INZ 1012: New Zealand Student Visa Application

Which type of student visa are you applying for? Domestic - Primary/Secondary Limited visa Other, please specify.

Attach two colour passport-size photographs of yourself here.

Write your full name on the back of both photographs.

A1 Name as shown in passport Family/last name Given/first name(s)

A3 Other names you are known by or have ever been known by.

A4 Gender Male Female A5 Date of birth DD MM YYYY.

A6 Town/city of birth Country of birth.

A7 Passport details Number Country Expiry date DD MM YYYY.

A8 Other citizenships you hold.

A9 Partnership status Single Separated Partner/De facto Married/in civil union Engaged Widowed.

Please provide your email address if you have one.

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

B3 Name and address for communication about this application. Name of contact person.

B4 Do you authorise the person stated at B3 to act on your behalf? Yes No.

B6 Have you received immigration advice on this application? Yes Make sure that your immigration adviser completes Section H: Immigration adviser's details.

B8 List all periods of employment, including self-employment Date from (DD/MM/YY) Date to (DD/MM/YY)

C1 Do you have tuberculosis (TB)? Yes No.

C2 Do you 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.

C3 Have you been identified as a person who requires special education services? (Refer to ‘Completing Section C: Your health' in the Student Visa Guide (INZ 1013) for further information). Yes No.

C5 If you have answered Yes to any of the questions in C1 to C4 , provide details.

C6 Are you pregnant? Yes Date you are due to give birth DD MM YYYY.

Medical certificates and chest X-ray certificates must be less than three months old when you submit them to Immigration New Zealand.

All applicants must complete this section.

D1 Have you 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.

D2 Are you currently: under investigation Yes No wanted for questioning Yes No facing charges Yes No for any offence in any country?

D3 Have you ever been: excluded Yes No refused entry Yes No removed or deported Yes No from any country, excluding New Zealand?

D4 Have you ever been refused a visa/permit to visit, work, study or reside in any country, excluding New Zealand? Yes No.

D5 Have you ever been a member of, or adhered to, any terrorist organisation? Yes No.

D6 Have you had (or do you 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.

If you have answered yes to any of the questions give full details. This includes full details of any charges, convictions and the sentence or penalty imposed. Continue on a separate piece of paper if necessary.

Police certificates must be less than six months old when you submit them to Immigration New Zealand.

E1 Tick one of the boxes to show the type of visa you are applying for and provide the date of your arrival in New Zealand if applicable.

Applying for a student visa while outside New Zealand. Date you will enter New Zealand (if applicable) DD MM YYYY.

Applying for a student visa while inside New Zealand. Note: student visas normally allow multiple entry travel.

Applying for a limited visa. List the reasons. Date you will enter New Zealand on a limited visa DD MM YYYY.

Applying for a further limited visa. List the reasons.

Complete this section if you will be living with your parent or guardian for the duration of your visa, or if you are applying for a visa as a dependent student.

F8 Relationship to you: Mother Father Legal guardian.

F10 Are you seeking work rights? Yes Note: if you are applying for tertiary study conditions and wish to undertake work, you will need to provide evidence of enrolment.

I have provided true and correct answers to the questions in this form.

I understand that if false or misleading information is submitted, my application may be declined without further warning.

Signature of applicant Date DD MM YYYY.

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 or offshore education agent, this section does not have to be completed.

This section must be completed and signed by any person who has assisted the applicant by providing immigration advice, explaining, translating, or recording information on the form for the applicant; or by the applicant's immigration adviser.

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.

"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.".

To find out much to pay, payment methods, where to send your application, and how long a decision may take, see www.immigration.govt.nz/fees.

Amount you are paying. Amount. Currency (e.g. NZD, USD, RMB).

You cannot use this form for an international student visa. International student visas must be applied for online.

If you are a dependent child of the holder of an Accredited Employer Work Visa, Essential Skills Work Visa, or Specific Purpose or Event Work Visa granted under the short-term National Occupation List (NOL) subcategory, evidence that your parent is eligible to support your visa - see www.immigration.govt.nz/bringing-family-with-work.

Accompanied by a parent or legal guardian Evidence of your relationship with your parent or legal guardian. Evidence that your parent or legal guardian cares for you in your home country.

In year 12 or 13 at secondary school, wishing to work: Permission to work 25 hours per week and/or full-time during the summer holiday period from your: parents, and education provider (not required if you are over 18 and at secondary school and wish to work during the summer holiday period).