3
Please list any other New Zealand addresses you have lived at in the last 10 years
Street address:
Suburb:
Town/City:
Post Code:
Street ad
dress:
Suburb:
Town/City:
Post Code:
Street ad
dress:
Suburb:
Town/City:
Post Code:
Step 3 Your identification
Please attach a legible photocopy of your identification which must contain your
signature. This can be any one of the following:
New Zealand Driver Licence – can be current or expired within the last 2 years, but cannot be cancelled, defaced or
a temporary licence.
New Zealand Passport – can be current or expired within the last 2 years, but cannot be cancelled or defaced. Must
show your signature.
Overseas Passports – must be current and cannot be expired, cancelled or defaced. Must show your signature.
New Zealand Firearms Licence – must be current and cannot be expired or defaced.
Your RealMe verified identity
If you do not have any of these forms of identification, you will need to complete Step 5.
Step 4 Your authority to release information to a
third party
I authorise the Criminal Records Unit, Ministry of Justice, to release a copy of my criminal convictions, subject to section 7
of the Criminal Records (Clean Slate) Act 2004, to the third party.
I want a copy of the information provided to the third party. Please send via
Email
Post
I do NOT require a copy of the report
Your signature:
Date:
Y Y Y YM M
D D
