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Private and Confidential
All questions must be answered.
Please fill in a separate form for you and your spouse if he/ she may be considered as the Principal Applicant.

Your Personal Details: (as it appears on your passport)
Applicant Name
 
First name *  :   Middle Name  :
Last Name *  :        
Present Address *  :  
Permanent Address  :
Telephone #: Residence *  :   Office  :
Mobile *  :   Fax  :
E-mail *  :     Date of Birth *  :  
Gender*  :
 
Marital Status*  :
 
Present Citizenship *  :        
Country of Residence  : Occupation with current designation  :
 

Spouse Details:
Name  : Date of Birth  :
Country of Birth  :      
Country of Citizenship  : Occupation with current designation  :
Do you have any children  :
     
 

Children’s Details:
 
Name Gender Age
   
   
   
   
Educational Background

(Starting with S.S.C standard onwards)

Month & Year
of Passing

Name of the Institution
( School/ College/ University)

 No. of years
completed		 Name of the Certificate/Diploma/Degree  Received

Certificate/Diploma/ Degree

Full Time/ Part Time/ Correspondence
           
           
           
           
    
Spouse’s Educational Background:
 

(Starting with S.S.C standard onwards)

Month & Year
of Passing

Name of the Institution
( School/ College/ University)

 No. of years
completed		 Name of the Certificate/Diploma/Degree  Received

Certificate/Diploma/ Degree

Full Time/ Part Time/ Correspondence
           
           
           
           
    
Trade / Technical / Vocational School / Apprenticeship
 

Month & Year
of Passing

Name of the Institution
( School/ College/ University)

 No. of years
completed		 Name of the Certificate/Diploma/Degree  Received

Certificate/Diploma/ Degree

Full Time/ Part Time/ Correspondence
           
           
           
           
 
Detailed Work Experience (Since your 18th birthday)
Please provide your resume in detail with job responsibilities separately
Full Time Positions, starting with Current Job
 
From To Name of The Employer Position
Month Year Month Year
       
       
       
       
       
       
 
Arranged Employment :

Do you have an offer of employment from a New Zealand Company, if so provide details.
 
Relatives :
Do you or your spouse have any relatives who live in New Zealand with
Permanent Residency status? (YES / NO)   :
Relationship (brother/sister/parents) :
Address  :
Telephone :
Will your relative undertake to provide you with accommodation / financial guarantee for your stay in
New Zealand after your arrival? :  
 
Language Ability:
  English
Have you completed the all your studies in English Medium?
     
Have you done an IELTS testing? If yes, please mention scores
                             Bands      
Speaking  Reading  Writing  Listening   
     
 
Score
The test was in :

Have you or any of your immediate family ever been: (Yes /No)
Convinced or charged with a crime?
Applied for Immigrant/ Visitor’s Visa?
Refused Immigrant/ Visitor’s Visa?
Refused admission or ordered to leave a country or any other country?

Suffered from or treated for any physical or mental disability
Or have any health problem?
 

If the answer to any of the above Questions is “Yes”, please explain
 
Any other information not otherwise requested which may be relevant
 

DECLARATION: I declare that the above information I have given in this Application Form is truthful, complete and that I am responsible for any errors, commissions and false information submitted here above.
 
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