section a personal detailspages.ctrip.com/webhome/purehtml/cn/corp/newzealand.pdf · 2020-01-13 ·...

Application forVisiting New Zealand

Section A Personal Details �� !

Principal applicant �� !�� !�� !�� !�� !

Name as shown in passport �� !"#

Family: Given:

Other names you are known by

Your name in ethnic script

Gender Male Female Date of birth

Place and country of birth Place:

Passport details Number:

Your citizenship

Partnership status Married Partner Engaged Widowed

A1

A4

A2

A3

A6

A5

A7

A8

day month year

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Country:

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day month year

Expiry Date:=��

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Number of persons applying on this form:

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Attach one recent passport

size photograph of each appli-

cant included in this applica-

tion form

PLEASE COMPLETE THIS FORM IN ENGLISH �� !"#$%

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for visitor’s visas for limited purpose visas

1

A9�� ! ��

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Additional information Principal applicant, please complete for yourself and on behalf of any accompanying family members.====�� !"#$%&'()*+,-./#0"#$%&'1

A10Name and address of any friends, relatives or contacts I have in New Zealand are:

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Name (��F Relationship E��F

Address E��F

A11

Email E�� !"

My postal address and contact phone number for this application are (please use Chinese characters):

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Address E��F Mobile phone E��F

Telephone E��F =======Fax E��F

Postcode E��

Never married��Separated

��Divorced

Telephone E��F

Telephone E��F

Telephone E��F


Address E��F


Address E��F

E��F

A13

Principal Applicant: Application Details�� !�� !�� !�� !�� !�� !!!!!"""""#####$$$$$%%%%%&&&&&'''''((((()))))*****+++++,,,,,&&&&&''''',,,,,-----...../////

Visitor’s Visa �� !�� !�� !�� !�� !

A14

A15 day month year

A16

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day month year�======�======�

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DO NOT complete this section if you are applying for a Limited Purpose Visa (see questions A17 to A18).�� !"�� !"#$%&�� !"^NRJ^NS�� ^NTJ^NU�

This is the date I will enter or re-enter New Zealand �� !"#$%&'():

This is the date I will finally depart New Zealand �� !"#$%&'()�

I would like a single journey Visitor’s Visa, or �� !"#

I would like a multiple journey Visitor’s Visa �� !"#

The purpose of this application is to visit New Zealand for:

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Tour�� Visiting friends or family �� !==== Marriage ��==== Business ��=====Medical ��

Other Please specify ��

If you wish to apply to study or work in New Zealand please use a study or work application form.

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A12My residential address in my home country is (Please use both English and Chinese characters):

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Telephone E��

I, or one of my family included in the application �� !"#$%&'(

have; or have not previously applied for a visa to go to New Zealand. If “have” please provide details.

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List all periods of employment, including self-employment. (�� !"#$%&'�� !"#$�� !"#�� !F

Limited Purpose Visa �� !"#�� !"#�� !"#�� !"#�� !"#DO NOT complete questions A17 to A18 if you are applying for a Visitor’s Visa.�� !"#$%&'�� !"^NTJ^NU�

Only complete this section, if :

• you are travelling to New Zealand for an “express purpose” and you wish to have a Limited Purpose Permit inNew Zealand, which means that you are not able to apply for any other type of permit in New Zealand or seek tostay longer or indefinitely in New Zealand. If you do not wish to apply for a Limited Purpose Visa, go to Section B.

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I am applying for a Limited Purpose Visa to travel to New Zealand

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2

Name of employer Type of work/Date from(dd/mm/yyyy)

Date to(dd/mm/yyyy)

E�F E�F �� ! L��

occupation/ job title

The limited purpose application is for the “express purpose” of attendance at an event such as a wedding, funeral,conference, seminar, graduation, sports tournament or match, religious event, or other significant ceremony; orMedical treatment in New Zealand; or family emergencies such as illness or accident affecting a family member or relativeof the applicant in New Zealand; or “Milestone” events such as reunions or anniversaries; or

Any other specific purpose other than employment, where the circumstances warrant the issue of a Limited Purpose Visa.

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Please specify the “express purpose”, the date the “express purpose” begins and the date the “express purpose” will becompleted below.�� !"#$�� !"#$�� !"#$%&!"#�

“Express purpose” details �� !"#��

Date begins (�� !F Date completed (�� !F

�� !Section B Family DetailsDetails of spouse and child, even if they are not travelling with you: (Please write on a separate sheet if more than four)

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Passport No

===�� !

Citizenship

====�===�

Date of Birth �� !" Relationship

�====� day � month � year �

B1

Section C Character DetailsHave you or any person included in this application been:

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convicted

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C3

If your “express purpose” is to study in New Zealand, please use the “application to Study in New Zealand” form.

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If applying for a Limited Purpose Visa: �� !"#�� !"#�� !"#�� !"#�� !"#�� !"#

This is the date I will enter New Zealand �� !"#$%&'()�

This is the date I will finally depart New Zealand �� !"#$%&'()�

A18

3

Name as shown in spouse orchild’s passport:�� !"#$%�� !"#

Travelling or not?

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If you have marked Yes to any of the above, please provide details below:�� !"#$%&'�� !�� !"#$%&'�

Have you or any person included in this application undertaken military service in any country?�� !"#$%&'()*+,-./012

Yes No� �

C4Are you or any other person included in this application subject to military service obligationsin any country? �� !"#$%&'()*+,-./0'123

Yes No� �

C5Have you or any other person in this application had association with any group or organisationwho have engaged in or promoted the use of violence to further their aims?�� !"#$%&'()*+,-./0123451678(9'':;�<=>?@A

Yes No� �

C6Have you or any other person in this application had association with any intelligence agency orgroup? �� !"#$%&'()*+,-./0123�456789

Yes No� �



C2�� !

deported Yes No� �

C1 ��

Yes No� � ��

Yes No� �

charged�� !

Yes No� �

under investigation

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Yes No� �

excluded (refused entry)�� !

Yes No� �

removed

for any offence(s) against the law in any country; or�� !"#�� !"#$%&'()*+�

Section D Health Details �� !

Are you, or any person included in the application , pregnant? Yes � No �� !"#$%&'()*+,-./0123

D1

D2

D3 If you have answered Yes to any of the above questions, please provide details below:

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Do you, or any person included in the application, have any of the following medical conditions:�� !"#$%&'()*+,-./012�

• Cancer �� Yes � No �

• Heart disease �� Yes � No �

• A mental, physical or intellectual disability �� !�� !"#$ Yes � No �

• Active tuberculosis (TB) =�� Yes � No �Do you, or any person included in the application, have any medical condition(s) that currentlyrequires, or may require during your intended stay in New Zealand:�� !"#$%&'()*+,�-./0123456789:�

• Renal dialysis �� Yes � No �

• Hospitalisation �� ! Yes � No �

• Residential care * �� ! Yes � No �

How long do you intend to stay in New Zealand?�� !"#$%&'()*+

Are you required to submit a medical certificate? Yes =� (go to question D6)

�� !"#$%&'( ====================No �===== (go to Section E)

mäÉ~ëÉ=êÉ~Ç=íÜÉ=eÉ~äíÜ=oÉèìáêÉãÉåíë=iÉ~ÑäÉíeÉ~äíÜ=oÉèìáêÉãÉåíë=iÉ~ÑäÉíeÉ~äíÜ=oÉèìáêÉãÉåíë=iÉ~ÑäÉíeÉ~äíÜ=oÉèìáêÉãÉåíë=iÉ~ÑäÉíeÉ~äíÜ=oÉèìáêÉãÉåíë=iÉ~ÑäÉí=Ekwfp=NNONF=Ñçê=ÑìêíÜÉê=ÇÉí~áäëK

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Have you submitted a medical certificate with another New Zealand Immigrationapplication in the past 24 months? Yes �= (go to question D7)

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No � (go to question D8)

==========�� aU�Please provide details of the type and date of the previous application:�� !"#�$%&$'()*+�

Type of application: Date of application:�� !� =�� !�

We will advise you if we need you to submit updated health certificates at a later date�� !"#$%&'()�� !"#$%&'()�� !"#$%&'()�� !"#$%&'()�� !"#$%&'()�� !"#$%�� !"#$%�� !"#$%�� !"#$%�� !"#$%

day month year��

If you are planning to stay over six months in News Zealand, have you attached Yes Noa completed Temporary Entry Chest X-ray Certificate (NZIS 1096)�� !"#$%&'()*+,-.�� !"#$%&�� !"#$%�� !"#$%�� !"#$%�� !"#$%�� !"#$%uuuuu��kwfp=NMVS�=�=======�

or �

If you are planning to stay over 12 months in New Zealand, have you attached Yes Noa completed Medical and Chest X-ray Certificate (NZIS 1007)�� !"#$%&'()*+,-./�� !"#$%&�� !"#$�� !"#$�� !"#$�� !"#$�� !"#$uuuuu��kwfp=NMMT�==�=======�

Please Note: All immigration visa and permit holders who access health services in New Zealand should carry acurrent passport to enable health providers to document eligibility status. We strongly recommend that you havecomprehensive health insurance for the duration of your visit. For more informatioin visit the Ministry of Healthwebsite at www.moh.govt.nz�� !"#$%�&'()*+,-./012�� !"#$%&'()*+,-�� !�� !

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D4

D5

D6

D7

D8

D9

4

*Residential care is long-term care provided in a live-in faclity such as an aged person’s facility or a facility for people with a physical or psychiatricdisability and includes 24-hour supervision and nursing care.

Section E DeclarationI understand the questions and contents of this form, and the information I have provided is true and correct.

I understand that if, between the time that I make this application and the time it is decided, or between the time I am issuedwith a visa and the time I travel to New Zealand, any relevant matter relating to the application changes, I am obliged toinform the INZ.

I understand I am responsible for making sure I leave New Zealand before my permit expires and that if I do not I may faceremoval action.

Residents and people holding work permits for a stay of two years or more (and their dependent children) are eligible forpublicly funded health and disability services. Other work permit holders, students, and visitor permit holders generally arenot eligible. People covered by New Zealand’s Reciprocal Health Agreements with Australia and the UK are entitled topublicly funded health care for immediately necessary medical treatment only. I understand that if not entitled to free treatment,I will pay for any health care or medical assistance I or any person included in my application may require in New Zealand.

I authorise INZ to provide information about my state of health and my immigration status to any health service agency. Iauthorise any health service agency to provide information about my state of health to the INZ.

I authorise INZ to make any enquiries it considers necessary in respect of information provided on this form in order to makea decision on this application and enquiries about my subsequent immigration status. I authorise any agency which holdsinformation (including personal information) relevant to those matters to disclose that information to INZ.

If granted a Limited Purpose Permit I understand that I am subject to immediate removal from New Zealand without appealif I fail to leave New Zealand on or before the expiry date of that Permit.

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Note: a parent or guardian may sign on behalf of any children aged under 17 years.�� !" NT�� !"#$%&'()*+

Important NoteIf you are an applicant who is using this form to apply for a Limited Purpose Visa you should have specifically chosen to takethe Limited Purpose Visa option rather than apply for a Visitor’s Visa. You will also have specified an “express purpose” incoming to New Zealand and will understand the limitations of a Limited Purpose Permit compared to a Visitor’s Permit.

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Signature of principal applicant �� !"#

Signature of spouse/partner �� !

Signature of dependent child �� !

Signature of dependent child �� !

5

I understand that after the applicant has signed this form it is an offence to alter or enter further information on it, alter anymaterial attached to it, or attach any further material to it, unless the person making the alteration or addition states on theform what information or material has been altered or attached, why and by whom. I understand that the maximum penaltyfor this offence is a fine of up to NZ$100,000 and/or a term of imprisonment of up to 7 years.�� !"#$%&"#'()*"#'+,-./012345/678901:;<=>?@/A�� !"#$%&

�� !"#$%&'()*+,-./01�� !"#$%&�� !"#$%&'()*+,)-NMMIMMM�� !"

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I certify that I have assisted in the completion of this form and any additional forms at the request of the applicant and that theapplicant understood the content of the form(s) and agreed that the information provided is correct before signing the declaration.I have assisted the applicant as a:�� !��"#$%&�'()*+,-./%&01234015�� !"#$%&'()*+��,-$./01!

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lawyer agent, consultant translator friend or other advisor or representative family member �� !

�� ==�� !�� !" ==�� =======�� !"#$ Please specify �� :

Signature of person assisting �� !"� day month year

�======�======�

Section G Payment Details �� !

Amount enclosed

I am paying by cash. �� ! I am paying by cheque.=�� !

I am paying by post office money order (only available for applications lodged to INZ Beijing & Shanghai branch).�� !�� !"#$%&'()*+,�� !"#$%&'(

I am paying by credit card -- visa or master card (only available for applications lodged to INZ Hong Kong branch)

�� !"=� visa�� !"�� !"#$%&'()*+,-./01234

Collection Details �� !�� !�� !�� !�� !�� !!!!!"""""#####$$$$$%%%%%&&&&&

I wish to collect my documents when ready. �� !"#$%&'()*+,-.

Please return all documents to me by “secure’’ post at the address given in A11. �� !"#$%&'^NN�� !"#$%

Please return all documents to me by EMS courier at the address given in A11 (courier fee prepaid RMB 40---INZ Beijing & Shanghai branch, HK$100---INZ HongKong branch). �� !"#$%&'()*+,^NN�� !"�� !"#$%�

=====�� QM�� !"#$%&'()*+�� !"#�� NMM�� !"#$%&'()*+,-.

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Declaration for Person Assisting the Applicant to Complete This Form

To be completed and signed by any person who has assisted the applicant to complete this form by explaining, translating orfilling in the form for the applicant.�� !"#$%&'�� !"#$%&'()"*+,-./012

Full name of person assisting �� !"�

Address of person assisting �� !"�

Section F

NZIS 1017

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Card number�� !" Expiry Date ��


Name of Cardholder�� !"

6

Type of Card �� !"===Name of Cardholder�� !"

1

2

4

5

6

8

10

12

13

14

15

16

3

7

9

Supplementary Application Form forChinese Visitors, Students and Workers

Please complete this form in English and attach it to your:• Application for a Visitor’s Visa • Application for a work Visa • Application for a Student’s Visa

day month year

day month year

Personal Details

My full name is (surname underlined):

My sex is: Male Female My date of birth is:

I am also known by these names:

My name in my own ethnic script is:

My place of birth was: My country of birth was:

My citizenship is: My Chinese Commercial Code is:

My passport number is: 11 My passport expires on:

My marital status is: please tick box. Married Never Married Separated

Divorced De facto Partnership Engaged Widowed Same Sex Partnership

My residential address and telephone number is:

Address

Telephone

Regular occupation:

Name and address of employer:

Name

Address

Details of spouse and children, even if they are not travelling with you:

Name Relationship to applicant Date of Birth

Spouse

Child 1

Child 2

Child 3

Child 4

11

1

2

3

4

5

6

Application Details

The reason I wish to visit New Zealand is: Please tick box. Work Holiday Study

Visiting friends or relatives Business Conference or convention Transit or stopover

Other (please state):

This is the date I will arrive in New Zealand:

This is the date I will finally depart New Zealand:

Name and address of all friends, relatives or contacts I have in New Zealand are:

Name Relationship to applicant

Address


Address


Address


Address


Address


Address

If studying in New Zealand, my course details are:

If working in New Zealand, my occupation, employer’s name and address will be:

Matters required by Privacy Act

The information about you on this form is collected to determine your eligibility for a temporary Visa or Permit.

The main recipient of the information is the New Zealand Immigration Service of the Department of Labour but it mayalso be shared with other Government agencies, which are entitled to this information under applicable legislation.

The address of the New Zealand Immigration Service is PO Box 3705, Wellington, New Zealand. This is not whereyour application should be sent.

The collection of the information is authorised by the Immigration Act 1987 and the Immigration Regulations 1991. Thesupply of the information is voluntary, but if you do not supply it then your application is likely to be declined.

You will, if you come to New Zealand, have a right to access the information about you held by New Zealand ImmigrationService and to ask for any of it to be corrected if you think that is necessary.

Your application should be sent to your nearest New Zealand Immigration Branch or New Zealand Embassyor High Commission.

I understand the questions and content of this form, and the information given is true and correct:

Signature of applicant

NZIS 1027 December 2005

day month year

day month year

day month year

section a personal detailspages.ctrip.com/webhome/purehtml/cn/corp/newzealand.pdf · 2020-01-13 ·...

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