2021 Residence Visa

Application Form.

Personal details
Details of all passports held
Details of all passports held
Contact details
Your residential address and telephone number in your home country
Your New Zealand residential address and telephone number (if you are already in New Zealand)
Name and address for communication about this form.
Do you authorise the person stated above to act on you behalf?
Do you authorise all other licensed immigration advisers or persons exempt from licensing who work for the organisation named above to act on your behalf (if applicable)?
Have you received immigration advice on this application?
Family Details
Give details of all your family, whether migrating with you or not, including those adopted legally or by custom. It is not necessary to list deceased family members
Parents (biological and adoptive). If both parents are deceased, give details of legal guardians (if any) and/or grandparents
Parents Details
Brothers and sisters (including half-, step- and adopted brothers and sisters).
Brothers and sisters details
Children (including biological, adopted and step-children, including those from previous marriages/relationships).
Children details
Partner's personal details
A partner may be either legally married, or in a civil union, or in a de facto relationship (whether opposite or same sex).
Details of all passports held by your partner
Is your partner included in this application?
Parner's family details
Give details of all your partner’s family, whether migrating with you or not, including those adopted legally or by custom. It is not necessary to list deceased family members
Parents (biological and adoptive). If both parents are deceased, give details of legal guardians (if any) and/or grandparents
Parents details
Brothers and sisters (including half-, step- and adopted brothers and sisters).
Brothers and sisters details
Children (including biological, adopted and step-children, including those from previous marriages/relationships).
Children details
Dependant children
Dependent child one
Dependent child two
Dependent child three
Dependent child four
Character requirements
The following questions apply to every person included in this application 17 years of age and over
List the countries you and/or your family have lived in for 12 months or more in (whether on one visit or intermittently) the last 10 years, with the dates you began and ended living there. If you do not know the exact dates you began and ended living in a country, give approximate dates. Please include your home country.
Have you, or anyone included in this application, been convicted at any time of any offence, including any driving offence? Please note that this includes any conviction(s) outside of New Zealand subsequently cleared or wiped by ‘clean slate’ legislation.
Are you, or is anyone included in this application, currently under investigation for any offence in any country?
Are you, or is anyone included in this application, currently wanted for questioning for any offence in any country?
Are you, or is anyone included in this application, currently facing charges for any offence in any country?
Do you, or does anyone included in this application, currently have an outstanding arrest warrant in any country?
Have you, or has anyone included in this application, ever been excluded from any country, excluding New Zealand?
Have you, or has anyone included in this application, ever been refused entry from any country, excluding New Zealand?
Have you, or has anyone included in this application, ever been removed or deported from any country, excluding New Zealand?
Have you, or has anyone included in this application, ever been a member of, or adhered to, any terrorist organisation?
Have you, or has anyone included in this application, been (or currently are) a member of an organisation or group which had objectives or principles based on hostility against people or groups on the basis of colour, race or ethnic/national origins; or an assumption that persons of a particular race or colour are inherently inferior or superior to other races or colours?
Have you, or has anyone included in this application, had (or currently have) an association with, membership of, or involvement with, any government, regime, group or agency that has advocated or committed war crimes, crimes against humanity and/or other gross human rights abuses?
If you have answered yes to any of the questions in this section, provide full details below. This includes full details of any charges, convictions and the sentence or penalty imposed. Continue on a separate piece of paper if necessary.
Have you, or has anyone included in this application, at any time in a public speech or public comments, or public broadcast, or in publicly distributing or publishing a document, argued that one race or colour is inherently inferior or superior to another race or colour; or used language intended to encourage hostility or ill will against any person or group of persons on the basis of colour, race, or ethnic or national origins of that person or group?
Health requirements
Have you or any other person included in this application submitted a medical certificate (General Medical Certificate (INZ 1007) or Limited Medical Certificate (INZ 1201) and Chest X-ray Certificate (INZ 1096)), completed and dated by a medical practitioner within the last 36 months with another Immigration New Zealand application?

Note: A Limited Medical Certificate (INZ 1201) may only be completed by applicants applying for residence as the partner or dependent child of a New Zealand citizen or resident.
If everyone included in the application has submitted a medical certificate and chest X-ray certificate in the last 36 months you do not need to provide further certificates now, unless:
• the health status of any applicant has deteriorated since their previous medical certificate was issued, or
• any applicant included in your application has spent six consecutive months since their last Chest X-ray Certificate (INZ 1096) was issued, in a country, area or territory not listed as having a low incidence of TB (see the leaflet Health Requirements (INZ 1121) for further information).
If not everyone included in the application has submitted medical certificates that were completed and dated by a medical practitioner within the last 36 months, they will have to provide certificates now
Tick the option(s) below which applies to you:
I am providing a Medical Certificate(s) for
A physician is submitting a medical and/or X-ray certificate for
Has the physician submitting your medical and/or X-ray certificates supplied you with an eMedical Reference Code (NZER)?
If the physician has returned the medical and/or X-ray certificate to you then you will need to submit these with your application.
Do you, or does anyone included in this application, have tuberculosis (TB)?
Do you, or does anyone included in this application have any medical condition that requires, or may require, one of the following during your stay in New Zealand? - Renal dialysis
Do you, or does anyone included in this application have any medical condition that requires, or may require, one of the following during your stay in New Zealand? - Hospital care
Do you, or does anyone included in this application have any medical condition that requires, or may require, one of the following during your stay in New Zealand? - Residential care
*Residential care is defined as in-patient care for people with psychiatric, sensory or intellectual disabilities or live-in facilities for the aged.
Do you have a dependent child included in this application who requires special education services?

2021 Residence Visa

Application Form

Personal details
Details of all passports held
Details of all passports held
Contact details
Your residential address and telephone number in your home country
Your New Zealand residential address and telephone number (if you are already in New Zealand)
Name and address for communication about this form.
Do you authorise the person stated above to act on you behalf?
Do you authorise all other licensed immigration advisers or persons exempt from licensing who work for the organisation named above to act on your behalf (if applicable)?
Have you received immigration advice on this application?
Family Details
Give details of all your family, whether migrating with you or not, including those adopted legally or by custom. It is not necessary to list deceased family members
Parents (biological and adoptive). If both parents are deceased, give details of legal guardians (if any) and/or grandparents
Parents Details
Brothers and sisters (including half-, step- and adopted brothers and sisters).
Brothers and sisters details
Children (including biological, adopted and step-children, including those from previous marriages/relationships).
Children details
Partner's personal details
A partner may be either legally married, or in a civil union, or in a de facto relationship (whether opposite or same sex).