Student Visa Application for New Zealand

Student Visa Application

OFFICE USE ONLY  Client no.   Date received   Application no.

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

Application checklist

Information and documents you must supply

Completed, signed application form.

Appropriate fee and immigration levy.

Two passport-size colour photographs.

Passport or travel document.

Medical or chest X-ray certificates if required by Section C: Your health.

Police certificates if required by Section D: Your character.

Which type of student visa are you applying for?

Foreign fee-paying   Domestic   Exchange   New Zealand Aid Programme-supported   Limited visa

Other, please specify

Section A Principal applicant’s personal details

Attach two colour passport-size photographs of yourself here. The photographs must be less than six months old. Write your full name on the back of both photographs.

A1 Name as shown in passport

Family/last name

Given/first name(s)

A2 Preferred title

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   Expiry date

A8 Other citizenships you hold

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

Section B Contact details

B1 Your current residential address.

Address

Telephone (landline)   Telephone (mobile)

Email

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

Address

B3 Name and address for communication about this application.

Same as address at B1, or as below

Name of contact person

Organisation name (if applicable) and address

New Zealand Business Number

Telephone (daytime)   Telephone (evening)

Email

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

B5 Do you authorise all other licensed immigration advisers or persons exempt from licensing who work for the organisation named at B3 to act on your behalf (if applicable)? Yes No

B6 Have you received immigration advice on this application? Yes No

B7 Names and addresses of any friends, relatives, or contacts you have in New Zealand (if applicable)

B8 List all periods of employment, including self-employment

Section C Your health

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

C3 Have you been identified as a person who requires special education services? Yes No

C4 If you have answered Yes to any of the questions in C1 to C3, provide details.

C5 Are you pregnant? Yes Date you are due to give birth No

C6 If you intend to give birth in New Zealand, indicate how the cost of maternity health services will be paid for.

Medical certificates and insurance requirements

C7 Will you be in New Zealand for less than six months? Yes No

C8 Will you be in New Zealand for more than six months and less than 12 months? Yes No

C9 Are you from, or have you visited for more than three months, a place outside the low TB incidence list? Yes No

C10 Have you previously provided a medical certificate issued less than 36 months ago? Yes No

C11 Have you previously provided a chest X-ray certificate issued less than 36 months ago? Yes No

C12 Have you spent six consecutive months since your previous visa application in a place outside the low TB incidence list? Yes No

Section C - Foreign fee-paying students

C13 Will you be in New Zealand for less than six months? Yes No

C14 Have you ever used intravenous drugs? Yes No

Have you ever had a blood or blood product transfusion? Yes No

Have you ever participated in or been exposed to any activity which may have exposed you to a serious infectious disease? Yes No

C15 Are you from, or have you visited for more than three months, a place outside the low TB incidence list? Yes No

C16 Have you previously provided a chest X-ray certificate issued less than 36 months ago? Yes No

C17 Have you spent six consecutive months since your previous visa application in a place outside the low TB incidence list? Yes No

C18 Have you been advised in writing by Immigration New Zealand to provide a medical certificate, chest X-ray certificate or other medical information? Yes No

C19 Tick the option that applies to you.

Is a physician submitting your medical and/or chest X-ray certificate to Immigration New Zealand on your behalf? Yes No

eMedical Reference Code

Clinic name

C20 Declaration regarding insurance requirements. I agree with the declaration

Section D Your character

D1 Have you been convicted at any time of any offence, including any driving offence? Yes No

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

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

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

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

D6 Have you had an association with any government/regime/group/agency that has advocated or committed war crimes or gross human rights abuses? Yes No

If you have answered yes to any of the questions above give full details.

Police certificates you must provide

D7 You do not need to provide a police certificate if any of the listed conditions apply.

D8 You must provide police certificates from your country of citizenship and any country you have lived in for five years or more since age 17 if you plan to be in New Zealand for 24 months, and one of the listed conditions applies.

Section E Your visa

E1 Tick one of the boxes below 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

Applying for a student visa while inside New Zealand.

Applying for a limited visa. Date you will enter New Zealand on a limited visa

Applying for a further limited visa. List the reasons below.

Section F Fee-paying, PhD, pathway and scholarship students

F1 Are you applying for a pathway student visa? Yes No

F2 Details of your programme(s) of study

F3 Provide the date to which your fees have been paid / scholarship end date

F4 Tick one or more of the following boxes below.

Evidence of sufficient funds equivalent to NZ$15,000 for a full year or NZ$1250 per month.

Evidence that living costs are already paid.

Access to sufficient funds to support myself throughout the intended length of my pathway student visa.

Letter from my home country government stating I am fully funded.

Sponsorship Form for Temporary Entry (INZ 1025).

Financial Undertaking for a Student (INZ 1014).

Written guarantee of maintenance from a relative in New Zealand.

Section G Your parent or legal guardian

G1 Name of parent/legal guardian as shown in their passport

Family/last name

Given/first name(s)

G2 Other names your parent/legal guardian is known by

G3 Gender Male Female

G4 Date of birth

G5 Place of birth

Country of birth

G6 Passport details

Number

Country   Expiry date

G7 Other citizenships your parent or legal guardian holds

G8 Relationship to you Mother Father Legal guardian

G9 Intended immigration status in New Zealand while you are studying

Guardian visitor visa to accompany me.

New Zealand citizen/resident/temporary visa entitling me to domestic student status.

Other – please explain:

Section H Declaration by applicant

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

Section I Immigration adviser’s (licensed and exempt) details

I1 Licence type full provisional limited

Licence number

I2 Exempt from licensing reasons

Informal or family context only.

Offshore advice in relation to student visa applications only.

Advice provided in the course of exempt work.

Lawyer with current New Zealand practicing certificate

Community Law Centre

Citizens Advice Bureau

New Zealand Member of Parliament or staff

New Zealand public servant

Foreign Diplomatic/Consular

Section J Declaration by person assisting the applicant

Family/last name   Given/first name(s)

Organisation name (if applicable) and address

Telephone (daytime)   Telephone (evening)

Fax   Email

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 and my details in Section I are correct.

Section K Paying your application fee and immigration levy

Amount you are paying

Amount   Currency

Application number (office use only)

Preferred methods of payment

Bank cheque/bank draft

Credit card (choose one) Mastercard Visa SWITCH card (UK only)

Name of cardholder

Card number

CVC/CVV number

Expiry date

Signature of cardholder

Date

Personal cheque

Cash

We do not accept money orders.

Returning your documents

B1 B2 B3