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Assessment Form
Assessment Form
Applicant Information
Full name :
Date of birth :
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Gender :
Citizenship :
Place of birth - city and country :
Immigration status in current country of residence
Contact number
Email address :
Current residential address :
Family Information (Principal Applicant and Spouse)
Marital status
Date of your marriage or commencement of partnership
Name of children (if applicable) including full name, DOB, citizenship
Full name :
Date of birth :
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Citizenship :
Full name :
Date of birth :
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Citizenship :
Personal Information (Spouse)
Full name :
Date of birth :
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Gender :
Citizenship :
Place of birth - city and country :
Immigration status in current country of residence :
Contact number :
Email address :
Current residential address :
Qualifications Self
Name of qualification :
Name of university :
Start date :
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End date :
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Qualifications Spouse
Name of qualification :
Name of university :
Start date :
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End date :
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Work Experience (for Principal Applicant only)
Name of company :
Job title :
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End date :
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Character questions
In any country including New Zealand are you currently under investigation, wanted for questioning or facing charges for any offence?
Yes
No
Have you previously supplied Immigration New Zealand any police checks? If you have supplied please attach copies of the police checks along with copies of any visas which you may have had issued from Immigration New Zealand.
Yes
No
Have you ever been removed from, deported from, expelled from, excluded from or refused entry to any country including New Zealand?
Yes
No
Have you ever been refused or declined a visa by any country?
Yes
No
Have you, your partner or children stayed in any country beyond the validity of your visas?
Yes
No
If the answer is yes to any of the above questions, please provide an explanation.
Health questions
Do you have any serious medical condition including a physical or mental disorder?
Yes
No
Do you have any medical history (issues, complications? Will you need residential care, hospital care, high-cost pharmaceuticals or renal dialysis?
Yes
No
Have you previously supplied any medical certificates or X-ray certificates to Immigration New Zealand?
Yes
No
If yes, please provide details
Submit