Intake Form - Principal Applicant - ExperieNZ Immigration Services Ltd

Intake Form - Principal Applicant

Complete The Form

Let Us Know Your Details

We use your information to assess your situation and to complete the relevant visa forms.

Complete All Questions

We use your information to assess your situation, and to complete all relevant visa forms

Save and Complete Later

Scroll down to the bottom of the form page and click on “save and continue later”.

Intake form - Principal Applicant

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Step 1 of 7

Personal details - Principal Applicant

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*

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 - principal applicant

Address*

Street Address City ZIP / Postal Code Country

Email*

Enter Email Confirm Email

(Mobile) Phone*

Relationship details

Are you in a relationship?*

You are in a genuine relationship if you are dating and/or living together with a partner/spouse with the intention that the relationship will last. A De Facto relationship is a where you and your partner are living together as a couple on a genuine domestic basis and are not married or in a civil union.

Yes

Yes, but my partner is an New Zealand or Australian citizen or (permanent) resident

Your spouse/partner's name (as in their passport)*

Title First Last

What is your relationship status?*

Are you?*

Is your partner/spouse coming with you to New Zealand (or already with you in NZ)?*

Yes

When did your relationship start?*

Are you living together?*

Yes

When did you start living together?*

Do you and your partner have any children together (biological or adopted)?*

Yes

Any comments you'd like to make about your relationship?

New Zealand visa details - principal applicant

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 New Zealand visa(s) you held in the past

Type of visa (e.g. work visa)

Visa subtype (e.g. Essential Skills)

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

Use the + to add more rows

Intake Form - Principal Applicant

Complete The Form

Let Us Know Your Details

Complete All Questions

Save and Complete Later

Intake form - Principal Applicant

Personal details - Principal Applicant

Contact details - principal applicant

Relationship details

New Zealand visa details - principal applicant

Health details - principal applicant

Character details - principal applicant

Employment & Qualifications - principal applicant

Family details

Dependent child 1

Dependent child 2

Dependent child 3

Dependent child 4