 (Design date 11/09) - Page 7

 Additional details
37 Question number Additional information

(If insufficient space, attach additional details)

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