Personal Details: Day Month Year

Supplementary Application Form for New Zealand
Immigration Service
Chinese Visitors, Students and Workers Te Ratonga Manene
Application No. For NZIS Use Only
Please complete this form in English and attach it to your:

• Application for a Visitor’s Visa • Application for a Work Visa • Application for a Student’s Visa
Personal Details
1 My full name is (surname underlined):
2 My gender is: Male Female 3 My date of birth is:

day month year
4 I am also known by these names:
5 My name in my own ethnic script is:
6 My place of birth was: 7 My Country of birth was:
8 My citizenship is: 9 My Chinese Commercial Code is:
10 Passport details: Number Expiry date:

day month year
Country
11 My partnership status is: Please tick box Married Never Married Separated Divorced
Partner Engaged Widowed
12 My residential address and telephone number is:

Address
Telephone
13 Regular occupation:
14 Name and address of employer:

Name
Address
15 Details of partner and children, even if they are not travelling with you:
Name Relationship to applicant
Partner
Child 1
Child 2
Child 3
Child 4
day month year
Application Details
1 The reason I wish to visit New Zealand is: Please tick box. Work Holiday Study
Visiting friends or relatives Business Conference or convention Transit or stopover
Other (please state):
This is the date I will arrive in New Zealand:

2
day month year
This is the date I will finally depart New Zealand:
day month year
3 Name and address of any friends, relatives or contacts I have in New Zealand are:
Address
Address
Address
4 If studying in New Zealand, my course details are:
5 If working in New Zealand:

My occupation will be:
My employer’s name is:
My employer’s address is:
Matters required by Privacy Act

The information about you on this form is collected to determine your eligibility for a temporary Visa or Permit. This information
may also be used to determine whether you may board a flight to come to, or return to New Zealand. Your personal information
will not be shared with airline check-in agents, however a boarding message will be returned to the airline check-in agent based
on information you have supplied on this form.
The main recipient of the information is the New Zealand Immigration Service of the Department of Labour but it may also be
shared with other Government agencies, which are entitled to this information under applicable legislation.
The address of the New Zealand Immigration Service is PO Box 3705, Wellington, New Zealand. This is not where your
application should be sent.
The collection of the information is authorised by the Immigration Act 1987 and the Immigration Regulations made under that
Act. The supply of the information is voluntary, but if you do not supply it then your application is likely to be declined.
You will, if you come to New Zealand, have a right to access the information about you held by New Zealand Immigration
Service and to ask for any of it to be corrected if you think that is necessary.
Your application should be sent to your nearest branch of the New Zealand Immigration Service or New Zealand
Embassy or High Commission.
Advance Passenger Screening
• New Zealand has implemented a system designed to enhance the security of New Zealand’s borders. You may be refused
permission to board your flight to come to, or return to, New Zealand if:
• you do not have an appropriate visa to enter New Zealand; or
• your visa has expired; or
• your visa has not been transferred to your current/new passport or the passport being used to enter New Zealand.
• To minimise any disruption to your travel plans please ensure your travel documents are up-to-date and that you have the
appropriate and current visa. if you have any questions check www.immigration.govt.nz
6 I understand the questions and content of this form, and the information given is true and correct:
Signature of applicant day month year

April 2005 This form has been approved under s132(1) Immigration Act 1987 NZIS 1027

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Supplementary Application Form for New Zealand

Application No. For NZIS Use Only

Please complete this form in English and attach it to your:

2 My gender is: Male Female 3 My date of birth is:

4 I am also known by these names:

5 My name in my own ethnic script is:

6 My place of birth was: 7 My Country of birth was:

8 My citizenship is: 9 My Chinese Commercial Code is:

10 Passport details: Number Expiry date:

12 My residential address and telephone number is:

14 Name and address of employer:

This is the date I will arrive in New Zealand:

Name Relationship to applicant

4 If studying in New Zealand, my course details are:

5 If working in New Zealand:

My employer’s name is:

My employer’s address is:

Matters required by Privacy Act

Signature of applicant day month year

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