Application to Study in New Zealand (to travel to New Zealand to study) Application No. For NZIS Use Only Please note: If you decide to apply directly for a Limited Purpose Visa and you are subsequently granted a Limited Purpose Permit, your immigration rights in New Zealand are restricted to fulfilling the express purpose to study for which you came.!"#$%&'()*+,-./!"#$%&'()"*+,!"#$%&'()*+,-!"#$%&'()*+,-.'/0 This form may be used to apply for a Student Visa, or Limited Purpose Visa to study.!"#$%&'()*+,-'(.%/-#$0 I am applying for a Student Visa to travel to New Zealand, or!"# I am applying for a Limited Purpose Visa to study.!"#$%! Section A Principal applicant Personal Details!" Client number:!!w A1 A2 A3 A4 A5 A7 A8 A9 Name as shown in passport!"# Family: Given: ================================= Preferred title Mr Mrs Ms Miss Dr other!" (please specify) Other names you are known by!" Your name in ethnic script!"#ef!"# A6 Gender Male Female Date of birth ==================================! =========== Place and country of birth Place: Country:!"#$ Passport details Number: Country:! Expiry Date: =========== Your citizenship Attach one recent passport size photograph of yourself here. Write your name and date of birth on the back.!"#$%&!"#$%&!"#$% A10 A11 Other citizenships currently held!"#$%&' Partnership status Married Never married Partner Separated! Engaged Widowed Divorced ====== Additional information! A12 I may be contacted at this New Zealand residential address and telephone number:!"#$%&'()*+,-./ Telephone 1
A13 Name and address of any friends, relatives or contacts I have in New Zealand are:!"#$%&'()*+,-. %/0123 Name Relationship Address Name Address Relationship Name Address Relationship A14 My postal address and contact details for this application are:!"#$%&'()*+,-./0!"#$%!&'()*+,-./(012 Telephone=EF MobileEF Fax EF Email E!F A15 A16 If you have given the name and address of an agent in A14, do you authorise that agent to act on your behalf? E A14!"#$%!&'()*+!"#$%&'())==Yes No ======= My residential address in my home country is:!"#$%& A17 I am employed by, and my regular occupation is:!"#$%&'() (Please give name and address of employer. If not employed, please state this.)!"#$%&'()!"#$! Employer details:! Occupation: A18 My stay in New Zealand will be financially supported in the following way:!"#$%&'()*+,-./012345678 A19 The arrangement I have made for outward travel from New Zealand is:!"#$% Application Details Student Visa=! 2 A20 Complete questions A20 to A24. DO NOT complete this section if you are applying for a Limited Purpose Visa to study!"#$%&'()!" A20-A24 (see questions A25 to A28).!"^ORJ^OU If applying for a Student Visa:!"#$% This is the date I will enter or re-enter New Zealand:!"#$%&'() ===========
A21 A22 A23 A24 This is the date my course starts:!"#$"%& =========== This is the date my course finishes:!"#$%&' Date to which fees have been paid or length of scholarship (if applicable):!"# My course(s) details in New Zealand are:!"#$%&' Name of institution Location in New Zealand where I will be studying Qualification I will be studying where I will be studying!"#$%=======================!"================================!"#$%&' =========== =========== Limited Purpose Visa!"# Complete questions A25 to A28. DO NOT complete questions A25 to A28 if you are applying for a Student Visa.!"#$%&'!"#$ ^ORJ^OU Only complete this section if you are travelling to New Zealand for the express purpose of studying and you wish to have a Limited Purpose Visa/Permit to study in New Zealand,!"#$!%&'() Such visas/permits mean that you are not able to apply for any other type of visa/permit in New Zealand or seek to stay longer or indefinitely in New Zealand. For general information and a list of express purposes see the Information Leaflet on Limited Purpose Visas and Permits (NZIS 1070).!"#$!"!"#!""#$%&'!"!"#$%&'()*+,-.)/L!"#$%&'()*+,-./!"#!"#$%&'()*+,kwfp=NMTMFK A25 A26 A27 A28 I am applying for a Limited Purpose Visa to travel to New Zealand to study!"#$%&'()*+, If applying for a Limited Purpose Visa to study:!"#$%&'! This is the date I will enter New Zealand:!"#$%&'() This is the date my course starts:!"#$"%& This is the date my course finishes:!"#$%&' Date to which fees have been paid:!" =========== =========== =========== =========== The limited purpose application is for the express purpose of study:!"#$%&'()* My course(s) details in New Zealand are:!"#$%#&' Name of institution Location in New Zealand where I will be studying Qualification I will be studying where I will be studying!"#$%=======================!"=================================!"#$%&' If your express purpose is other than to study in New Zealand please use the Application for Visiting New Zealand (NZIS 1017) form.!!"#!"!"#$%& 3
Section B Character Details B1 Have you been:!"#$%"&'()*+ convicted == Yes No charged === Yes No under investigation ===! Yes No for any offence(s) against the law in any country; or!"# deported ===! Yes No excluded (refused entry)!! Yes No removed! Yes No from any country. If you have marked Yes to any of the above, please provide details below:!"#$%&'()*!"#$ B2 B3 B4 Are you intending to study in New Zealand for 2 years or longer? Yes (go to question B3)!"#$%& 2!"#$% No (go to Section C) If yes, are you aged 17 years or over? Yes (go to question B4)!!" 17!"# No (go to Section C) Have you submitted police certificates with another New Zealand Immigration application in the past 24 months? Yes (go to question B5)! 24!!"#$%&'()*+,-./01234567 No (go to Section B6) B5 Please provide details of the type of application made and the date the application was lodged.!"#$%&'()*+,- Type of application: Date of application: We will advise you if we need you to submit updated police certificates at a later date.!"#$%&'()*+,-./012"345 B6 Have you attached police certificates from:!"#$%&'()*+, all countries in which you have lived for 5 years or more since attaining the age of 17 years? NT!"#$%&' R!"# $%&'()*+,-=Yes No your country(ies) of citizenship? Yes No!"#$%&'()*+,&-./01234 If no, please state any country(ies) of which you are a citizen but for which you have not provided police certificates because you have never lived there.!"#$!"#$%&'()*+(,-./012$34 4
Section C Health Details! C1 C2 Are you, or any person included in the application, pregnant? Yes ======== No==!"#$%&'()*+,-./0123 Do you, or any person included in the application, have any of the following medical conditions:!"#$%&'()*+,-./012 Cancer Yes No Heart disease Yes No A mental, physical or intellectual disability!!"#$ Yes No Active tuberculosis (TB) = Yes No Do you, or any person included in the application, have any medical condition(s) that currently requires, or may require during your intended stay in New Zealand:!"#$%&'()*+,-./0123456789: Renal dialysis Yes No Hospitalisation! Yes No Residential care *! Yes No * Residential care is long-term care provided in a live-in faclity such as an aged person s facility or a facility for people with a physical or psychiatric disability and includes 24-hour supervision and nursing care. C3 =If you have answered Yes to any of the above questions, please provide details below: =!"#$%&'()*+!!"#$%&' C4 C5 C6 How long do you intend to stay in New Zealand?!"#$%&'()*+ Are you required to submit a medical certificate? Yes = (go to question D6)!"#$%&'( ====================No ===== (go to Section E) Please read the Health Requirements Leaflet (NZIS 1121) for further details.!"#nzis1121f!"#$ Have you submitted a medical certificate with another New Zealand Immigration application in the past 24 months? Yes = (go to question D7) OQ!!"#$%&'()*+,-./0123 ============== at C7 Please provide details of the type and date of the previous application:!"#$%&$'()*+ No (go to question D8) ========== au C8 C9 Type of application: Date of application:! =! We will advise you if we need you to submit updated health certificates at a later date!"#$%&'()!"#$% If you are planning to stay over six months in News Zealand, have you attached Yes No a completed Temporary Entry Chest X-ray Certificate (NZIS 1096)!"#$%&'()*+,-.!"#$%&!"#$% unzis 1096======== or If you are planning to stay over 24 months in New Zealand, have you attached Yes No a completed Medical and Chest X-ray Certificate (NZIS 1007)!"#$%&'()*+,-./0!"#$%&!"#$ u =(NZIS 1007) ====== Please Note: All immigration visa and permit holders who access health services in New Zealand should carry a current passport to enable health providers to document eligibility status. We strongly recommend that you have comprehensive health insurance for the duration of your visit. For more informatioin visit the Ministry of Health website at www.moh.govt.nz!"#$%&'()*+,-./012!"#$%&'()*+,-!!"#$!"#$%!"#$%&'()*!"#$!"#$% www.moh.govt.nz 5
Section D Declaration I understand the questions and contents of this form, and the information I have provided is true and correct. I understand that if, between the time that I make this application and the time it is decided, or between the time I am issued with a visa and the time I travel to New Zealand, any relevant matter relating to the application changes, I am obliged to inform the NZIS. I understand I am responsible for making sure I leave New Zealand before my permit expires and that if I do not I may face removal action. Residents and people holding work permits for a stay of two years or more (and their dependent children) are eligible for publicly funded health and disability services. Other work permit holders, students, and visitor permit holders generally are not eligible. People covered by New Zealand s Reciprocal Health Agreements with Australia and the United Kingdom are entitled to publicly funded health care for immediately necessary medical treatment only. I understand that if not entitled to free treatment, I will pay for any health care or medical assistance I or any person included in my application may require in New Zealand. I authorise NZIS to provide information about my state of health and my immigration status to any health service agency. I authorise any health service agency to provide information about my state of health to the NZIS. I authorise NZIS to make any enquiries it considers necessary in respect of information provided on this form in order to make a decision on this application and enquiries about my subsequent immigration status. I authorise any agency which holds information (including personal information) relevant to those matters to disclose that information to NZIS. If granted a Limited Purpose Permit I understand that I am subject to immediate removal from New Zealand without appeal if I fail to leave New Zealand on or before the expiry date of that Permit.!"#$%&'()!"#$%&'()*+,-$.!"#$%&'()*+,(-./01!"#!"#$%&'()*+!"#$%&'()*+,-!"#$%&'()!"#$%&'()'!"#$%&'!"#$%!"#$%&'(!"#$% 2!"#$%&!"#$%&!"#$%&'()*+,!"#$%!"#!"#$%&'(#)%*+,!"#$%&'()*+,-./0123456789:;<=>?@AB01C!!"#$%&'(!"#$%&'()*+,$-./012)*+3456!789:;<=!"#$%&'()*+,-./012345$%6789:)*;<=>?@AB>CD!"#$%&'($)!"#$%&'()*+,-./!"#$%&'()*+,-./01234567!"#$%&'(!"#!"#$%&'()*+,-./!"#$%&'()*+,-!"#$%&'()*+,!"#$%&!"#$%&'()*!+, Signature of principal applicant (!") =========== Important Note: Limited Purpose Visas If you are an applicant who is using this form to apply for a Limited Purpose Visa you should have specifically chosen to take the Limited Purpose Visa option rather than apply for a Student Visa.You will also have specified an express purpose in coming to New Zealand and will understand the limitations of a Limited Purpose Permit compared to a Student Permit.!!"#!"#$%&'()*+,-.(/0123!"#$%!"!"#!"#!"#!"#!"#!"#$%&'()%&*+,-.$!/"01 Section E Declaration for Person Assisting the Applicant to Complete This Form!"#$%&'()"*+ To be completed and signed by any person who has assisted the applicant to complete this form by explaining, translating or filling in the form for the applicant.!"#$%&'!"#$%&'()"*+,-./012 Full name of person assisting:!" L!"# Address of person assisting:!" 6
I understand that after the applicant has signed this form it is an offence to alter or enter further information on it, alter any material attached to it, or attach any further material to it, unless the person making the alteration or addition states on the form what information or material has been altered or attached, why, and by whom. I understand that the maximum penalty for this offence is a fine of up to $NZ100,000 and/or a term of imprisonment of up to 7 years.!"#$%"#&'()*+,!"#$%&'(!"#$%&'()*+,-".!"#$%&'(!"#$%&$'()*+,-.*/01!"#$!"#$%&'()*+10!"#$%&'(7!"# I certify that I have assisted in the completion of this form and any additional forms at the request of the applicant and that the applicant understood the content of the form(s) and agreed that the information provided is correct before signing the declaration. I have assisted the applicant as a:!"#$%&'()*+,-./%&01234015!"#$!%&'()*+!"#$%&'!"#$%&!"#$%& lawyer agent, consultant translator friend or other advisor or representative family member! ===! ========= Please specify: === ===! Signature of person assisting:!" Section F Fee Payment Details Amount enclosed! I am paying by cash.! I am paying by cheque.! I am paying by post office money order (only available for applications lodged to NZIS Beijing & Shanghai).!!"#$%&'()*+,!"#$%&'( I am paying by credit card (only available for applications lodged to NZIS HongKong)!"!"#$%&'()*+,-./01234 Type of Card!" Name of Cardholder!" Card number!" Expiry Date Name of Cardholder!" ============ Collection Details!!"#$%& I wish to collect my documents when ready.!"#$%&'()*+,-. Please return all documents to me by securepost at the address given in A14.!"#$%&'A14!"#$% Please return all documents to me by EMS courier at the address given in A14 (courier fee prepaid RMB 40---NZIS Beijing & Shanghai, HK$100---NZIS HongKong).!"#$%&'()*+, A14!"!"#$% 40!"#$%&'()*+!"# 100!"#$%&'()*+,-. 7
DETAILS OF EDUCATION AND EMPLOYMENT!"#$%&'() (Please complete in English and Chinese) E!"#$%&'(F FROM TO NAME & ADDRESS OF SCHOOL!"#$% DIPLOMA/ DEGREE L TYPE OF COURSE FROM TO NAME & ADDRESS OF WORK UNIT!"#$%&' POSITION TYPE OF BUSINESS! Please include a business card, if possible. =!"#!" NAME OF APPLICANT IN PINYIN =!"#$%&' SIGNATURE OF APPLICANT =!"# DATE = 8
FINANCIAL ANALYSIS - SUMMARY SHEET!"#$ (Please complete in English)E!"#F APPLICANT: ^ååì~ä=p~ä~êói=áååäìçáåö=äçåìëéë=ñêçã=~ää=àçäë=eáñ=~ééäáå~ääéfw!!"#$%&!" SPOUSE OF APPLICANT:!"# ^ååì~ä=p~ä~êói=áååäìçáåö=äçåìëéë=ñêçã=~ää=àçäë=eáñ=~ééäáå~ääéfw!!"#$%&!" PARENTS OF APPLICANT:!"# ^ååì~ä=ë~ä~êói=áååäìçáåö=äçåìëéë=ñêçã=~ää=àçäë=üéäç=äó=äçíü=é~êéåíëw!!"#$%&'() TOTAL AVAILABLE SAVINGS IN RMB ARE:!"#$%& TOTAL AVAILABLE SAVINGS IN ALL OTHER CURRENCIES ARE:!"#$%& (specify amount and type of currency!"#$%&'() DETAILS OF ANY OTHER SOURCE OF FUNDS/FINANCIAL SUPPORT: (including any secondary employment)!"#$%& '()*+,!"#$%&' It would be helpful if you could enclose information about your savings history for the last 12 months, deposit slips, bank statements that cover this period of time.!"#$%&' NO!"#$%!"#$%&!"#$%& NO!"#!"!"#$% 9
***TO BE INCLUDED WITH YOUR APPLICATION, IF APPLICABLE***!"#$%&'()*+ FAMILY COMPOSITION / DETAILS OF EDUCATION AND EMPLOYMENT!"!"#! Father of Applicant (Please provide all names in both pinyin and Chinese characters)!"#$%!"#$%&' Name: Brothers and Sisters (Including half and step brothers and sisters)!"#!"#$%&'()*+,-./0 Name Sex Marital Date of Present Address Present Occupation Status Birth =================!=============== ================ Education of Father:!"#$ Date School Type of Course Diploma / Degree From To Employment of Father for the last ten years:!"#$%&'() From Date Type of Business Position Name and Address of Work Unit/Company! To!"#$%& I declare that the above information is accurate and true.!"#$%&'( Signature of Father: Date: 10
***TO BE INCLUDED WITH YOUR APPLICATION, IF APPLICABLE***!"#$%&'()*+ FAMILY COMPOSITION / DETAILS OF EDUCATION AND EMPLOYMENT!"!"#! Mother of Applicant (Please provide all names in both pinyin and Chinese characters)!"#$%!"#$%&' Name: Brothers and Sisters (Including half and step brothers and sisters)!"#!"#$%&'()*+,-./0 Name Sex Marital Date of Present Address Present Occupation Status Birth =================!=============== ================ Education of Mother:!"#$ From Date= School Diploma / Type of Course Degree To Employment of Mother for the last ten years:!"#$%&'() From Date Name and Address of Work Type of Business Position Unit/Company! To!"#$%& I declare that the above information is accurate and true.!"#$%&'( Signature of Mother: Date: 11
***TO BE INCLUDED WITH YOUR APPLICATION, IF APPLICABLE***!"#$%&'()*+ FAMILY COMPOSITION / DETAILS OF EDUCATION AND EMPLOYMENT!"#!"#!" Spouse of Applicant (Please provide all names in both pinyin and Chinese characters)!"#$%!"#$%&' Name: Brothers and Sisters (Including half and step brothers and sisters)!"#!"#$%&'()*+,-./0 Name Sex Marital Date of Present Address Present Occupation Status Birth =================!=============== ================ Education of Spouse:!"#$ Date School Diploma / Type of Course Degree From To Employment of Spouse for the last ten years:!"#$%&'() From Date Type of Business Position Name and Address of Work Unit/Company! To!"#$%& I declare that the above information is accurate and true.!"#$%&'( Signature of Spouse:! Date: 12 September 2005