Statutory Declaration

Statutory Declaration

USE THIS FORM if you wish to give, or have been asked by the Department of Internal Affairs to provide, additional information.

Making a statutory declaration

A statutory declaration is a written statement declaring something to be true in the presence of an authorised witness. It is an offence to give any altered, false, incomplete or misleading information or to make a false statement or declaration.

How to complete this declaration

Applicant's details

This information will help us match this declaration to the correct application.

► If you are filling in this declaration for yourself write your name and date of birth.

► If you are filling in the declaration for someone else write their name and date of birth.

Your contact details

► Write your name, home address and contact details even if you are filling in the form for someone else.

Signing the declaration

This statutory declaration must be signed and dated in front of someone who has the authority to take statutory declarations and they must also sign to confirm that you have signed the declaration in front of them.

Who can be an authorised witness for a statutory declaration?

The witness for a statutory declaration must be one of the following:

• Member of Parliament
• Lawyer
• Justice of the Peace
• Registered Legal Executive (Fellow of NZILE)
• Government Officer authorised to take statutory declarations.

When you have found your witness, you may need to make an appointment to sign this declaration in front of them.

Send your signed declaration to us

(If you fax this declaration, please also send us the original form by mail.)

NEW ZEALAND

New Zealand Passport Office

PO Box 1568

Wellington 6140

New Zealand

Freephone: 0800 22 50 50

Phone: +64 4 474 8100

Fax: +64 4 382 3410

AUSTRALIA

New Zealand Passport Office

GPO Box 365

Sydney, New South Wales 2001

Australia

Freephone: 1300 559 535

Phone: +61 2 9225 2300

Fax: +61 2 9223 0223

UNITED KINGDOM

New Zealand Passport Office

New Zealand House

80 Haymarket

London SW1Y 4TQ

United Kingdom

Phone: +44 20 7968 2730

Fax: +44 20 7968 2739

Website: www.passports.govt.nz Email: passports@dia.govt.nz

Privacy statement

How is your privacy protected?

All relevant information about you is collected in line with the Passports Act 1992 and is held securely by the New Zealand Passport Office, Department of Internal Affairs, 120 Victoria Street (PO Box 10-526), Wellington. Under the Privacy Act 1993 you may access and request a correction of any of your personal information.

For more information visit www.dia.govt.nz

When may information from your passport records be disclosed?

Under the Passports Act 1992 and the Privacy Act 1993, this information may be disclosed, subject to agreement in writing between the Secretary of Internal Affairs and the Chief Executive of the organisation requesting the information, to any appropriate agency, body, or person to aid border security, facilitate the processing of passengers, verify the identity of a holder of a travel document, or determine whether a person is a New Zealand citizen.

The information that may be disclosed includes the information recorded in your passport; your eye colour; your height; the status of your passport; our passport database key number; and any other information relating to your passport that may be required.

Statutory Declaration

Write the name and date of birth of the applicant here

Full name

Write your name and contact details here

Full name (if different from above)

Home address

I solemnly and sincerely declare that:

Provide information or explanations here

If you do not have enough space, write further details on a separate piece of paper. Ensure that both you and your authorised witness sign and date each separate piece of paper.

This statutory declaration must be signed and dated in the presence of a Justice of the Peace, a lawyer, a Registered Legal Executive (fellow of NZILE) a Member of Parliament or a Government Officer who has the authority to take statutory declarations, such as our Customer Services Officers at our public counters.

I make this declaration believing it to be true by virtue of the Oaths and Declarations Act 1957.

WARNING

It is an offence to make a statement which is false in any particular for the purpose of gaining a New Zealand travel document. If a New Zealand travel document is obtained by fraud, false representation or the concealment of any material fact, it can be cancelled and the person concerned can, by law, be fined or imprisoned, or both.