Form 842: Application for an Offshore Humanitarian visa – Main applicant

Main Applicant’s Full Name: _______________________________________________

‘Relationship Status’ Codes ‘Relationship to Main Applicant’ Codes

N Never married or in a de facto relationship PB Biological Parent
‘Status in Country of Residence’ Codes
M Married legally PA Adoptive Parent
C Citizen
E Engaged to be married PS Step Parent
PR Permanent Resident
S Separated PO Parent Other
TR Temporary Resident
F In a de facto relationship SB Biological Sibling (Full sibling)
S Student
D Divorced SA Adoptive Sibling
V Visitor/Tourist
W Widowed SS Step Sibling
R Refugee
MT Married by tradition/custom SO Sibling Other (Eg. Half siblings)
I Illegal Resident
MR Married religiously CB Biological Child
A Asylum/protection applicant
CA Adoptive Child
O Other – give details on separate page
CS Step Child
CO Child Other

Form 842- Question 14: Relatives of Main Applicant

Give details of all your parents, brothers, sisters, and non-dependent children. Include all relatives, even if they are deceased or their whereabouts are
unknown.

Full Name Mother’s Sex Date of Relationship Place and Relationship to Country Status in
Maiden birth Status (use Country of main Applicant where they Country of
Name (if the codes Birth (use the codes are now living Residence
applicable) above) (Country, above) (“deceased” (use codes
province, or “unknown” above)
town) if applicable)
 Form 842- Question 15: Relatives of Main Applicant’s Partner
Give details of all your partner’s parents, brothers, sisters, and non-dependent children. Include all of your partner’s relatives, even if they are deceased
or their whereabouts are unknown.

Full Name Mother’s Sex Date of Relationship Place and Relationship to Country Status in
Maiden birth Status (use Country of main Applicant where they Country of
Name (if the codes Birth (use the codes are now living Residence
applicable) above) (Country, above) (“deceased” (use codes
province, or “unknown” above)
town) if applicable)

Form 842- Question 24: List of residential addresses

Please include every address in which you have lived during the last ten years

Address you currently live in Town Country Date you started Names of other people included in
to live in this this application who lived at that
address address (if all, write “ALL”)
(dd/mm/yyyy)

Past Addresses Town Country Date you started Names of other people included in
to live in this this application who lived at that
address address (if all, write “ALL”)
(dd/mm/yyyy)
Form 842- Question 25: Religion, ethnic group and political groups

Please give details of your ethnicity, political affiliation and religion (if any).

Ethnic group Religion Membership of political

party/group

Form 842- Question 33: Travel history

Please give details of every country that you have travelled through or stayed at before arriving in the country where you are now living.

Country Date of arrival Date of exit

Form 842- Question 38: Employment history

Please fill out your employment history, including all the jobs that you have had in the last 15 years. Start with your current job and keep going
backwards in time. If you were unemployed for a period of time, please write “UNEMPLOYED”.

Date Date Name of employer Location of Type of Business Occupation and Main Duties
employment employment employer
started finished
(dd/mm/yyyy) (dd/mm/yyyy)
Form 842- Question 40: Education history

Please fill out your education history

Primary school Secondary school Post-secondary Highest educational qualification obtained

education (for example: primary school certificate,
secondary school certificate, Bachelor’s
degree, trade certificate)
Date of Date of Date of Date of Date of Date of
start finish start finish start finish
Form 842- Question 39: Language skills

Please give details of your language skills

Main Language Spoken Other Languages Spoken How well does this person speak
English (REFER TO CODES)

English language codes

1 Very well (can speak English with few errors)
2 Well (can speak English well enough to deal with basic situations)
3 Not Well (can only speak English a little bit)
4 Not At All

Form 842- Question 40: Education history

Please fill out your education history

Primary school Secondary school Post-secondary Highest educational qualification obtained

education (for example: primary school certificate,
secondary school certificate, Bachelor’s
degree, trade certificate)
Date of Date of Date of Date of Date of Date of
start finish start finish start finish