form 1221

(1)

Part A – Your details

3

Name in your own language or script (if applicable). Please write Chinese names in Chinese Commercial Code Numbers

2

Other names you are, or have been, known by

(including name at birth, previous married names, aliases)

Date of birth

4

DAY MONTH YEAR

Place of birth

5

Town/City Country Your full name

(as shown in your passport or travel document)

1

Family name Given names Sex

6

Male Female Form

1221

Additional personal particulars

information

Citizenship or nationality (give details of all held)

8 About this form

This is a supplementary form required to support your visa application and is to be completed by all applicants who are 18 years of age or over.

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.

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.

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, enter and remain in Australia and other purposes relating to 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 who are authorised to receive information. 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.

Date granted

DAY MONTH YEAR

Place granted

Please use a pen, and write neatly in English using BLOCK LETTERS.

Telephone 131 881 during business hours in Australia to speak to an operator (recorded information available outside these hours). If you are outside Australia, please contact your nearest Australian mission.

General

enquiry line

Home page

www.immi.gov.au

Tick where applicable

Please use a pen, and write neatly in English using BLOCK LETTERS.

Relationship status

7

Married Never married or

been in a de facto relationship Separated De facto Engaged Widowed Divorced Patel Bhaul 14-Apr-1982

Hirpura, Vijapur, Mehsana India ✔ ✔ Indian 14-Apr-1982 India

(2)

Details from your passport

14

10

Address for correspondence

(if the same as your residential address, write ‘AS ABOVE’)

POSTCODE

Do you agree to the department communicating with you by fax, e-mail or other electronic means?

13

Yes No

Give details

9

Your current residential address

(a post office box address is not acceptable as a residential address)

POSTCODE

Fax number E-mail address

COUNTRY CODE AREA CODE NUMBER

Passport number Country of passport Date of issue

15

DAY MONTH YEAR

Date of expiry Issuing authority/ Place of issue as shown in your passport

12

Your contact details

Office hours After hours

( ) ( )

11

Your residential address in Australia (if known)

POSTCODE

Part B – Travel details

Are you applying for a visa to travel to Australia as a:

16

temporary resident student/academic migrant/refugee

visitor

Are you applying for: OR

protection permanent residency

a further temporary stay

Visa subclass you are applying for

17

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

18

If you are outside Australia, give details of your intended arrival

19

Date of arrival

DAY MONTH YEAR

Flight/Ship details

20

How long do you intend to stay in Australia?

From to

DAY MONTH YEAR DAY MONTH YEAR

Fax number E-mail addresses

( ) ( )

If insufficient space give details at Question 43

13/28, Westbury St St Kilda East VIC 3183 13/28, Westbury st St Kilda East VIC 3183 0430459933 0430459933

[email protected]

✔ [email protected] E0541903 India 26-Dec-2001 25-Dec-2011 Ahmedabad ✔ 485

During the temporary resident period, I will try to find out the job in my field as well study the professional year program which help me to develop my future career.

(3)

Give details of your employment for the last 5 years (list your most recent experience first)

23

Type of business

Duties From

Are you funding your trip?

22

Yes

No Give details of the person/institution funding your trip Full name

Name of institution (if applicable)

Address

POSTCODE COUNTRY CODE AREA CODE NUMBER

( ) ( )

Telephone number

21

Give details of each place you intend to stay in Australia, including the length and purpose of each stay

From to

Place you intend to stay

Purpose of stay

From to

Purpose of stay

From to

Purpose of stay

From to

Purpose of stay

Part C – Employment details

Employer’s address POSTCODE Name of employer Occupation/Position Type of business Duties From

Employer’s address POSTCODE Name of employer Occupation/Position to to to If insufficient space give details at Question 43

1. 2. 3. 4. 1. 2. 3. Melbourne

Further study + Job

01-Jun-2010 31-Dec-2012 ✔ 01-Dec-2008 18/05/2010 Borgcraft Pty Ltd 31-33, Slough Rd Altona VIC 3018 Pastry manufacturing Process worker

Pick-packing, general cleaning, lifting

01-Jun-2009 18-May-2010

Drake International

479, Warrigal Rd

Moorabbin

Employment Agency

On-call casual stock taker

RF Scanning, Stock moving

01-May-2008 18-May-2010

Peter Rowland Catering Pty ltd

8, River st

South Yarra

VIC 3141

Catering

On-call casual Stacker

(4)

Type of business

Duties From

Employer’s address

POSTCODE Name of employer

Occupation/Position

Give details of all post secondary qualifications (list your most recent experience first)

24

Main subjects or duties

Part D – Education and trade

qualifications

Institution and city

Qualification

to

Year of award

Main subjects or duties Institution and city

Qualification

Year of award

Qualification

Year of award

Qualification

Year of award

Describe any workshops, training, conferences or seminars you have attended in the last 2 years

25

List all titles and describe any previous academic or research papers you have had published

26

4.

1.

2.

If insufficient space give details at Question 43

If insufficient space give details at Question 43 3. 4. 01-Jun-2008 18-May-2010 GTE Workplacement 4/20, Commercial road Melbourne VIC 3004 Employment Agency

On-call Casual Stock-taker

RF scanning

Swinburne University of Technology

M.I.T(Professional computing)

Information System & Project Managment, Database, sql-oracle, SAP

2009

Shree U.V.Patel College of Engg

B.E.I.T

c, c++, database, Software Engg

2004

In the final semester of my post-graduation, i am the part of team who developed a website related project for the Inform Financial Group. Also, we have updated their existing website.

(5)

Part E – Details of your personal

contact in Australia

Yes No

Do you have a personal contact in Australia (eg. your sponsor, the person you will be staying with, the person funding your holiday, a family relative or an educational institution)?

27

Go to Part F Family name Given names

29

30

Current residential address of your personal contact

(a post office box address is not acceptable as a residential address)

POSTCODE Personal contact’s telephone numbers

Office hours After hours

Personal contact’s current employment details

31

Type of business Duties Employer’s address POSTCODE Name of employer Occupation/Position

Part F – Details of your journey to Australia

have applied for a Business visa

32

Only complete the section(s) relevant to you If you:

have applied for a Visitor visa

are a student, academic, researcher or fellow have applied for a Migration visa

Do you intend to do a course of study while in Australia?

33

Name of the institution

Part G – Visitor visa

Name of course

Type of course Yes

No

Give details

Intended employment details

34

Type of business

Duties

Part H– Business visas

Employer’s address

POSTCODE Name of employer

Occupation/Position

Will your intended business activity in Australia require you to visit more than one place of work?

35

Yes No

List the name and location of institutions you will visit during your stay in Australia, the type of business each institution does and the name of your contact at each institution

Do you intend to inspect and/or negotiate the purchase of any equipment during your stay in Australia?

36

Yes No Give details Date of birth of personal contact

28

DAY MONTH YEAR

( ) ( ) ( ) ( ) Go to Part G Go to Part H Go to Part I Go to Part J ✔ Patel Jigar 26-Jan-1982 13/28, Westbury st St Kilda East VIC 3183 0425112782 0425112782 AHS Hospitality Level 3, 255 Burke st Melbourne, VIC 3000

Hospitality Employment agency

Room attendent

cleaning, dusting, moping

(6)

Where do you intend to live?

37

Town/City State/Territory

Part I – Migration visas

Do you intend to do a course of study while in Australia?

38

Name of the institution Name of course

Type of course Yes

No

If you have organised your course, give details below

Do you intend to work in Australia?

39

Yes No

If you have organised your employment, give details below

Type of business Duties Employer’s address POSTCODE Name of employer Occupation/Position

Part J –

Student/Academic/Researcher/Fellows

Give details of your thesis topic and research to be undertaken

40

Do you intend to work in Australia?

41

Yes No

If you have organised your employment, give details below

Type of business Duties Employer’s address POSTCODE Name of employer Occupation/Position Melbourne Victoria ✔

Professional year of Program

(7)

Part K – Additional information

Are there any other details you would like taken into consideration?

43 Part L – Declaration

I declare that:

• the information I have supplied in this application is complete, correct and up-to-date in every detail; and

• I have read and understood the information supplied to me.

44

DAY MONTH YEAR Date

Signature of applicant

WARNING: Giving false or misleading information is a serious offence.

We strongly advise that you keep a copy of this form and all

attachments for your records.

42

Have you ever been denied or refused a visa or entry to another country?

No

Yes Give details

Question

number Additional information ✔