Intake Form - Partner/Spouse - ExperieNZ Immigration Services Ltd

Step 1 of 9

Personal details - partner/spouse

Name (as in passport)*

Title First Last

Other names you have been known by, eg. maiden name or preferred name

Name Type

Gender*

Date of birth*

Place of birth*

Country of birth*

Are you a New Zealand or Australian citizen or permanent resident?*

Yes

Are you a*

New Zealand citizen

New Zealand resident or permanent resident

Australian citizen

Australian permanent resident

Passport details*

Passport number Issue date Expiry date Country of issue

Other citizenships you have

Birth Certificate Details

Birth certificate number Issuing Authority Country of issue

Contact details - partner/spouse

Address*

Street Address City ZIP / Postal Code Country

Email*

Enter Email Confirm Email

(Mobile) Phone*

New Zealand visa details - partner/spouse

Do you currently hold a valid visa for New Zealand?*

Yes

What type of visa do you have?*

Do You know the visa sub-type?*

Expiry date visa?*

Please provide details of the New Zealand visa(s) you held in the past

Type of visa (e.g. work visa or student visa)

Sub-type (e.g. Essential Skills work visa)

Start date (dd/mm/yyyy)

End date (dd/mm/yyyy)

INZ client number?*

You can find the client number on your visa label

Your most recent overseas address*

Street Address City ZIP / Postal Code Country

Is a visa application for New Zealand ever declined?*

Yes

Please provide details of why the visa was declined , when and what type of visa*

Have you completed an English language test?*

e.g. IELTS or Pearson PTE

Yes

When did you take the English test?*

What where your test scores*

Listening

Reading

Writing

Speaking

Overall

Did you complete a medical check and/or chest X-ray with a previous application?*

Date medical check*

Date chest X-ray*

Did you provide a police clearance certificate with a previous visa application?*

Yes

Please list the countries that you submitted a Police Clearance Certificate (PCC) for*

PCC Country

PCC Date of issue

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Intake Form - Supporting Partner

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