Student Visa Information Form

This form is for our Licensed Immigration Adviser/Lawyer to collect all necessary information when you are ready to apply for the Student Visa.

SECTION A: IDENTITY AND CONTACT

Title (as on your passport)

Mr. Mrs. Ms.

First Name (Given Name)

Middle Names

Gender

Male Female

Date of birth

dd-MMM-yyyy

Place of birth

National ID Number

Please write NA if not applicable.

Passport number

Passport expiry

dd-MMM-yyyy

Phone (mobile)

Partnership status

Single Partner Married Separated Divorced Engaged Widowed

Have you applied for a New Zealand visa before?

Yes No

Current address

Street Address

Address Line 2

City

State/Region/Province

Postal/Zip Code

Country

Are you in New Zealand now?

Yes No

Intended travel date to NZ

dd-MMM-yyyy

SECTION B: STUDY DETAILS

Course/qualification

Education provider

Programme start date

dd-MMM-yyyy

Programme finish date

dd-MMM-yyyy

Intended stay duration in NZ

Less than 24 months More than 24 months

SECTION C: HEALTH DETAILS

Health situation

I am in good/normal health I have a serious chronic illness or am otherwise in poor health I have a serious communicable illness (eg. HIV, Tuberculosis) or have contracted such an illness in the past

Provided Chest X-Ray in previous NZ visa application?

Yes No

Obtained new Chest X-Ray for this application?

Yes No, but I intend to obtain one No, because I submitted Chest X-Ray issued in the last 36 months in a previous application No, and I do not believe I intend to because of my age, the short duration I will stay in New Zealand, or because I am pregnant

Date of new Chest X-Ray

dd-MMM-yyyy

X-Ray options

I provided a Chest X-ray in a previous application, but my health has since deteriorated My current visa states in the notes that I am required to obtain new medical evidence for my next visa application None of the above

SECTION D: CHARACTER DETAILS

Countries of citizenship

Countries lived in for 5+ years since age 17

Provided police certificates in previous NZ visa application?

Yes No

Obtained new police certificate(s) for this application?

Yes No, but intend to obtain new ones No, because I submitted police certificate(s) issued in the last 36 months in a previous application No, and I do not believe I need to because of my age or the short duration I will stay in New Zealand

Ever convicted of a criminal offense?

Yes No

Excludes minor driving infractions

Had immigration problems?

Yes No

Ever refused a visa?

Yes No

Country that declined visa

Category of visa declined

eg. Student, Visitor, Work

Date of decline decision

dd-MMM-yyyy

letter

Declined for visa more than once?

No, only declined once Yes, declined twice or more

SECTION E: EDUCATION AND WORK HISTORY

Education background

I have completed a qualification higher than secondary school (eg. university degree, certificate, diploma) I have completed secondary school, but do not hold a qualification higher than this I am currently studying in secondary school

Education details

Name of qualification

Name of Institution

Institution location

Start Date

Finish Date

Currently working?

Yes No

Ever worked before?

Yes No

SECTION H: OTHER DETAILS

Contacts in New Zealand?

Yes No

SECTION I: FAMILY VISAS

Plan to apply for partner/children visas?

Yes No / Not sure yet Not applicable (I don't have a partner or children)

SECTION J: FINAL DECLARATION

Additional declarations

You may answer "No" if you have nothing else to declare.

I declare that all the information provided by me on and with this application form is correct and complete.