Additional personal particulars information

Form

1221

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.

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

Part A Your details

1
Your full name (as shown in your passport or travel document) Family name Given names

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.

Patel
Bhaul

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.

Other names you are, or have been, known by (including name at birth, previous married names, aliases)

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

DAY

MONTH

YEAR

4 5

Date of birth Place of birth Town/City Country

14-Apr-1982

Home page www.immi.gov.au General Telephone 131 881 during business hours enquiry line in Australia to speak to an operator (recorded
information available outside these hours). If you are outside Australia, please contact your nearest Australian mission.

Hirpura, Vijapur, Mehsana India

6 7

Sex

Male

Female

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

Citizenship or nationality (give details of all held)

Indian
DAY MONTH YEAR

Date granted Place granted

14-Apr-1982
India

COMMONWEALTH OF AUSTRALIA, 2009

1221 (Design date 07/09) - Page 1

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

Part B Travel details

14 Details from your passport
Passport number

13/28, Westbury St
St Kilda East

E0541903
India
DAY MONTH YEAR

VIC

POSTCODE

3183

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

10 Address for correspondence

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

26-Dec-2001
25-Dec-2011

Ahmedabad

POSTCODE

11 Your residential address in Australia (if known)

13/28, Westbury st St Kilda East VIC
POSTCODE

15 Other travel document details

3183

12 Your contact details

COUNTRY CODE AREA CODE ( ( ) ) NUMBER

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

migrant/refugee visitor OR Are you applying for: permanent residency a further temporary stay protection temporary resident student/academic

Office hours After hours Fax number E-mail addresses

( (

) )

0430459933
0430459933

bharat007patel@hotmail.com
If insufficient space give details at Question 43

17 Visa subclass you are applying for 13 Do you agree to the department communicating with you by fax, e-mail
or other electronic means? No Yes Fax number E-mail address Give details
COUNTRY CODE ( ) ( AREA CODE ) NUMBER

485

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

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.

bharat007patel@hotmail.com

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

DAY MONTH YEAR

Date of arrival Flight/Ship details

20 How long do you intend to stay in Australia?

DAY MONTH YEAR DAY MONTH YEAR

From

01-Jun-2010

to

31-Dec-2012

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COMMONWEALTH OF AUSTRALIA, 2009

21 Give details of each place you intend to stay in Australia, including the
length and purpose of each stay 1. Place you intend to stay

Part C Employment details

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

Melbourne
Purpose of stay 1. From

01-Dec-2008

to

18/05/2010

Further study + Job

DAY MONTH YEAR DAY MONTH YEAR

Name of employer

Borgcraft Pty Ltd

Employers address From

01-Jun-2010

to

31-Dec-2012

31-33, Slough Rd Altona VIC

Type of business
POSTCODE

2. Place you intend to stay Purpose of stay

3018

Pastry manufacturing
Occupation/Position

Process worker
DAY MONTH YEAR DAY MONTH YEAR

From 3. Place you intend to stay Purpose of stay

to

Duties

Pick-packing, general cleaning, lifting

DAY

MONTH

YEAR

DAY

MONTH

YEAR

2. From

01-Jun-2009

to

18-May-2010

Name of employer

Drake International
DAY MONTH YEAR DAY MONTH YEAR

From 4. Place you intend to stay Purpose of stay

to

Employers address

479, Warrigal Rd

Moorabbin
POSTCODE

Type of business

Employment Agency
Occupation/Position
DAY MONTH YEAR DAY MONTH YEAR

On-call casual stock taker

Duties

From

to

If insufficient space give details at Question 43

RF Scanning, Stock moving

22 Are you funding your trip?

No Give details of the person/institution funding your trip Full name 3. From
DAY MONTH YEAR DAY MONTH YEAR

01-May-2008

to

18-May-2010

Name of employer Name of institution (if applicable) Address

Peter Rowland Catering Pty ltd

Employers address

8, River st

South Yarra
VIC
POSTCODE POSTCODE

3141

Type of business

Telephone number
COUNTRY CODE ( ) ( AREA CODE ) NUMBER

Catering
Occupation/Position

On-call casual Stacker

Duties

Yes

Filling of drinks,spirits bottles

COMMONWEALTH OF AUSTRALIA, 2009

1221 (Design date 07/09) - Page 3

DAY

MONTH

YEAR

DAY

MONTH

YEAR

3. Institution and city

4. From

01-Jun-2008

to

18-May-2010

Name of employer

GTE Workplacement
Employers address

Qualification Main subjects or duties

POSTCODE

4/20, Commercial road

Melbourne

VIC
Type of business

3004
Year of award

Employment Agency
Occupation/Position

On-call Casual Stock-taker

Duties

4. Institution and city

RF scanning
Qualification

If insufficient space give details at Question 43

Main subjects or duties

Part D Education and trade qualifications

24 Give details of all post secondary qualifications
(list your most recent experience first)
1. Institution and city

Year of award

If insufficient space give details at Question 43

Swinburne University of Technology

Qualification

25 Describe any workshops, training, conferences or seminars you have

attended in the last 2 years

M.I.T(Professional computing)
Main subjects or duties

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.

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

Year of award

2009
2. Institution and city

Shree U.V.Patel College of Engg

Qualification

B.E.I.T
Main subjects or duties

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

c, c++, database, Software Engg

Year of award

2004

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COMMONWEALTH OF AUSTRALIA, 2009

Part E Details of your personal contact in Australia

27 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)? No Yes Go to Part F Family name

Part G Visitor visa

33 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

Patel
Given names

Jigar

28 Date of birth of
personal contact

DAY

MONTH

YEAR

26-Jan-1982

Part H Business visas

34 Intended employment details
Name of employer

29 Current residential address of your personal contact

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

13/28, Westbury st St Kilda East

VIC
POSTCODE

Employers address

3183
POSTCODE NUMBER

30 Personal contacts telephone numbers

COUNTRY CODE AREA CODE ( ( ) )

Type of business Occupation/Position Duties

Office hours After hours

( (

) )

0425112782 0425112782

31 Personal contacts current employment details

Name of employer

AHS Hospitality
Employers address

Level 3, 255
Burke st

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

Melbourne, VIC
Type of business

3000

No Yes 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

Hospitality Employment agency

Occupation/Position

Room attendent
Duties

cleaning, dusting, moping

Part F Details of your journey to Australia

32 Only complete the section(s) relevant to you
If you: have applied for a Visitor visa have applied for a Business visa have applied for a Migration visa are a student, academic, researcher or fellow Go to Part G Go to Part H Go to Part I Go to Part J
COMMONWEALTH OF AUSTRALIA, 2009 1221 (Design date 07/09) - Page 5

36 Do you intend to inspect and/or negotiate the purchase of any equipment

during your stay in Australia? No Yes Give details

Part I Migration visas

37 Where do you intend to live?
Town/City

Part J Student/Academic/Researcher/Fellows
40 Give details of your thesis topic and research to be undertaken

Melbourne

State/Territory Victoria

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

No Yes If you have organised your course, give details below Name of course

Professional year of Program

Name of the institution

Navitaas
Type of course

39 Do you intend to work in Australia?

No Yes If you have organised your employment, give details below

Name of employer

Employers address

POSTCODE

Type of business Occupation/Position Duties

41 Do you intend to work in Australia?

No Yes If you have organised your employment, give details below

Name of employer

Employers address

POSTCODE

Type of business Occupation/Position Duties

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COMMONWEALTH OF AUSTRALIA, 2009

Part K Additional information

42 Have you ever been denied or refused a visa or entry
to another country? No Yes Give details

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

44 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.
Signature of applicant
DAY MONTH YEAR

43 Are there any other details you would like taken into consideration?
Question number Additional information

Date 18-May-2010

We strongly advise that you keep a copy of this form and all attachments for your records.

COMMONWEALTH OF AUSTRALIA, 2009

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