Form
Information regarding
travel sanctions: Fiji
2
About the information you give
The information you provide will be used to determine if you
are subject to Australian Government autonomous travel
restrictions against those responsible for the
December 2006 military coup in Fiji and appointees of Fiji’s
interim Government.
Have you been known by any other names?
(Including name at birth, previous married names, aliases)
No
Yes
Give details
Family name
Making a false or misleading statement in respect of entry to
Australia may result in the refusal of your visa application or, if
a visa has been granted, in the cancellation of your visa.
Given names
The information collected in this form may be provided to
other Australian Government departments and agencies to
determine if the restrictions apply.
Reason for
change
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 for 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 department may disclose information you provide to
other government departments or agencies to assist in
assessing your application or to ensure Australian laws are
complied with.
The information provided might also be disclosed to agencies
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, review of decisions and registration of migration
agents.
The collection, access, storage, use and disclosure by the
department of the information you provide in this form is
governed by the Privacy Act 1988 and, in particular, by the 11
Information Privacy Principles. The information form 993i
Safeguarding your personal information, available from the
offices of the department, gives details of agencies to which
your personal information might be disclosed. Form 993i is
also available from the department’s website
www.immi.gov.au/allforms/
Your details
1380
You must attach supporting evidence eg. certified copy of
birth certificate/marriage certificate.
DAY
3
MONTH
Military background
4
Are you a current member of the Republic of Fiji Military
Forces (RFMF)?
No
Yes
5
Give details at Question 7
Were you formerly a member of the RFMF?
No
Yes
6
7
Give details at Question 7
Are you a current member of the Territorial Forces, or
Reserve Force of the RFMF?
No
Go to Question 8
Yes
Give details at Question 7
Give details of all former and active service with the Full-Time or
Territorial Forces of the RFMF since 5 December 2006. If more space
is required please attach a separate sheet.
DAY
1
YEAR
Date of birth
Your full name
Date commenced
Family name
Full-time or
Territorial Forces
Given names
Rank
MONTH
Full-time
YEAR
Territorial Forces
Unit
DAY
MONTH
YEAR
Date of discharge
© COMMONWEALTH OF AUSTRALIA, 2013
1380 (Design date 11/13) - Page 1
8
Are any of your family members (including spouse, parents, siblings,
children, spouse’s parents or spouse’s siblings) currently a member of
the Regular or Territory Forces of the RFMF?
10 Are you a Minister or deputy Minister in the interim Fiji Government?
No
No
Yes
Yes
Give details
Give details
Position in the
interim government
Family name
DAY
Given names
DAY
Full-time or
Territorial Forces
MONTH
YEAR
Full-time
children, spouse’s parents or spouse’s siblings) currently a Minister or
deputy Minister in the interim Fiji Government?
Territorial Forces
No
Yes
Unit
Family name
Relationship to you
Given names
Have any of your family members (including spouse, parents, siblings,
children, spouse’s parents or spouse’s siblings) ever been discharged
or retired from the Regular or Territory Forces of the RFMF?
Date of birth
No
Position
Give details
1.
MONTH
YEAR
Date
Retired
Given names
DAY
MONTH
YEAR
If insufficient space, attach additional details
This includes as a Permanent Secretary, CEO, Chairman, President or
as a member of the board, committee, council or other body of the
organisation.
Unit
No
Relationship
to you
Yes
DAY
Discharged
Date
Retired
MONTH
YEAR
Give details
Your position
DAY
MONTH
Given names
Declaration
DAY
MONTH
YEAR
13 I declare that the information I have provided in this form is complete
and correct.
I understand that making a false or misleading statement in respect of
entry to Australia may result in the refusal of my visa application or, if a
visa has been granted, in the cancellation of my visa. I understand that
if my visa is cancelled after entry to Australia I will be required to leave.
I authorise the Department of Immigration and Border Protection to release
the information provided in this form to the government departments and
agencies referred to in form 993i Safeguarding your personal information.
Signature
DAY
Date
1380 (Design date 11/13) - Page 2
YEAR
Date of appointment
Family name
Relationship
to you
YEAR
Fiji Government owned or controlled organisation, including a
Government department, a statutory authority, company, board, other
quasi-government entity or the judiciary?
Rank
Unit
MONTH
12 Since 5 December 2006, have you been appointed to a position in a
Date of birth
Rank
DAY
Government appointees
Family name
Date of birth
Give details
Relationship to you
DAY
Discharged
2.
YEAR
11 Are any of your family members (including spouse, parents, siblings,
Rank
Yes
MONTH
Date of appointment
Date of birth
9
Association with the interim Fiji Government
© COMMONWEALTH OF AUSTRALIA, 2013
MONTH
YEAR