OFFICE USE ONLY Client no.

Date received:

Application no.:

INZ 1017

Visitor Visa Application

for a temporary stay in New Zealand Refer to the Visitor Visa Guide
The Visitor Visa Guide (INZ1018) contains important information about the requirements for a visitor visa and how to complete this form. It can be downloaded from www.immigration.govt.nz/forms.

Documents required
Use the checklist on page 2 of this form to find out which documents you must provide. If you have not provided the correct documents, we will return your application.

Including your family

You can use this form to apply for a visa for a single person or a family. Family may include a principal applicant, partner and dependent children under 20.

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 [email protected]. Lawyers provide immigration advice and are exempt from licensing under the Immigration Advisers Licensing Act 2007. 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.

For further information on immigration visit www.immigration.govt.nz

July 2013

When filling in this form, please write clearly using CAPITAL LETTERS.

Application checklist
All applicants must provide: Completed, signed application form. Appropriate fee. Two passport-sized colour photographs for everyone included in the application. Passport or travel document for everyone included in the application. Medical or chest X-ray certificates if required by Section E: Health for everyone included in the application. Evidence of financial support consisting of: a completed Sponsorship Form For Temporary Entry (INZ 1025), or evidence showing you have sufficient funds in your name to support yourself. Evidence that you have the means to leave NewZealand consisting of: a completed Sponsorship Form For Temporary Entry (INZ 1025), or pre-purchased travel out of New Zealand, or evidence showing you have sufficient funds in your name to purchase travel out of New Zealand. If your partner and/or dependent children are included in this application: evidence of your relationship with your partner and evidence that you are currently living together in a genuine and stable partnership and/or evidence that you are the parent or legal guardian of the children included in this application Applicants for specific visa types must provide the documents listed below. Must provide... Applicants who are... Tourists or Evidence that you are visiting family a bona fide visitor, for or friends example: evidence that you intend to return to your home country at the end of your stay evidence that you are genuinely visiting for the purpose of holidaying, sightseeing or visiting family or friends Evidence of your employment Evidence of the business you will undertake in NewZealand

Guardians of students

Dependent children of New Zealand citizens, residents, or temporary visa holders

Evidence that you are the parent or legal guardian of the student you are accompanying and evidence you provided care for the student in your home country. Evidence of your relationship with your parent or legal guardian. If you are a dependent child of an Essential Skills visa holder, evidence that your parent meets the minimum income threshold. If you are a dependent child of a Religious worker visa holder, either: evidence that your parent meets the minimum income threshold, or a completed Sponsorship Form For Religious Workers (INZ 1190) indicating that the religious organisation sponsoring my parent will support me. Sponsorship Form for Temporary Entry (INZ1025) completed by your NewZealand child or grandchild. Evidence of your relationship with your child or grandchild.

Parents and grandparents of New Zealand citizens or residents

Note: Detailed information about the type of documents you should provide in support of your application is available from the Immigration New Zealand branch where your application will be processed. Go to www.immigration.govt.nz/contactus and select the appropriate branch. If your circumstances are not covered in the above list, refer to the Immigration New Zealand website, www.immigration.govt.nz/visit, or the Immigration New Zealand Operational Manual, www.immigration.govt.nz/opsmanual, for information about the documents you must provide.

Returning your documents

Please tick one of the following options Please return all documents to me by secure post at the address given at B3 . I wish to collect my documents when ready.
Note: This option is not available in all branches, see your branch website at www.immigration.govt.nz/contactus to check if you can collect your documents

Visiting for business

2 Visitor Visa Application - July 2013

OFFICE USE ONLY Client no.:

Date received:

Application no.:

Which type of visitor visa are you applying for? General (tourist) Business Dependent child Other

Parent or grandparent

Guardian of a student

Section A

Principal applicants personal details

Attach two colour passport-size photographs of yourself here. The photographs must be less than sixmonths old. Write your full name on the back of both photographs.
For more information about the questions in this section, see Completing SectionsA, C, and D: Personal details in the Visitor Visa Guide.

A1 Name as shown in passport Family/last name A2 Preferred title Mr Mrs Ms Miss Dr Given/first name(s)

4.5cm

4.5cm

3.5cm

3.5cm

other (specify)

A3 Other names you are known by or have ever been known by A4 Gender Male Female A5 Date of birth

A6 Town/city of birth Country of birth A7 Passport details Number Country A8 Other citizenships you hold A9 Partnership status Single Married/in civil union Separated Engaged Partner Widowed Divorced Expiry date

Section B

Contact details

B1 Your current residential address. Telephone (landline) Telephone (mobile) Address

Email B2 If you are currently in New Zealand, your most recent overseas address. Address

Visitor Visa Application - July 2013 3

When filling in this form, please write clearly using CAPITAL LETTERS.

B3 Name and address for communication about this application. Same as address at Family/last name Company name (if applicable) and address
B1

, or

as below Given/first name(s)

Telephone (daytime) Email B4 Do you authorise the person stated at

B3

Telephone (evening)

to act on your behalf?

Yes

No

B5 Have you received immigration advice on this application?

You can find a definition of immigration advice at www.immigration.govt.nz/advice.

Yes No

Make sure that your immigration adviser completes Section J: Immigration advisers details.

B6 Names and addresses of any friends, relatives, or contacts you have in New Zealand (if applicable) Name Address Relationship Name Address Relationship B7 List all periods of employment, including self-employment
Date from (DD/MM/YY) / / / / / / / / / / Date to (DD/MM/YY) / / / / / / / / / / Name of employer Location Type of work/occupation/job title

Date of birth (if known)

Date of birth (if known)

4 Visitor Visa Application - July 2013

Section C

Partners personal details

A9

If you selected Married/in civil union, Partner or Engaged in question or not your partner is travelling with you. If applicable, attach two colour passport-size photographs of your partner here. The photographs must be less than six months old. Write your partners full name on the back of both photographs. C1 Partners name as shown in passport Family/last name C2 Other names your partner is known by or has ever been known by Given/first name(s)

, you must complete this section, whether

4.5cm

4.5cm

3.5cm

3.5cm

For more information about this question, see Completing SectionsA, C, and D: Personal details in the Visitor Visa Guide.

C3 Partners gender

Male

Female

C4 Partners date of birth

C5 Partners town/city of birth Partners country of birth C6 Partners passport details Number Country Expiry date

For more information about this question, see Completing Sections A, C, and D: Personal details in the Visitor Visa Guide.

C7 Other citizenships your partner holds C8 Is your partner included in this application? Yes No

Visitor Visa Application - July 2013 5

When filling in this form, please write clearly using CAPITAL LETTERS.

Section D

Dependent childrens personal details

You must complete this section with the details of each dependent child included in this application. If you wish to include more than four dependent children in your application, use the form Additional Dependants for a Visitor Visa (INZ 1205). Dependent child one Attach two recent colour passport-size photographs of the child here. The photographs must be less than sixmonths old. Write the childs full name on the back of both photographs. D1 Childs name as shown in passport Family/last name
4.5cm 4.5cm

Given/first name(s)

3.5cm

3.5cm

D2 Childs gender

Male

Female

D3 Childs date of birth

D4 Childs country of birth D5 Childs passport details Number Country D6 Other citizenships child holds
For more information about this question, see Completing Sections A, C, and D: Personal details in the Visitor Visa Guide.

Expiry date

Dependent child two Attach two recent passport-size photographs of the child here. The photograph must be less than sixmonths old. Write the childs full name on the back of bothphotographs. D7 Childs name as shown in passport Family/last name
4.5cm 4.5cm

Given/first name(s)

3.5cm

3.5cm

D8 Childs gender

Male

Female

D9 Childs date of birth

D10 Childs country of birth D11 Childs passport details Number Country Expiry date

D12 Other citizenships child holds

6 Visitor Visa Application - July 2013

Dependent child three Attach two recent passport-size photographs of the child here. The photographs must be less than sixmonths old. Write the childs full name on the back of both photographs. D13 Childs name as shown in passport Family/last name
4.5cm 4.5cm

Given/first name(s)

3.5cm

3.5cm

D14 Childs gender

Male

Female

D15 Childs date of birth

D16 Childs country of birth D17 Childs passport details Number Country Expiry date

D18 Other citizenships child holds Dependent child four Attach two recent passport-size photographs of the child here. The photograph must be less than sixmonths old. Write the childs full name on the back of bothphotographs. D19 Childs name as shown in passport Family/last name
4.5cm 4.5cm

Given/first name(s)

3.5cm

3.5cm

D20 Childs gender

Male

Female

D21 Childs date of birth

D22 Childs country of birth D23 Childs passport details Number Country Expiry date

D24 Other citizenships child holds

Visitor Visa Application - July 2013 7

When filling in this form, please write clearly using CAPITAL LETTERS.

Section E

Health

For more information about the questions in this section, see Completing Section E: Health in the Visitor Visa Guide.

E1 Do you or any person included in this application have tuberculosis (TB)?

Yes

No

E2 Do you or any person included in this application have any medical condition that requires, or may require, one of the following during your stay in NewZealand? Yes No Renal dialysis Hospital care Yes No Residential care Yes No Residential care is long-term care provided in live-in facilities for the aged or for people with physical, sensory, intellectual, or psychiatric disabilities. E3 If you have answered Yes to any of the questions in
E1

and

E2

, please provide details.

E4 Are you or any person included in this application pregnant? Yes No

Date the pregnant applicant is due to give birth Go to E6 Go to E5

E5 If the applicant who is pregnant intends to give birth in New Zealand, please indicate how the cost of maternity health services will be paid for and provide the relevant evidence. Not applicable as the applicant who is pregnant does not intend to give birth in New Zealand. The applicant who is pregnant is, or will be eligible for publicly funded maternity health services and has provided evidence of her eligibility. The applicant who is pregnant will cover the cost of maternity health services and has attached copies (not originals) that they have at least NZ$9000 of funds available. The sponsor of the applicant who is pregnant has guaranteed to cover the cost and a completed Sponsorship Form for Temporary Entry (INZ 1025) is attached.

Medical certificates you must provide

Select the appropriate option to indicate whether you and the other people included in this application are required to provide medical certificates. Medical certificates must be less than three months old when you submit them to Immigration New Zealand E6 Are you applying for a parent/grandparent visitor visa? Yes No
You must complete a General Medical Certificate (INZ 1007) and Chest X-Ray Certificate (INZ 1096). Go to E10 . Go to E7 .

E7 Will you be in New Zealand for more than six months in total? Yes No
You may have to provide a General Medical Certificate (INZ 1007) or Chest X-ray Certificate (INZ 1096) if indicated at E8 You do not have to provide a chest X-ray certificate or a medical certificate. Go to Section F: Character

E8 How long do you intend to stay in New Zealand? If you are in New Zealand, this includes time you have already spent here. More than six months but not more than 12 months. You must provide a Chest X-ray Certificate (INZ 1096) if you are from a
place that is not listed as having a low incidence of tuberculosis. See notes below E9 , then go to E10 .

More than 12 months.

You must provide a General Medical Certificate (INZ 1007) and a Chest X-ray Certificate (INZ 1096).

8 Visitor Visa Application - July 2013

E9 Are you applying for a visitor visa as the dependent child of a New Zealand citizen or resident? Yes You may be able to provide a Limited Medical Certificate (INZ 1201) rather than a General Medical Certificate (INZ 1007). Refer to the Visitor Visa Guide (INZ 1018) for further information. See notes below, then go to E10 . No
Notes: Refer to Completing Section E: Health in the Visitor Visa Guide (INZ 1018) for the List of countries, areas and territories with a low incidence of tuberculosis. Pregnant women and children under the age of 11 are not required to have an X-ray, unless a special report is required. You do not need to provide a chest X-ray certificate if you have provided one which was issued less than 36 months ago, with a previous Immigration New Zealand application, unless your health has deteriorated since your previous certificate was issued, or unless you have spent six consecutive months since your previous certificate was issued, in a place not listed as having a low incidence of tuberculosis. You do not need to provide a medical certificate if you have provided one which was issued less than 36 months ago, with a previous Immigration New Zealand application, unless your health has deteriorated since your previous certificate was issued. See notes below, then go to E10 .

E10 Tick the option below which applies to you: I attach both a Chest X-ray Certificate (INZ 1096) and a General Medical Certificate (INZ 1007) or a Limited Medical Certificate (INZ 1201). Go to Section F: Character. I have attached only a Chest X-ray Certificate (INZ 1096) because: I am staying between six to 12 months and I am from, or have visited for more than three months, a place that is not listed as having a low incidence of tuberculosis, or I have previously provided a chest X-ray certificate; however: it was dated by the radiologist more than 36 months ago, or my health has deteriorated since my last certificate was issued, or I have spent six consecutive months since my previous certificate was issued, in a place not listed as having a low incidence of tuberculosis. Go to Section F: Character. I am required to provide a Chest X-ray Certificate (INZ 1096), however, as I am pregnant or under 11 years of age, I am not required to have an X-ray; and: I am not required to provide a General Medical Certificate (INZ 1007) at this stage; or I have therefore provided only a General Medical Certificate (INZ 1007) or a Limited Medical Certificate (INZ1201). Go to Section F: Character. I attach only a General Medical Certificate (INZ 1007) or a Limited Medical Certificate (INZ 1201) because I have previously provided a medical certificate, however: it was dated by the medical examiner more than 36 months ago; or my health has deteriorated since my last certificate was issued.
Go to Section F: Character

I do not have to provide a Chest X-ray Certificate (INZ 1096) and either a General Medical Certificate (INZ 1007) or a Limited Medical Certificate (INZ 1201) at this stage because: I have provided a medical certificate and chest X-ray certificate which were issued less than 36 months ago, with a previous Immigration New Zealand application; and my health has not deteriorated; and I have not spent six consecutive months in a place which is not listed as having a low incidence of tuberculosis since my previous certificate was issued. Go to Section F: Character.

Visitor Visa Application - July 2013 9

When filling in this form, please write clearly using CAPITAL LETTERS.

Section F

Character

All applicants must complete this section. Note: if your application is declined for character reasons, Immigration NewZealand may place a notation in your passport indicating that you applied for a visa for New Zealand.
For more information about the questions in this section, see Completing Section F: Character in the Visitor Visa Guide.

F1 Have you, or any other person included in this application, ever been convicted for any offence(s) against the law in any country, including New Zealand? Yes No

F2 Are you currently: under investigation wanted for questioning facing charges

Yes Yes Yes

No No No

for any offence(s) against the law in any country, including New Zealand? F3 Have you or any other person included in this application been: Yes No deported excluded (refused entry) Yes No refused a visa Yes No Yes No removed from any country? If you have answered Yes to any of the questions in paper if necessary.
F1

to

F3

, provide details below. Continue on a separate piece of

10 Visitor Visa Application - July 2013

Section G

Visa type

G1 Are you outside New Zealand? Yes Estimated date of arrival in New Zealand No Estimated date of departure from New Zealand Estimated date of departure from New Zealand

G2 If you are applying for a visitor visa, what is the purpose of your visit to New Zealand?

G3 If you are applying for a limited visa, what is the express purpose for visiting New Zealand? If you are applying for a further limited visa, also give the reasons why you need to stay in New Zealand for longer.

Date your express purpose starts/started Date your express purpose will be completed
See the Visitor Visa Guide (INZ 1018) for more information about the restrictions imposed on limited visas.

G4 Is your visa application dependent on another person who is either in New Zealand or holds a visa to be in NewZealand? No Yes
Go to Section H: Financial support while you are in New Zealand. Indicate the relationship with the other person. Note you must provide evidence of that relationship.

I am the guardian of a student visa holder. I am the parent or grandparent of a New Zealand citizen or resident who has sponsored me. I am the dependent child of a New Zealand citizen, resident or temporary visa holder. Other (specify)

Please provide details of the other person: Family/last name

Given/first name(s)

Date of birth

Section H

Financial support while you are in New Zealand

For more information about this section and acceptable evidence of funds, see Completing Section H: Financial support while you are in NewZealand in the Visitor Visa Guide.

H1 Are you using your own funds for your visit to New Zealand or are you being sponsored? Own funds attach copies of evidence you have sufficient funds to support yourself and evidence you either have arranged travel out of New Zealand or have sufficient funds* to do so. Sponsored attach completed sponsorship form.

* Sufficient funds for support means at least NZ$1000 per month you intend to stay in New Zealand per person included in your application, or NZ$400 if you have accommodation. Funds must be in your own name.

Visitor Visa Application - July 2013 11

When filling in this form, please write clearly using CAPITAL LETTERS.

Section I

Declaration by applicant

All of the people included in this application must complete this section. I have provided true and correct answers to the questions in this form. I will inform Immigration New Zealand of any relevant fact or change of circumstances (including a change in my employment or partnership status) 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 agree to leave New Zealand before my visa expires. If I remain in New Zealand after my visa has expired, I may be deported by Immigration New Zealand. I agree that if I am not entitled to free health care in New Zealand, I will pay for any health care or medical assistance I may require in New Zealand. 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 authorise Immigration New Zealand to provide information about my health and my immigration status to any health service agency. I authorise any health service agency to provide information about my health to Immigration New Zealand. I authorise Immigration New Zealand to make any necessary enquiries about information on this form and/or accompanying documentation. 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, health care providers, police or other law enforcement agencies, that holds information (including personal information) related to information on this application form and/or accompanying documentation to disclose that information to Immigration New Zealand, so that they can: make a decision on this application answer enquiries about my immigration status once my application has been decided. If I am granted a visa with the condition that I accompany a student, I agree to live with that student. I understand that both the student and I may be liable for deportation if I do not meet this condition. If I am granted a limited visa, I agree that I will leave New Zealand on or before the expiry date of that visa . If I do not leave New Zealand, I may be immediately deported from New Zealand without the right of appeal. I have provided all the documents required by the checklist on page 2. Signature of principal applicant Signature of partner Signature of accompanying dependent children over 18 years of age (if applicable) Child one Child two Child three Child four Date Date Date Date Date Date

Note that a parent or guardian may sign on behalf of a child under 18 years.

12 Visitor Visa Application - July 2013

This form has been approved under section 381 of the Immigration Act 2009

Section J

Immigration advisers details

This section must be completed by the applicants immigration adviser. If the applicant does not have an immigration adviser, this section does not have to be completed. J1 If you are a licensed adviser, please provide your licence details. full provisional limited List conditions specified in the register Licence type Licence number 2 0
Go to Section K: Declaration by person assisting the applicant

J2 If you are exempt from licensing, tick one box below to show why you are exempt from licensing then go to SectionK: Declaration by person assisting the applicant. I provided immigration advice in an informal or family context only, and I did not provide the advice systematically or for a fee. I have provided immigration advice in the course of my work (employed or volunteer) and that work exempts me from the requirement to be licensed. Indicate the reason for your exemption below. Lawyer with current New Zealand practicing certificate New Zealand Member of Parliament or staff Community Law Centre Citizens Advice Bureau New Zealand public servant Foreign Diplomatic/Consular

See www.immigration.govt.nz/adviserlicensing for more information about who is exempt from licensing.

Section K

Declaration by person assisting the applicant

This section must be completed and signed by the applicants immigration adviser, or by any person who has assisted the applicant by providing immigration advice, explaining, translating, or recording information on 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 not exempt under the Immigration Advisers Licensing Act 2007, it is an offence for you to provide immigration advice without holding a license, and Immigration New Zealand will refuse to accept your clients application. More information about immigration adviser licensing can be obtained from the Immigration Advisers Authority website www.iaa.govt.nz, via email [email protected] or by telephone on 0508422422.

Name and address of person assisting applicant. Family/last name

Same as address given at Given/first name(s)

B3

, or

as below.

Company name (if applicable) and address

Telephone (daytime) Fax Email

Telephone (evening)

I understand that after the applicant has signed this form it is an offence to change or add further information, change any documents attached to the form, or attach any further documents to the form. I note 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. However, if changes are needed, the person making the changes must state on the form what information or documents have been changed and give reasons for the changes. 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 J: Immigration advisers details are correct. Signature of person assisting Date
D D M M Y Y Y Y

Visitor Visa Application - July 2013 13

When filling in this form, please write clearly using CAPITAL LETTERS.

14 Visitor Visa Application - July 2013

About the information you provide

Deciding whether you are eligible for a visa
Immigration New Zealand collects the information about you on this form to decide whether you are eligible for a visitor visa or a limited 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.

Section L

Paying your application fee

To find out how much the fee is and where to send your application, use our office and fees finder at www.immigration.govt.nz/fees. Note: some offshore branches do not accept credit cards. The office and fees finder contains information about alternative methods of payment.

Your application fee

Amount you are paying: Currency Application number
(office use only)

Deciding whether you are eligible to board a flight to NewZealand

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 3705, Wellington, New Zealand. This is not where your application should be sent.

Preferred methods of payment

We recommend that you use one of the following methods of payment for better security and faster processing: Bank cheque/bank draft Credit card (choose one) Mastercard SWITCH card (UK only)
Name of cardholder

Visa
SWITCH card issue number

Other documents we may need

Sometimes we may ask for additional documents or information to consider with an 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.

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 card. Expiry date

For more information

If you have questions about completing the form: see our website www.immigration.govt.nz/contactus phone our call centre on 0508 558 855 (within New Zealand).

Signature of cardholder

Date

Other methods of payment

Personal cheque. Note that we will hold your application for
10 working days to allow the cheque to be cleared.

Cash. Our New Zealand branches do not accept cash. Most of our
branches outside New Zealand do not accept cash. person in one of our New Zealand offices.

EFTPOS. Note this option is only available for applications lodged in We do not accept money orders.

Visitor Visa Application - July 2013 15

When filling in this form, please write clearly using CAPITAL LETTERS.

16 Visitor Visa Application - July 2013