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
18years 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 departments
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
Ifyou 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

 10 Your current residential address (this is the place where you currently live)
Note: A post office box, migration agent address or mailbox address is
not acceptable as a residential address.

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, 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) - Page 2 COMMONWEALTH OF AUSTRALIA, 2015

14 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

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, been refused entry to, or been deported from, any country?
No
Yes Give details of dates, countries and circumstances
(If insufficient space, 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, give details at Part O Additional details)

Type of visa (eg. visitor, Place where

Your names shown on visa Reason for visit
student, business) visa was issued

17 What is the general purpose of your journey/further stay?

18 If you are outside Australia, 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, 2015 1221 (Design date 10/15) - Page 3

 20 Give details of any intended stopovers on your way to Australia 2. Relationship to you (eg. partner, sister, 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, 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. Relationship to you (eg. partner, sister, 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) - Page 4 COMMONWEALTH OF AUSTRALIA, 2015

 Part E Employment status in the last 10 years
25 Give details of your employment status in the last 10 years (including internships, work experience, 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. 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)
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, 2015 1221 (Design date 10/15) - Page 5

 Part G Education and trade 28 Describe any workshops, training, 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. Institution and city/campus

Qualification

Main subjects or duties

Year of award

2. 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. 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, business
contacts, the person you will be staying with, a family relative or an
Year of award educational institution)?
No Go to Part I
Yes Family name
4. 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, give details at Part O Additional details

POSTCODE

1221 (Design date 10/15) - Page 6 COMMONWEALTH OF AUSTRALIA, 2015

32 Contacts 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 Contacts 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, 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

 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, type of course, 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, 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, give details below

Name of employer

Address of employer

POSTCODE

Type of business

Occupation/Position

Duties

1221 (Design date 10/15) - Page 8 COMMONWEALTH OF AUSTRALIA, 2015

 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

 Part O Additional details
45 Question number Additional information

Part P Declaration
WARNING: Giving false or misleading information is a serious offence.
46 I declare that:
the information I have supplied in this application is complete,
correct and up-to-date in every detail.
I have read and understood the information supplied to me.
I have read the information contained in form 1442i Privacy notice.
I understand the department may collect, use and disclose my
personal information (including biometric information and other
sensitive information) as outlined in form 1442i Privacy notice.

Signature of
applicant
-
DAY MONTH YEAR

Date

We strongly advise that you keep a copy of your application

and all attachments for your records.

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