Fillable Residence Application INZ 1000 under Family Category, Residence (Accident Compensation Corporation New Zealand)

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Residence Application INZ 1000 under Family Category, Residence (Accident Compensation Corporation New Zealand)

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OFFICE USE ONLY Client no.: Date received: / / Application no.:
July 2021
Residence
Application
INZ 1000
under Family Category, Residence from Work Category, and special instructions
immigration.govt.nz
Use the guide to help you complete the application form
For help completing this form, please refer to the Residence Guide (INZ 1002).
Immigration Advisers Licensing Act 2007
Under the Immigration Advisers Licensing Act 2007 it is an offence to provide immigration advice without being
licensed or exempt. If your immigration adviser is not licensed when they should be, Immigration New Zealand will
return your application.
For more information and to view the register of licensed advisers, go to the Immigration Advisers Authority website
www.iaa.govt.nz or email info@iaa.govt.nz.
Lawyers provide immigration advice and are exempt from licensing under the Immigration Advisers Licensing Act.
For more information and to view the register of immigration lawyers, go to the New Zealand Law Society website
www.lawsociety.org.nz.
When filling in this form, please write clearly in English using CAPITAL LETTERS.
Residence category/instructions you are applying under
Which residence category are you applying under?
Family
Pacific Access Category
Refugee Family Support Category
Residence from Work
Samoan Quota Scheme
Employees of a Relocating Business Category
South Island Contribution
Other (Specify)
If you are applying under the Family: Partnership Category or the Family: Dependent Child Category, answer the
followingquestion.
Is your partner or parent an expatriate New Zealander?
Yes
No
An ‘expatriate New Zealander’ is a New Zealand citizen or resident class visa holder, who has been living outside of
NewZealand for at least two years before the date of this application (apart from short visits back to New Zealand).
For partnership applications, the New Zealand partner and principal applicant must:
• have been living together for 12 months or more at the time of lodgement of the application;
• be in a genuine and stable relationship; and
• be able to provide evidence to support the above.
2 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
Section A
Principal applicant’s personal details
All principal applicants must complete this section.
Attach two passport-size photographs of yourself here. The photographs must be less than six months old.
Writeyour full name on the back of the photographs.
For more information about the questions in this section, see
‘Completing Section A: Principal applicant’s personal details’
in the Residence Guide.
A1
Name as shown in passport
Family/last name
Given/first name(s)
A2
Preferred title Mr Mrs Ms Miss Dr
Other (specify)
A3
Other names you are known by or have ever been known by
A4
Your name in ethnic script
A5
Gender Male Female
A6
Date of birth
D M Y YD M Y Y
A7
Town/city of birth
Country of birth
A8
Other citizenships you hold
A9
Partnership status:
Single Separated Partner/De facto
Divorced
Married/in civil union Engaged
Widowed
For definition of partner, see ‘Completing Section D: Partner’s personal details’ in the Residence Guide.
A10
What is your main occupation?
A11
Details of all passports held
Passport 1
Number
Country
Expiry date
D M Y YD M Y Y
Issue date
D M Y YD M Y Y
Place of issue
Family/last name as shown in passport Given/first name(s) as shown in passport
Passport 2
Number
Country
Expiry date
D M Y YD M Y Y
Issue date
D M Y YD M Y Y
Place of issue
Family/last name as shown in passport Given/first name(s) as shown in passport
4.5cm
3.5cm
4.5cm
3.5cm
Residence Application – July 2021 – 3
When filling in this form, please write clearly using CAPITAL LETTERS.
Passport 3
Number
Country
Expiry date
D M Y YD M Y Y
Issue date
D M Y YD M Y Y
Place of issue
Family/last name as shown in passport Given/first name(s) as shown in passport
Section B
Contact details
All principal applicants must complete this section.
For more information on the questions in this section see ‘Completing Section B: Contact details’ in the Residence Guide.
B1
Your residential address and telephone number in your home country
Address
Telephone (daytime)
Telephone (evening)
Fax
Email
B2
Your New Zealand residential address and telephone number (if you are already in New Zealand)
Address
Telephone (daytime)
Telephone (evening)
Fax
Email
B3
Name and address for communication about this application
Same as address at
B1
, or
Same as address at
B2
, or
Other
Name of contact person
Organisation name (if applicable) and address
New Zealand Business Number (if applicable)
For help search: www.nzbn.govt.nz
Telephone (daytime) Telephone (evening)
Fax
Email
B4
Do you authorise the person stated at
B3
to act on your behalf?
Yes
No
B5
Do you authorise all other licensed immigration advisers or persons exempt from licensing who work for the
organisation named at
B3
to act on your behalf (if applicable)?
Yes Note: the person identified at
B3
will receive all communication from Immigration New Zealand.
No Only the person indicated at
B3
may act on my behalf.
B6
Have you received immigration advice on this application?
You can find a definition of immigration advice at www.immigration.govt.nz/advice.
Yes Make sure that your immigration adviser completes Section R: Immigration adviser’s details.
No
4 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
Section C
Principal applicant’s family details
C1
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.
For definition of partner, see ‘Completing Section D: Partner’s personal details’ in the Residence Guide.
Note: if you do not declare all your family members, your residence application could be declined. If you are granted residence and it is later
found that all family members were not declared, you may become liable for deportation. In addition, any family members not declared may
not be eligible for residence.
Parents (biological and adoptive). If both parents are deceased, give details of legal guardians (if any) and/or grandparents.
Full name Gender
(M/F)
Date of birth
(DD/MM/YY)
Partnership status
(e.g. single, married,
partner/de facto, etc.)
Country of residence
/ /
/ /
/ /
/ /
/ /
/ /
Brothers and sisters (including half-, step- and adopted brothers and sisters).
Full name Gender
(M/F)
Date of birth
(DD/MM/YY)
Partnership status
(e.g. single, married,
partner/de facto, etc.)
Country of residence
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
Children (including biological, adopted and step-children, including those from previous marriages/relationships).
Full name Gender
(M/F)
Date of birth
DD/MM/YY
Partnership status
(e.g. single, married,
partner/de facto, etc.)
Country of
residence
Does the person
intend to migrate
with you? (Y/N)
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
Residence Application – July 2021 – 5
When filling in this form, please write clearly using CAPITAL LETTERS.
Section D
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).
For more information on the questions in this section see ‘Completing Section D: Partner’s personal details’ in the Residence Guide.
Attach two passport-size photographs of your partner here.
The photographs must be less than six months old. Writeyour
partner’s full name on the back of the photograph.
D1
Partner’s name as shown in passport
Family/last name
Given/first name(s)
D2
Partner’s preferred title
Mr
Mrs Ms Miss Dr
Other (specify)
D3
Other names your partner is known by or has ever been known by
D4
Partner’s name in ethnic script
D5
Partner’s gender
Male
Female
D6
Date of birth
D M Y YD M Y Y
D7
Partner’s town/city of birth
Partner’s country of birth
D8
Other citizenships your partner holds
D9
Details of all passports held by your partner
Passport 1
Number
Country
Expiry date
D M Y YD M Y Y
Issue date
D M Y YD M Y Y
Place of issue
Family/last name as shown in passport Given/first name(s) as shown in passport
Passport 2
Number
Country
Expiry date
D M Y YD M Y Y
Issue date
D M Y YD M Y Y
Place of issue
Family/last name as shown in passport Given/first name(s) as shown in passport
4.5cm
3.5cm
4.5cm
3.5cm
6 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
Passport 3
Number
Country
Expiry date
D M Y YD M Y Y
Issue date
D M Y YD M Y Y
Place of issue
Family/last name as shown in passport Given/first name(s) as shown in passport
D10
Is your partner included in this application?
Yes
You must provide evidence of your relationship as described in ‘Completing Section D: Partner’s personal details’ in the
Residence Guide (INZ 1002).
No
Section E
Partner’s family details
E1
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.
For definition of partner, see ‘Completing Section D: Partner’s personal details’ in the Residence Guide.
Note: if you do not declare all your partner’s family members, your residence application could be declined. If you are granted residence
and it is later found that all family members were not declared, you may become liable for deportation. In addition, any family members
not declared may not be eligible for residence.
Parents (biological and adoptive). If both parents are deceased, give details of legal guardians (if any) and/or grandparents.
Full name Gender
(M/F)
Date of birth
(DD/MM/YY)
Partnership status
(e.g. single, married,
partner/de facto, etc.)
Country of residence
/ /
/ /
/ /
/ /
/ /
/ /
Brothers and sisters (including half-, step- and adopted brothers and sisters).
Full name Gender
(M/F)
Date of birth
(DD/MM/YY)
Partnership status
(e.g. single, married,
partner/de facto, etc.)
Country of residence
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
Residence Application – July 2021 – 7
When filling in this form, please write clearly using CAPITAL LETTERS.
Children (including biological, adopted and step-children, including those from previous marriages/relationships).
Full name Gender
(M/F)
Date of birth
DD/MM/YY
Partnership status
(e.g. single, married,
partner/de facto, etc.)
Country of
residence
Does the person
intend to migrate
with you? (Y/N)
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
8 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
Section F
Dependent children
Supply the following details for each dependent child included in this application. Please ensure that you complete
F49
(atthe end of thissection). If you have no dependent children included in this application, go to Section G
Character requirements.
For more information on the questions in this section see ‘Completing Section F: Dependent children’ in the Residence Guide.
Dependent child one
Attach two recent passport-size photographs of the child
here.The photographs must be less than six months old.
Write the child’s full name on the back of the photographs.
F1
Child’s name as shown in passport
Family/last name
Given/first name(s)
F2
Child’s gender
Male
Female
F3
Child’s date of birth
D M Y YD M Y Y
F4
Child’s country of birth
F5
Child’s passport details
Number
Country
Expiry date
D M Y YD M Y Y
F6
Other citizenships child holds
F7
Partnership status For a definition of partnership, see Completing Section D: Partner’s personal details’ in the Residence Guide
(INZ 1002). A person is single if they are not living with a partner in a genuine and stable partnership.
Single Separated Partner/De facto
Divorced
Married/in civil union Engaged
Widowed
F8
Does this child have children of his/her own?
Yes
No
Dependent child two
Attach two recent passport-size photographs of the child
here. The photographs must be less than six months old.
Write the child’s full name on the back of the photographs.
F9
Child’s name as shown in passport
Family/last name
Given/first name(s)
F10
Child’s gender
Male
Female
F11
Child’s date of birth
D M Y YD M Y Y
F12
Child’s country of birth
4.5cm
3.5cm
4.5cm
3.5cm
4.5cm
3.5cm
4.5cm
3.5cm
Residence Application – July 2021 – 9
When filling in this form, please write clearly using CAPITAL LETTERS.
F13
Child’s passport details
Number
Country
Expiry date
D M Y YD M Y Y
F14
Other citizenships child holds
F15
Partnership status
Single Separated Partner/De facto
Divorced
Married/in civil union Engaged
Widowed
F16
Does this child have children of his/her own?
Yes
No
Dependent child three
Attach two recent passport-size photographs of the child
here. The photographs must be less than six months old.
Write the child’s full name on the back of the photographs.
F17
Child’s name as shown in passport
Family/last name
Given/first name(s)
F18
Child’s gender
Male
Female
F19
Child’s date of birth
D M Y YD M Y Y
F20
Child’s country of birth
F21
Child’s passport details
Number
Country
Expiry date
D M Y YD M Y Y
F22
Other citizenships child holds
F23
Partnership status
Single Separated Partner/De facto
Divorced
Married/in civil union Engaged
Widowed
F24
Does this child have children of his/her own?
Yes
No
4.5cm
3.5cm
4.5cm
3.5cm
10 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
Dependent child four
Attach two recent passport-size photographs of the child
here. The photographs must be less than six months old.
Write the child’s full name on the back of the photographs.
F25
Child’s name as shown in passport
Family/last name
Given/first name(s)
F26
Child’s gender
Male
Female
F27
Child’s date of birth
D M Y YD M Y Y
F28
Child’s country of birth
F29
Child’s passport details
Number
Country
Expiry date
D M Y YD M Y Y
F30
Other citizenships child holds
F31
Partnership status
Single Separated Partner/De facto
Divorced
Married/in civil union Engaged
Widowed
F32
Does this child have children of his/her own?
Yes
No
Dependent child five
Attach two recent passport-size photographs of the child
here. The photographs must be less than six months old.
Write the child’s full name on the back of the photographs.
F33
Child’s name as shown in passport
Family/last name
Given/first name(s)
F34
Child’s gender
Male
Female
F35
Child’s date of birth
D M Y YD M Y Y
F36
Child’s country of birth
F37
Child’s passport details
Number
Country
Expiry date
D M Y YD M Y Y
F38
Other citizenships child holds
F39
Partnership status
Single Separated Partner/De facto
Divorced
Married/in civil union Engaged
Widowed
F40
Does this child have children of his/her own?
Yes
No
4.5cm
3.5cm
4.5cm
3.5cm
4.5cm
3.5cm
4.5cm
3.5cm
Residence Application – July 2021 – 11
When filling in this form, please write clearly using CAPITAL LETTERS.
Dependent child six
Attach two recent passport-size photographs of the child
here. The photographs must be less than six months old.
Write the child’s full name on the back of the photographs.
F41
Child’s name as shown in passport
Family/last name
Given/first name(s)
F42
Child’s gender
Male
Female
F43
Child’s date of birth
D M Y YD M Y Y
F44
Child’s country of birth
F45
Child’s passport details
Number
Country
Expiry date
D M Y YD M Y Y
F46
Other citizenships child holds
F47
Partnership status
Single Separated Partner/De facto
Divorced
Married/in civil union Engaged
Widowed
F48
Does this child have children of his/her own?
Yes
No
Give details of any additional dependants on the form Additional Dependants for Residence in New Zealand
(INZ1001), and attach it to this page.
F49
Are you separated or divorced from the parent of any of the above children or is the parent of any of the above
children not included in this application?
Yes You must provide evidence. See ‘Completing Section F: Dependent children’ in the Residence Guide.
No
4.5cm
3.5cm
4.5cm
3.5cm
12 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
Section G
Character requirements
The following questions apply to every person included in this application 17 years of age and over.
For more information about the questions in this section, see ‘Completing Section G: Character requirements’ in the Residence Guide.
G1
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.
Name of applicant or family member
Name of country
Date of arrival
D M Y YD M Y Y
Date of departure
D M Y YD M Y Y
Name of applicant or family member
Name of country
Date of arrival
D M Y YD M Y Y
Date of departure
D M Y YD M Y Y
Name of applicant or family member
Name of country
Date of arrival
D M Y YD M Y Y
Date of departure
D M Y YD M Y Y
Name of applicant or family member
Name of country
Date of arrival
D M Y YD M Y Y
Date of departure
D M Y YD M Y Y
G2
Have you attached police certificates for each person aged 17 years and over included in your application from
all countries you have lived in for 12 months or more (whether on one visit or intermittently) in the last 10 years?
Yes
No
Have you attached police certificates for each person aged 17 years and over included in your application from
your country/countries of citizenship?
Yes
No
If you have not provided all of the police certificates required, please explain why.
Applicants under the Partnership or Dependent Child Categories only: if a police certificate is not attached
to this application because it was previously submitted with a temporary entry visa application, provide details.
The certificate must be less than 24 months old when this application is lodged.
Name of applicant or family member
Type of application
Date of application
D M Y YD M Y Y
Name of applicant or family member
Type of application
Date of application
D M Y YD M Y Y
Residence Application – July 2021 – 13
When filling in this form, please write clearly using CAPITAL LETTERS.
Name of applicant or family member
Type of application
Date of application
D M Y YD M Y Y
Name of applicant or family member
Type of application
Date of application
D M Y YD M Y Y
For information on how to obtain a police certificate you can visit our website at www.immigration.govt.nz/policecertificate. If you do not
have access to the internet you can call us on 0508 55 88 55 if you are in New Zealand, or (09) 914 4100 if you are in Auckland; or contact
yournearest Immigration New Zealand office.
G3
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.
Yes
No
G4
Are you, or is anyone included in this application, currently:
• under investigation
Yes
No
• wanted for questioning
Yes
No
• facing charges
Yes
No
for any offence in any country?
G5
Do you, or does anyone included in this application, currently have an outstanding arrest warrant in any country?
Yes
No
G6
Have you, or has anyone included in this application, ever been:
• excluded
Yes
No
• refused entry
Yes
No
• removed or deported
Yes
No
from any country, excluding New Zealand?
G7
Have you, or has anyone included in this application, ever been a member of, or adhered to,
any terrorist organisation?
Yes
No
G8
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?
Yes
No
G9
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?
Yes
No
G10
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?
Yes
No
14 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
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.
Section H
Health requirements
H1
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?
Yes
Provide details in the table below
No A medical certificate (General Medical Certificate (INZ 1007) or Limited Medical Certificate (INZ 1201)) and Chest X-ray Certificate
(INZ1096) must be provided for every person included in this application. Go to
H2
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.
Full name Type of application
Date application was lodged
DD/MM/YY
1.
/ /
2.
/ /
3.
/ /
4.
/ /
5.
/ /
6.
/ /
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).
Otherwise we will tell you if you need any further medical information.
Go to
H2
.
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.
Go to
H2
.
Residence Application – July 2021 – 15
When filling in this form, please write clearly using CAPITAL LETTERS.
H2
Tick the option(s) below which applies to you:
• I do not have to provide any medical certificates or chest X-ray certificates at this stage.
Go to
H4
• I am providing a Medical Certificate(s) for
principal applicant
partner
child(ren). Go to next section
• I am providing a Chest X-ray Certificate(s) (INZ 1096) for
principal applicant
partner
child(ren).
Go to
next section
• A physician is submitting a medical and/or X-ray certificate for
principal applicant partner child(ren).
Go to
H3
H3
Has the physician submitting your medical and/or X-ray certificates supplied you with an eMedical Reference
Code (NZER)?
Yes Enter your eMedical Reference Code(s) here: __________________________________________ Go to next section
No Enter the name of the clinic submitting your health information: _________________________ Go to next section
If the physician has returned the medical and/or X-ray certificate to you then you will need to submit these
with your application.
H4
Do you, or does anyone included in this application, have tuberculosis (TB)?
Yes
No
H5
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
Yes
No
• Hospital care
Yes
No
• Residential care
*
Yes
No
*Residential care is defined as in-patient care for people with psychiatric, sensory or intellectual disabilities or live-in facilities for the aged.
H6
Do you have a dependent child included in this application who requires special education services?
(See Completing Section H: Health requirements in the Residence Guide (INZ 1002) for further information).
Yes
No
H7
If you have answered Yes to any of the questions in
H4
to
H6
, provide further details.
16 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
Checklist for sections A to H
The Immigration regulations in New Zealand require that we only accept residence applications for consideration that
include the documents below. Complete the following checklist to ensure that you have included all these documents.
OFFICE
USE
ONLY
Information and documents you must supply
CHECK
LIST
I have completed and signed the application form.
I have provided current passport(s) or certificate(s) of identity (original documents or certified copies) for every person included
in this application.
I have attached two passport-sized photographs of every person included in this application.
I have attached full birth certificate(s) for every person included in this application.
I have attached the application fee and immigration levy
I or my physician have submitted a General Medical Certificate (INZ 1007) (less than three months old) for every applicant if required.
I or my physician have submitted a Chest X-ray Certificate (INZ 1096) (less than three months old) for every applicant if required.
I or my physician have submitted a Limited Medical Certificate (INZ 1201) (less than three months old) for every applicant if required.
I have attached police certificate(s) (less than six months old) for every person included in this application.
Sections I to R set out the information and documents required for your application to be considered under the
Residence from Work Category, Family Category, Refugee Family Support Category, Pacific Access Category, Samoan
Quota Scheme, or Employees of a Relocating Business Category. You must provide ALL the information requested for
the category you are applying under as outlined in the Residence Guide (INZ 1002).
Failure to provide any of the documents outlined above or the information required for Sections J to P may result
in your application being returned.
• If you are applying under Residence from Work Category (including the South Island Contribution resident visa)
go to Section I: Residence from Work Category.
• If you are applying under Family: Partnership Category go to Section J: Family: Partnership Category.
• If you are applying under Family: Dependent Child Category go to Section K: Family: Dependent Child Category.
• If you are applying under Refugee Family Support Category go to Section L: Refugee Family Support Category.
• If you are applying under Pacific Access Category go to Section M: Pacific Access Category.
• If you are applying under Samoan Quota Scheme go to Section N: Samoan Quota Scheme.
• If you are applying under Employees of a Relocating Business Category go to Section O: Employees of a Relocating
Business Category
Section I
Residence from Work Category
For more information about the questions in this section, see Completing Section I: Residence from Work Category in the Residence Guide.
I1
Which Work to Residence option below was your work visa approved for?
Long Term Skill Shortage List Talent (Accredited Employer)
Talent (Arts and Culture)
Talent (Sports) Religious Worker South Island Contribution
I2
Are you currently in New Zealand?
Yes
No You must be in New Zealand to lodge a residence application under the Residence from Work Category.
I3
What date was your work visa first granted? (If your work visa was granted while you were outside NewZealand
give the date you first arrived in New Zealand on that visa.)
D M Y YD M Y Y
I4
What is the expiry date of your work visa?
D M Y YD M Y Y
I5
Have you held a Talent, South Island Contribution, or Long Term Skill Shortage List work visa for at least
24months? Yes No
Residence Application – July 2021 – 17
When filling in this form, please write clearly using CAPITAL LETTERS.
English language requirement for partner and dependants and Religious Worker applicants
I6
Partners and dependent children aged 16 and over are required to meet English language requirements or
prepurchase ESOL tuition.
Partners and dependent children included in applications for a South Island Contribution resident visa do not
need to meet English language requirements or prepurchase ESOL tuition.
Indicate how your partner or dependent child(ren) aged 16 or over will meet English language requirements or
whether they will preprurchase ESOL tuition. Write “N/A” or “not applicable” if no one else aged 16 or over is
included in your application.
For more information, see our leaflet English Language Information (INZ 1060).
Name of partner or dependant Meets minimum standard of English?
Yes - list evidence provided with application No - intends to
prepurchase ESOL
tuition
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
I7
Principal applicants under Religious Worker instructions are required to meet a minimum standard of English.
Please list below the evidence you have provided with your application to demonstrate you meet the minimum
standard of English required for your application:
Long Term Skill Shortage List, Talent (Accredited Employer), and South Island Contribution applicants go to
I8
.
Talent (Arts, Culture and Sports) applicants go to
I12
.
Religious Worker applicants go to
I15
.
To be completed by Long Term Skill Shortage List, Talent (Accredited Employer), and South
Island Contribution applicants
I8
Give details of your employer(s) since your Long Term Skill Shortage List, Talent (Accredited Employer), or South
Island Contribution work visa was granted.
Employer one
From
D M Y YD M Y Y
To
D M Y YD M Y Y
Name and address of employer
New Zealand Business Number (if applicable)
For help search: www.nzbn.govt.nz
Type of business
Position held
Base salary
$
Contact name and position
18 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
Telephone (daytime) Fax
Email
Employer two
From
D M Y YD M Y Y
To
D M Y YD M Y Y
Name and address of employer
New Zealand Business Number (if applicable)
For help search: www.nzbn.govt.nz
Type of business
Position held
Base salary
$
Contact name and position
Telephone (daytime) Fax
Email
If you have more employer details to provide, please include them on a separate sheet.
I9
Is registration required in New Zealand to practise in the occupation you are employed in?
Yes Do you have a current registration certificate?
Yes
No
No
I10
Talent (Accredited Employer) applicants only. Have you been employed by an accredited employer (or another
INZ-approved employer) in New Zealand for at least 24 months?
Yes
No
I11
Long Term Skill Shortage List applicants only. Have you been employed in an occupation on the Long Term Skill
Shortage List for at least 24 months?
Yes
No
I12
South Island Contribution applicants only. Have you been employed in a full-time role of at least 30 hours per
week, in the region and industry that was specified on your visa?
Yes
No
Evidence you must provide
Attach evidence (see the Residence Guide) of:
• employment in New Zealand since you were granted your Long Term Skill Shortage List, Talent (Accredited
Employer), or South Island Contribution work visa
• full or provisional New Zealand registration if registration is required for your occupation (refer to the Long Term
Skill Shortage List)
• For Long Term Skill Shortage and Talent (Accredited Employer) applicants only: current ongoing employment that
meets the NZ$55,000 minimum base salary requirement (per annum)
• For South Island Contribution applicants only: current ongoing employment or an offer of employment in the region
and industry specified on your South Island Contribution work visa.
Long Term Skill Shortage, Talent (Accredited Employer) and South Island Contribution applicants go to Section P: Declaration.
Residence Application – July 2021 – 19
When filling in this form, please write clearly using CAPITAL LETTERS.
To be completed by Talent (Arts, Culture and Sports) applicants
I13
Have you attached a Talent (Arts, Culture and Sports) Sponsorship Form (INZ 1091) sponsoring you for residence?
Yes
No
I14
Have you or any person included in this application applied for or been granted any form of welfare assistance
or benefits in New Zealand since you were granted your Talent work visa?
Yes
No
I15
Do you consent to INZ seeking confirmation from Work and Income that you have not applied for or been granted
welfare assistance or benefits during this time? (If No, your application may be declined.)
Yes
No
Evidence you must provide
Also attach evidence (see the Residence Guide) of:
• active engagement in your field over a period of 24 months in New Zealand including a completed Summary
of Earnings form from the IRD
• your continued prominence in your field
• how your continued presence in New Zealand will enhance New Zealand’s accomplishments and participation
in arts, culture or sport.
Talent (Arts, Culture and Sports) applicants go to Section P: Declaration
To be completed by Religious Worker instructions applicants
I16
Have you been employed by a religious organisation as a religious worker on a Religious Worker work visa
for at least three years?
Yes
No
I17
Have you or any person included in this application applied for or been granted any form of welfare assistance
or benefits in New Zealand since you were granted a work visa under Religious Worker instructions?
Yes
No
I18
Do you consent to INZ seeking information from Work and Income that you, or any other person included
in this application, have not applied for any form of welfare assistance or benefits during this time?
(If No, your application may be declined)
Yes
No
Evidence you must provide
Also attach evidence to support your resident visa application under Religious Worker instructions (see the Residence
Guide), including:
• a completed Sponsorship Form for Religious Workers (INZ 1190), and
• evidence of the sponsoring organisation’s financial ability to sponsor you for five years,
• an employment agreement or a description of the religious work from the sponsoring organisation, and
• evidence of a long-term need for a religious worker with the sponsoring organisation.
Religious Worker applicants go to Section P: Declaration.
20 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
Section J
Family: Partnership Category
Partnership means either legally married, or in a civil union, or in a de facto relationship (whether opposite
or same sex).
For more information about the questions in this section, see ‘Completing Section J: Family Category Partnership Instructions’ in the
Residence Guide.
J1
New Zealand partner’s family name or surname
New Zealand partner’s first name or given names
J2
This person is my:
spouse
partner
J3
If married, what was the date of your marriage and in what country did this marriage take place?
Country
Date
D M Y YD M Y Y
J4
If in a civil union, what was the date of your civil union? Date
D M Y YD M Y Y
J5
If in a de facto relationship, when did your relationship begin? Date
D M Y YD M Y Y
J6
How long have you been living together in this partnership? You must have lived together for 12 months or more
to be eligible for a visa under this category.
Years
Months
Are you living in a genuine and stable relationship (entered into with the intention of being maintained
on a long-term and exclusive basis)?
Yes
No
If you are not living together, please explain.
J7
Do you meet the minimum requirements for recognition of partnerships?
Yes
No
J8
Is your partner eligible to support you?
Yes
No
J9
Is your partner a New Zealand citizen?
Yes
No
J10
Does your partner hold a New Zealand residence class visa? Yes
No
J11
Does your partner hold a valid Australian passport? Yes No
Residence Application – July 2021 – 21
When filling in this form, please write clearly using CAPITAL LETTERS.
Evidence you must provide
You must provide:
• details of your New Zealand partner in sections D and E
• a Partnership Support Form for Residence (INZ 1178) completed by your partner
• evidence of your relationship as described in the Residence Guide at Completing Section K: Family:
Partnership Category.
Your partner (if 17 years of age or over) must provide police certificate(s) for all countries that they have lived in
for 12months or more in the 10 years prior to the date the application is made. However, your partner does not
need to provide a police certificate from New Zealand (we will obtain this on their behalf if required).
The onus is on you to provide as much evidence as possible to show you and your partner are living together
in a genuine and stable partnership.
Family: Partnership Category applicants go to Section P: Declaration.
Section K
Family: Dependent Child Category
For more information about the questions in this section, see ‘Completing Section K: Family Category: Dependent Child Instructions’
in the Residence Guide.
K1
Are you aged 17 or under?
Yes
No
K2
Are you aged 18 to 20 years, with no children?
Yes
No
K3
Are you aged 21 to 24 years, with no children and totally or substantially reliant on an adult (whether your
parent or not) for financial support, whether living with them or not?
Yes
No
K4
Are you the dependent child of a person who is a New Zealand citizen or residence class visa holder and
who is living in NewZealand?
Yes
No
K5
Are you single? Note that single means you are not living together with a partner in a genuine and
stable relationship.
Yes
No
Evidence you must provide
You must provide evidence of your relationship to your New Zealand resident or citizen parent(s).
Family: Dependent Child Category applicants go to Section P: Declaration.
22 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
Section L
Refugee Family Support Category
For more information about the questions in this section, see ‘Completing Section L: Refugee Family Support Category Instructions’
in the Residence Guide.
L1
Which tier of the Refugee Family Support Category do you want to apply under?
Tier one Go to
L2
Tier two Go to
L3
L2
Tick the box that applies to you (tier one applicants only):
My sponsor has no immediate family in New Zealand
My sponsor is the sole carer of a dependent relative(s) in New Zealand on an ongoing basis. My sponsor has
no other immediate family in New Zealand (excluding their dependent relative or relatives being cared for).
The dependent relative also has no other immediate family in New Zealand (excluding my sponsor).
Note that if your sponsor is eligible under tier one on the basis that they are a sole carer, you must provide evidence that they are a sole carer.
L3
Supply the following details about your sponsor:
Your sponsor’s registration reference number
Your sponsor’s name
Your sponsor’s date of birth
D M Y YD M Y Y
Evidence you must provide
You must provide evidence of your relationship to your sponsor, and their immigration status.
Refugee Family Support Category applicants go to Section P: Declaration.
Section M
Pacific Access Category
For more information about the questions in this section, see ‘Completing Sections M and N: Pacific Access Category/Samoan Quota Scheme’
in the Residence Guide.
M1
Supply your registration reference number
M2
Do you have an offer of employment in New Zealand? Yes You must submit evidence of your employment offer.
No
Evidence you must provide
You must submit evidence of your offer of employment.
Pacific Access Category applicants go to Section P: Declaration.
Section N
Samoan Quota Scheme
For more information about the questions in this section, see ‘Completing Sections M and N: Pacific Access Category/Samoan Quota Scheme’
in the Residence Guide.
N1
Please supply your registration reference number
N2
Do you have an offer of employment in New Zealand? Yes You must submit evidence of your employment offer.
No
Evidence you must provide
You must submit evidence of your offer of employment.
Samoan Quota Scheme applicants go to Section P: Declaration
Residence Application – July 2021 – 23
When filling in this form, please write clearly using CAPITAL LETTERS.
Section O
Employees of a Relocating Business Category
English language requirements apply to every person 16 years of age and over who is included in an application
under Employees of a Relocating Business Category.
Principal applicants must meet the minimum standard of English. Partners or dependent children included in this
application may either show that they meet the minimum standard of English or pre-purchase English language tuition.
For more information about the questions in this section, see ‘Completing Section O: Employees of a Relocating Business Category’.
O1
Does the principal applicant meet the minimum standard of English?
For more information, see our booklet English Language Information [INZ 1060]
Yes List evidence provided with your application.
No Your application cannot be approved.
O2
Partners and dependent children
Name of partner or dependant Meets minimum standard of English?
Yes - list evidence provided with application No - intends to
prepurchase ESOL
tuition
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
O3
Trading name and address of business in New Zealand.
New Zealand Business Number (if applicable)
For help search: www.nzbn.govt.nz
O4
Your role/involvement in the business
24 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
O5
Your educational qualifications
Date obtained
(DD/MM/YY)
Qualification Educational institution (if applicable)
/ /
/ /
/ /
/ /
/ /
/ /
O6
Your work experience
Date from
(DD/MM/YY)
Date to
(DD/MM/YY)
Organisation Position
/ / / /
/ / / /
/ / / /
/ / / /
O7
Are you eligible for residence under any other category?
See the Self-Assessment Guide for Residence in NewZealand (INZ 1003) for eligibility requirements for other residence categories.
Yes Your application cannot be approved under the Employee of a Relocating Business Category
No
O8
Have all businesses you have had significant influence over complied with all immigration, employment and
taxation laws?
Significant influence includes, but is not limited to, control of management and administrative functions when acting as a director or
seniormanager.
Yes
No Provide details
O9
Have you ever been investigated by the Serious Fraud Office or the New Zealand Police for any offences arising in
the course of, or resulting from, business dealings?
Yes Provide details
No
O10
Have you ever been involved in business fraud or financial impropriety?
Yes Provide details
No
Residence Application – July 2021 – 25
When filling in this form, please write clearly using CAPITAL LETTERS.
Evidence you must provide
Attach evidence (see the Residence Guide) of:
A letter to Immigration New Zealand from the Chief Executive Officer (CEO) of the relocating business that
• explains why the business is relocating and what the benefits will be to New Zealand; and
• provides details of the employee(s) to be relocated explaining why they are not eligible for approval under
any of the other categories of residence instructions.
The relocation of the business must be supported by New Zealand Trade and Enterprise (NZTE). INZ will consult
with NZTE to determine their support of your application.
Section P
Declaration
This section must be signed by the principal applicant and any partner and dependent children aged 18 years
and over who are included in the application. Make sure you understand the declarations below before you
sign them.
For more information about the declaration, see Section ‘Completing Section P: Declaration’ in the Residence Guide.
I understand that if I make any false statements, or provide any false or misleading information, or have changed
or altered this form in any way, my application may be declined, or I may become liable for deportation.
I understand the notes and questions in this form and I declare the information given about myself, my partner
andany children is true and complete.
I declare that I have listed all my family members, including any adopted by custom and my grandparents or legal
guardians (if any) if both my parents are deceased, and understand that the non-declaration of any family members
may result in that family member not being recognised as part of my family in future applications.
I will inform Immigration New Zealand of any relevant fact or change of circumstances that may (i) affect the
decision on my application for a visa, or (ii) affect the decision to grant entry permission based on the visa for
whichIamapplying.
I am aware that convictions for certain criminal offences committed up to 10 years after first being granted
aresidence class visa can result in deportation from New Zealand.
I declare that there are no matters or warrants outstanding, or investigations of any kind, which could have any
current or future effect on the assessment of my good character or the good character of any other persons included
in this application.
I understand that if I have received immigration advice from an immigration adviser and if that immigration adviser
is not licensed under the Immigration Advisers Licensing Act 2007 when they should be, Immigration New Zealand
willreturn my application.
I understand that Immigration New Zealand may provide information about my entitlement to work to potential
employers via the online VisaView system. VisaView is authorised by legislation.
I authorise INZ to make any enquiries it deems necessary in respect of the information provided on this form and/or
accompanying documentation, and to share this information with other government agencies (including overseas
agencies) to the extent necessary to make decisions about my immigration status.
I authorise any agency whether in New Zealand or overseas, including but not limited to border or immigration
agencies, education providers, financial institutions, foreign embassies, government authorities, healthcare
providers, police or other law enforcement agencies, that holds information (including personal information)
relatedto information on this form and/or accompanying documentation to disclose that information to Immigration
NewZealand.
I authorise INZ to provide information about my state of health and my immigration status to any health service
agency. I authorise any health service agency to provide information about my state of health to INZ.
I accept that any advice given to me by INZ before lodging this application was intended to assist me, and acting
onthat does not mean that my application for residence will be approved.
I understand that in order to work in certain occupations in New Zealand, registration is required by law. I accept
thatthe granting of a residence class visa does not guarantee that registration will be granted.
26 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
I have sufficient personal resources to maintain myself and my dependants for at least my first 24 months as a
resident in New Zealand. (This does not apply to applicants under the Refugee Family Support Category, applicants
under the Family categories or whose sponsor has been recognised as a refugee, applicants under the Family:
Partnership Category or Family: Dependent Child Category, or applicants under the Religious Worker instructions.)
The personal resources I will use are (tick at least one):
my cash and assets
a verified definite offer of employment in New Zealand (evidence attached).
I agree that information about my personal resources and the contents of this form may be provided to Work and
Income (a service unit of the Ministry of Social Development) if I apply for an emergency benefit. I understand that
I will need to give a copy of this declaration to Work and Income if I apply for an emergency benefit.
I understand that I am not entitled to an emergency benefit, unemployment benefit on grounds of hardship
or sickness benefit on grounds of hardship from Work and Income for the first 24 months of my residence in
New Zealand unless I can show that I am in hardship. I also understand that if I apply for an emergency benefit,
unemployment benefit on grounds of hardship or sickness benefit on grounds of hardship that I will need to show
that I cannot support myself and my dependants before any application for emergency benefit, unemployment
benefit on grounds of hardship or sickness benefit on grounds of hardship is considered. I understand that my
application for an emergency benefit, unemployment benefit on grounds of hardship or sickness benefit on grounds
of hardship may be declined if I have deprived myself of income or property, by gift or any other method.
If my application is approved under the Talent (Arts, Culture and Sports) Instructions, I agree that the Ministry
of Social Development may provide INZ with:
• any information concerning welfare assistance that I (or any other person included in my application for residence)
have applied for, or have been granted, during the five years in which my residence in New Zealand is supported, and
• any information that I provide to the Ministry of Social Development about my sponsor.
Should my residence application be approved under Religious Worker instructions, I understand that my resident
visa will be subject to the condition, under Section 55 of the Immigration Act 2009, that my sponsor must meet the
obligations they agreed to in the Sponsorship Form for Religious Workers (INZ 1190) for five years. If my sponsor fails
to meet their obligations, I understand I may be liable for deportation. I agree that the Ministry of Social Development
may provide INZ with:
• any information concerning welfare assistance that I (or any other person included in my application for residence)
have applied for, or have been granted, during the five years in which my residence in New Zealand is supported,
and for the period since I was granted a work visa under Religious Worker immigration instructions, and
• any information that I provide to the Ministry of Social Development about my sponsor.
Should my residence application be approved under the Talent (Arts Sport and Culture) Instructions, I understand
that my resident visa will be subject to the condition under section 55 of the Immigration Act 2009 for two years,
that my sponsor must meet the obligations they agreed to in the Talent (Arts, Culture and Sports) Sponsorship Form
(INZ1091). If my sponsor fails to meet their obligations, I understand I may become liable for deportation.
Signature of principal applicant
Date
D M Y YD M Y Y
Signature of partner Date
D M Y YD M Y Y
Signature of parent or guardian if principal applicant is under 18 years of age
Date
D M Y YD M Y Y
Signatures of accompanying dependent children over 18 years of age (if applicable)
Child one
Date
D M Y YD M Y Y
Child two Date
D M Y YD M Y Y
Child three Date
D M Y YD M Y Y
Child four Date
D M Y YD M Y Y
Child five Date
D M Y YD M Y Y
This form has been approved under section 381 of the Immigration Act 2009
Residence Application – July 2021 – 27
When filling in this form, please write clearly using CAPITAL LETTERS.
Child six Date
D M Y YD M Y Y
Child seven Date
D M Y YD M Y Y
Child eight Date
D M Y YD M Y Y
Child nine Date
D M Y YD M Y Y
Child ten Date
D M Y YD M Y Y
Section Q
Immigration adviser’s details
This section must be completed by the applicant’s immigration adviser. If the applicant has authorised all
advisers within an organisation to act on their behalf at
B5
, only the person named at
B3
must complete this
section. If the applicant does not have an immigration adviser, this section does not have to be completed.
Q1
Tick the one option that applies to you.
I am a licensed immigration adviser under the New Zealand Immigration Advisers Licensing Act 2007. Go to
Q2
I am exempt from licensing under the New Zealand Immigration Advisers Licensing Act 2007. Go to
Q3
If you are unlicensed when you should be licensed under the Immigration Advisers Licensing Act 2007, Immigration New Zealand
will return your client’s application. It is an offence to provide immigration advice without holding a licence, unless you are exempt.
Q2
Licensed advisers. Please provide your licence details.
Licence type
full
provisional
limited. List conditions specified in the register.
Licence number
2 0
Go to Section R: Declaration by person assisting the applicant.
Q3
Exempt from licensing. Tick one box below to show why you are exempt from licensing.
I provided immigration advice in an informal or family context only, and I did not provide the advice
systematically or for a fee.
I am a New Zealand member of Parliament or member of their staff and I provided immigration advice
as part of my employment agreement.
I am a foreign diplomat or consular staff.
I am an employee of the New Zealand public service and I provided immigration advice within the scope
of my employment agreement.
I am a lawyer and I hold a current practising certificate as a barrister or as a barrister and solicitor of the
High Court of New Zealand.
I am employed by, or I am working as a volunteer for, a New Zealand community law centre where at least one
lawyer is on the employing body of the community law centre or is employed by or working as a volunteer for
the community law centre in a supervisory capacity.
I am employed by, or I am working as a volunteer for, a New Zealand citizens advice bureau.
Go to Section R: Declaration by person assisting the applicant.
28 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
Section R
Declaration by person assisting the applicant
This section must be completed and signed by the applicant’s immigration adviser, or by any person who has
assisted the applicant by providing immigration advice, explaining, translating, or filling in the form for the
applicant. If the applicant does not have an immigration adviser, and no one helped the applicant to fill in this
form, this section does not have to be completed.
If you are unlicensed when you should be licensed under the Immigration Advisers Licensing Act 2007, Immigration New Zealand will return
your client’s application. It is an offence to provide immigration advice without holding a licence.
For more information, go to the Immigration Advisers Authority website www.iaa.govt.nz, or email info@iaa.govt.nz or write to them
at POBox6222, Wellesley Street, Auckland 1141, New Zealand.
Name and address of person assisting applicant  Same as name and address given at
B3
, or  as below.
Family/last name Given/first name(s)
Organisation name (if applicable) and address
New Zealand Business Number (if applicable)
For help search: www.nzbn.govt.nz
Telephone (daytime)
Telephone (evening)
Fax Email
I understand that after the applicant has signed this form it is an offence for me to change or add further information,
or change or add any documents attached to the form, without making a statement identifying what information or
material has been changed, added or attached and by whom. If I make these changes or additions, I must state on the
form what they were, who made them and the reason they were made.
I understand that the maximum penalty for this offence is a fine of up to NZ$100,000 and/or a term of imprisonment
of up to seven years.
I certify that the applicant asked me to help them complete this form and any additional forms. I certify that the
applicant agreed that the information provided was correct before signing the declaration.
I have assisted the applicant as an interpreter/translator
I have assisted the applicant with recording information on the form
I have assisted the applicant in another way. Specify
I have provided immigration advice (as defined in the Immigration Advisers Licensing Act 2007) and my details
in Section Q: Immigration adviser’s details, are correct.
Signature of person assisting
Date
D M Y YD M Y Y
Residence Application – July 2021 – 29
When filling in this form, please write clearly using CAPITAL LETTERS.
About the information you provide
Immigration New Zealand collects the information
about you on this form to decide whether you are
eligible for a resident visa. We may also use the
information to contact you for research purposes
or to advise you on immigration matters.
Collecting the information is authorised by the
Immigration Act 2009 and the Immigration
Regulations
made under that Act. You do not have
toprovide the information, but if you do not we are
likely to decline your application.
It is an offence to employ a person who is not
entitled to work in New Zealand. One way for
employers to avoid committing this offence is
to check a person’s entitlement to work with
Immigration New Zealand’s online VisaView system.
VisaView is authorised by legislation.
If you believe that an employer has been given
the wrong entitlement information via VisaView
you may contact the Immigration Contact
Centre (0508 558 855) to request correction
of that information.
Deciding whether you are eligible to board
a flight to New Zealand
The information we collect may also be used
to determine whether you are allowed to board
aflight to New Zealand.
We will not share your personal information with
airline check-in agents; however, we will send a
boarding message to the airline check-in agent
based on the information you have provided in
thisform.
Immigration New Zealand may also share
the information you have provided with other
government agencies that are entitled to it by
law, or with other agencies (as you have agreed
in the declaration).
You are able to ask for the information we hold
about you and have any of it corrected if you
think it is necessary. The address of Immigration
New Zealand is PO Box 1473, Wellington 6140,
New Zealand. This is not where your application
should be sent.
Other documents we may need or you may wish
to send
We may ask for additional documents or information
so that we can consider it with this application.
You may wish to send other documents or
information so that we can consider it with this
application. Send photocopies only (not original
documents), as these documents will not be
returned to you. If we need to see an original
document, we will ask you to produce it later.
Application checklist
Office
Use
only
Information and documents you must supply
Check
list
I have completed the application form.
Each person included in the application has signed the form
.
I have provided the application fee and immigration levy.
I have attached passports or travel documents (the original
documents or certified copies) for each person included in
the application.
I have attached full birth certificates for every person included
in the application.
I have attached medical certificates and chest X-ray certificates
for all applicants if required.
I have attached police certificate(s) (less than six months old)
for every person included in this application.
I have attached two recent passport-size photographs of each
person included in the application.
I have attached the required evidence as outlined in sections I
to O, and in the Residence Guide (INZ 1002).
Returning your documents
Please return documents to me by secure post at the
address given at:
B1
B2
B3
For more information
If you have questions about completing the form:
• see our website www.immigration.govt.nz/contactus
• telephone our call centre on 0508 558 855
(within NewZealand).
30 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
Residence Application – July 2021 – 31
When filling in this form, please write clearly using CAPITAL LETTERS.
Section S
Paying your application fee
and immigration levy
To find out how much to pay, payment methods, where to
send your application, and how long a decision may take,
see www.immigration.govt.nz/fees.
Your application fee and immigration levy
Amount you are paying:
Amount
Currency
(e.g. NZD, USD, RMB)
Application number
(office use only)
Credit/debit card details
Mastercard
Visa
Name of cardholder
Card number
CVC/CVV number
Note: Your CVC/CVV number is the three-digit number found on the
signature strip on the back of your credit/debit card.
Expiry date
D M Y YD M Y Y
Signature of cardholder
Date
D M Y YD M Y Y
32 – Residence Application – July 2021
When filling in this form, please write clearly using CAPITAL LETTERS.
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Residence Application INZ 1000 under Family Category, Residence (Accident Compensation Corporation New Zealand)

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Completed 17 October 2021

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