NEW ZEALAND VISA QUESTIONNAIRE

PLEASE ANSWER IN CAPITAL LETTER AND IN BOLD FONT. PUT N/A IF NOT APPLICABLE

PERSONAL INFORMATION

Last Name: First Name:

Date of Birth Place & Country

Gender: (YY-MM-DD): of Birth:
Passport/Travel Date of Issuance of
Document Number: Passport (YY-MM-DD):
Place & Country of Date of Expiry of
Issuance of Passport: Passport (YY-MM-DD):

Nationality:
Do You Hold Or Have You Held Any Nationality Other Than The One Indicated Above On
YES OR NO Nationality?
If yes, please advise other county/region of Origin (Nationality):

Do You Hold A Passport For The Other Country/Region Of Origin (Nationality) Indicated
YES OR NO Above?

If Yes, Please Provide Passport Number:

Are You A Permanent Resident Of A Country/Region Other Than Your Country/Region Of
YES OR NO Origin (Nationality) Indicated Above?
If Yes, Please Advise Other Permanent Resident Country/Region:

Marital Status:
If Married, please provide the following information:
Spouse’s Full Spouse’s Date of Birth
Name: (YY-MM-DD):

Spouse’s Place & Country of Birth:

TRAVEL INFORMATION

Has this applicant undertaken a health examination for a New Zealand visa in the last 12
YES OR NO
months?

YES OR NO Has this applicant previously travelled to New Zealand or previously applied for a visa?

Intended Arrival in NZ Intended Departure from

(YYYY-MM-DD): NZ (YYYY-MM-DD):

YES OR NO Does the applicant intend to enter New Zealand on more than one occasion?
If yes, provide dates.
 YES OR NO Are you traveling as a group?
If yes, kindly provide the details of all companions below:

Gender Date of Birth Relationship to

Family Name Given Names (M/F) (YYYY-MM-DD) the Applicant

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APPLICANT’S CONTACT INFORMATION

Complete Home Address With Zip Code:

Postal Address With Zip Code

(if different from home):

Personal Landline Number: Personal Mobile Number:

Work Phone Number: Email Address:

WORK / SCHOOL / BUSINESS

Primary Occupation:
(If Retired/Unemployed, please indicate)

Name of Present Employer / School / Business:

Address (Line 1), City, State/Province, Postal Zone/ZIP Code and Country/Region:

Start date with current employer / school / business

(if Retired, kindly provide the retirement date) (day/month/year) :
Contact Details of employer / school / business:
Contact Number: Email Address:

FINANCIAL INFORMATION
Who will pay for your trip? FULL NAME:
If sponsored, use sponsor financial information.

Relationship of sponsor to applicant?

How much is the pocket money of the applicant or sponsor for the trip?
How much is the applicant / sponsor's monthly income?

Available Money of applicant or sponsor in Bank Account:

Average Daily Balance of Bank Account for the past 6 months?

Sponsors’ Address (Line 1), City, State/Province, Postal Zone/ZIP Code, Phone Number and
Country/Region:

FAMILY OR FRIEND TO VISIT

Date of Birth
Full Name: (YYYY-MM-DD):

Contact Number: Email Address:

Complete Address:

EMPLOYMENT DETAILS:
Occupation: Company Name:

Company Address:

Company Mobile Company Email

Number: Address:

TRAVEL HISTORY
Countries Visited in the past 8 years Arrival Date and Departure date
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