新西兰2015学生签证申请表

OFFICE USE ONLY Client no.:Date received: / /Application no.:

https://www.sodocs.net/doc/ff10738502.html,

When filling in this form, please write clearly using CAPITAL LETTERS.

Full-time vacation work rights

If you are entitled to work full-time during vacation periods scheduled by your education provider, you must provide evidence of these vacation periods along with the credit value of your programme of study with your application. (To confirm entitlement, see ‘Can you work while holding a student visa?’ section in the Student Visa Guide (INZ 1013)).

Note: Detailed information about the type of documents you should provide in support of your application is available from the Immigration New Zealand (INZ)

office where your application will be processed. Go to https://www.sodocs.net/doc/ff10738502.html,/contactus and select the appropriate office.

If your circumstances are not covered in

the above list, refer to the INZ website,

https://www.sodocs.net/doc/ff10738502.html,/migrant/stream/study/, or Operational M anual, w https://www.sodocs.net/doc/ff10738502.html,/opsmanual, for information about the documents you must provide.

2 – Student Visa Application - July 2015

Student Visa Application - July 2015– 3

Which type of student visa are you applying for?

Foreign fee-paying Domestic Exchange New Zealand Aid Programme-supported Limited visa Other, please specify

A1

A2 A3

A4 A6 Town/city of birth

Country of birth A7 Passport details Number

Country

Expiry date A8 Other citizenships you hold A9 Partnership status Single

Separated Partner Divorced

Married/in civil union

Engaged

Widowed

4 – Student Visa Application - July 2015

When filling in this form, please write clearly using CAPITAL LETTERS.

Note: We prefer to contact you using email. Please provide your email address if you have one.

B1 Your current residential address. Address

Telephone (landline)

Telephone (mobile)

Email

B2

If you are currently in New Zealand, your most recent overseas address.

Address

B3 Name and address for communication about this application.

Same as address at B1

, or as below

Family/last name

Given/first name(s)

Company name (if applicable) and address

Telephone (daytime) Telephone (evening)

Email

B4 Do you authorise the person stated at B3 to act on your behalf? Yes No B5 Have you received immigration advice on this application?

You can find a definition of immigration advice at https://www.sodocs.net/doc/ff10738502.html,/advice .

Yes Make sure that your immigration adviser completes Section I: Immigration adviser’s details.

No

B6 Names and addresses of any friends, relatives, or contacts you have in New Zealand (if applicable)

Name Address Relationship Date of birth (if known)

Name Address Relationship

Date of birth (if known)

B7

List all periods of employment, including self-employment

For more information about the questions in this section, see ‘Completing Section C: Your health’ in the Student Visa Guide.

C1Do you have tuberculosis (TB)? Yes No

C2Do you have any medical condition that requires, or may require, one of the following during your stay in New Zealand?

? Renal dialysis Yes No

? Hospital care Yes No

? Residential care Yes No

Residential care is defined as in-patient care for people with psychiatric, sensory or intellectual disabilities or live-in facilities for the aged.

C3Have you been identified as a person who requires special education services? (Refer to ‘Completing Section C: Your health’ in the Student Visa Guide (INZ 1013) for further information).

Yes No

C4If you have answered Yes

to any of the questions in

C1 to C3, provide details.

C5Are you pregnant?

Yes Date you are due to give birth D M Y Y

D Y Go to C6

M Y

No Go to C7

C6If you intend to give birth in New Zealand, please indicate how the cost of maternity health services will be paid for and provide the relevant evidence.

Not applicable as I do not intend to give birth in New Zealand.

I am, or will be eligible for publicly-funded maternity health services and have provided evidence of my

eligibility.

I will cover the cost myself and have attached copies (not originals) that I have at least NZ$9000 of funds

available.

My sponsor has guaranteed to cover the cost and I have attached a completed Sponsorship Form for

Temporary Entry (INZ 1025).

Student Visa Application - July 2015– 5

When filling in this form, please write clearly using CAPITAL LETTERS.

Medical certificates and insurance requirements

Answer the questions below to find out whether you are required to provide a medical certificate or chest X-ray certificate as part of your application. Medical certificates and chest X-ray certificates must be less than three months old when you submit them to Immigration New Zealand. This section also includes a declaration regarding insurance requirements for foreign fee-paying students.

Only domestic, exchange, PhD and NZ Aid Programme-supported students should answer questions C7 to C12. Foreign fee-paying students must go to C13All applicants required to provide a medical or X-ray certificate must answer question C19.

C7Will you be in New Zealand for less than six months?

Yes You do not need to provide a medical certificate or chest X-ray certificate. Go to Section D: Your character

No Go to C8

C8Will you be in New Zealand for more than six months and less than 12 months?

Yes Go to C9

No Go to C10

C9Are you from, or have you visited for more than three months, a place that is outside the list of ‘Countries, areas, and territories with a low incidence of tuberculosis’*?

Yes Go to C11

No You do not need to provide a medical certificate or chest X-ray certificate. Go to Section D: Your character.

C10Have you previously provided a medical certificate which was issued less than 36 months ago?

Yes You do not need to provide a new medical certificate (or further medical information other than a chest X-ray certificate, if required below) unless (select an option if applicable):

your health has deteriorated, or

you been advised in writing by Immigration New Zealand to provide a medical certificate or further medical information with this

application. Go to C11

No You must provide a completed medical certificate**. Go to C11

C11Have you previously provided a chest X-ray certificate which was issued less than 36 months ago?

Yes Go to C12

No You must provide a Chest X-ray Certificate (INZ 1096) unless you are (select an option if applicable):

pregnant, or

under 11 years of age. Go to Section D: Your character.

C12Have you spent six consecutive months since your previous visa application in a place that is outside the list of ‘Countries, areas, and territories with a low incidence of tuberculosis’*?

Yes You must provide a new Chest X-ray Certificate (INZ 1096) unless you are (select an option if applicable):

pregnant, or

under 11 years of age. Go to Section D: Your character.

No You do not need to provide a new chest X-ray certificate. Go to Section D: Your character.

* Refer to ‘Completing Section C: Health’ in the Student Visa Guide (INZ 1013) for the ‘List of Countries, areas and territories with a low incidence of tuberculosis’.

** Refer to ‘Completing Section C: Your health’ in the Student Visa Guide (INZ 1013) for information about the two types of medical certificates which may be provided:

– the General Medical Certificate (INZ 1007), which should be used by most students, and

– the Limited Medical Certificate (INZ 1201), which should be used by students who are the dependent child of a New Zealand citizen or resident, and meet the requirements to be granted residence under the Dependent Child Category, except where limitations apply.

6 – Student Visa Application - July 2015

Only foreign fee-paying students (excluding PhD, exchange and NZ Aid Programme-supported students) should answer the questions C13 to C20

C13Will you be in New Zealand for less than six months?

Yes You do not need to provide a medical certificate or chest X-ray certificate. Go to C20

No Go to C14

C14Have you ever used intravenous drugs? Yes No

Have you ever had a blood or blood product transfusion? Yes No

Have you ever participated in or been exposed to any activity which may have exposed you to a serious infectious disease (such as HIV, or hepatitis B or C)?

Yes No

If you answered Yes to any of the questions in C14 you must provide a completed General Medical

Certificate (INZ 1007) regardless of any other advice below. Go to C15

C15Are you from, or have you visited for more than three months, a place that is outside the list of ‘Countries, areas, and territories with a low incidence of tuberculosis’**?

Yes Go to C16

No Y ou do not need to provide a chest X-ray certificate. Go to C18

C16Have you previously provided a chest X-ray certificate which was issued less than 36 months ago?

Yes Go to C17

No You must provide a Chest X-ray Certificate (INZ 1096) unless you are (select an option if applicable):

pregnant, or

under 11 years of age. Go to C18

C17Have you spent six consecutive months since your previous visa application in a place that is outside the list of ‘Countries, areas, and territories with a low incidence of tuberculosis’*?

Yes You must provide a new Chest X-ray Certificate (INZ 1096) unless you are (select an option if applicable):

pregnant, or

under 11 years of age. Go to C18

No You do not need to provide a new chest X-ray certificate. Go to C18

C18Have you been advised in writing by Immigration New Zealand to provide a medical certificate, a chest X-ray certificate or any other medical information with this application?

Yes You must provide a General Medical Certificate (INZ 1007), a Chest X-ray Certificate (INZ 1096) or the further medical information requested by Immigration New Zealand. Go to C19

No Unless the previous questions have indicated that you must provide a medical certificate, or a chest X-ray certificate, or further medical information, you do not need to provide any further documents about your health. Go to C20

C19Tick the option that applies to you:

Is a physician submitting your medical and/or chest X-ray certificate to Immigration New Zealand on your behalf?

Yes Has your physician supplied you with an eMedical Reference Code (NZER)?

Yes Enter your eMedical Reference Code here: Go to C20

No Enter the name of the clinic that is submitting your health information: Go to C20 No If the physician has returned the medical and/or chest X-ray certificate to you, then you will need to submit these with your visa application. Go to C20

* Refer to ‘Completing Section C: Your health’ in the Student Visa Guide (INZ 1013) for the ‘List of Countries, areas and territories with a low incidence of tuberculosis’.

Student Visa Application - July 2015– 7

8 – Student Visa Application - July 2015

When filling in this form, please write clearly using CAPITAL LETTERS.

C20

Declaration regarding insurance requirements.

For more information about insurance requirements, refer to ‘Completing Section C: Your health’ in the Student Visa Guide .

I agree to arrange and hold insurance which my education provider considers acceptable, from the period of my enrolment until the expiry of my student visa, unless I depart New Zealand earlier. Yes

I understand that holding insurance will be a condition of my visa and that I may become liable for deportation if I do not hold insurance, from the period of my enrolment until my visa expires, unless I depart New Zealand earlier. Yes

I understand that if I apply for a further visa, I may be required to provide evidence that I held acceptable insurance while in New Zealand, holding the visa that I am currently applying for. Yes

All applicants must complete this section. Note: if your application is declined for character reasons,

Immigration New Zealand may place a notation in your passport indicating that you applied for a visa for New Zealand.

D1 Have you been convicted at any time of any offence, including any driving offence? Please note that this includes any

conviction(s) outside of New Zealand subsequently cleared or wiped by ‘clean slate’ legislation.

Yes No D2 Are you currently:

? under investigation Yes No ? wanted for questioning Yes No ? facing charges Yes No for any offence in any country?

D3 Have you ever been:

? excluded Yes No ? refused entry Yes No ? removed or deported Yes No from any country, including New Zealand?

D4 Have you ever been refused a visa/permit to visit, work, study or reside in any country? Yes No D5 Have you ever been a member of, or adhered to, any terrorist organisation? Yes No

D6 Have you had (or do you currently have) an association with, membership of, or involvement with, any

government, regime, group or agency that has advocated or committed war crimes, crimes against humanity and/or other gross human rights abuses?

Yes No

If you have answered yes to any of the questions above give full details. This includes full details of any charges, convictions and the sentence or penalty imposed. Continue on a separate piece of paper if necessary.

Student Visa Application - July 2015– 9

Police certificates you must provide

Select the appropriate option to indicate whether you are required to provide a police certificate with this application. Police certificates must be less than six months old when you submit them to Immigration New Zealand.

D7 You do not need to provide a police certificate if:

you are under 17, or

you are not intending to be in New Zealand for 24 months or longer , or

you have provided a police certificate to Immigration New Zealand with a previous application, and that certificate was dated:

less than 36 months ago, if you are a full-fee-paying or PhD student,or less than 24 months ago if you are not a full-fee-paying or PhD student, or you are younger than 20, and

held a student visa on your 17th birthday, and

have held student visas (or interim visas with study conditions) continuously since turning 17.

D8 You must provide police certificates from your country of citizenship and any country you have lived in for

five years or more since the age of 17 if you plan to be in New Zealand for 24 months, and, either:

you have not previously provided police certificates to Immigration New Zealand, or

you have previously provided a police certificate to Immigration New Zealand, but that certificate was dated: more than 36 months ago, if you are a full-fee-paying or PhD student, or more than 24 months ago if you are not a full-fee-paying or PhD student.

E1 Tick one of the boxes below to show the type of visa you are applying for and provide the date of your arrival in

New Zealand if applicable.

Applying for a student visa while outside New Zealand. Date you will enter New Zealand (if applicable)

D

M

Y

Y

M

Y

D

Y

Note: student visas normally allow multiple entry travel.

Applying for a limited visa. List the reasons below. Date you will enter New Zealand on a limited visa D M Y

Y

M Y D Y

Applying for a further limited visa. List the reasons below.

10 – Student Visa Application - July 2015

When filling in this form, please write clearly using CAPITAL LETTERS.

If you are a dependent child with domestic status, go to Section G: Your parent or legal guardian.

Your programme of study

F1 When does your programme of study start? D

M

Y

Y

M

Y

D

Y

F2 When does your programme of study finish?

D M Y Y M Y D Y

F3 Provide the date to which your fees have been paid. If you have a scholarship, provide the date your scholarship

ends D M Y Y M Y D Y F4

Details of the programme of study you have enrolled in

Your financial support

F5 Tick one or more of the boxes below to show how you will be financially supported.

I have attached copies (not originals) of evidence that I have sufficient funds equivalent to NZ$15,000 for a full year of study, or NZ$1250 per month that I will be in New Zealand.

I have attached copies (not originals) of evidence that my living costs are already paid.

I have attached a letter from my home country government that states that I am fully funded for my study and the duration of my stay in New Zealand.

I have attached a Sponsorship Form for Temporary Entry (INZ 1025) completed by an acceptable sponsor. I have attached a completed Financial Undertaking for a Student (INZ 1014).

Note : If you are in New Zealand, a financial undertaking can only be provided if your original student visa

application made outside New Zealand included a financial undertaking. The financial undertaking supplied with this application must be completed by the same person who completed the original undertaking.

I have attached a written guarantee of maintenance from a relative in New Zealand who is either a New Zealand citizen or residence class visa holder. This option is for students from Tonga or Samoa only.

Complete this section if you will be living with your parent or guardian for the duration of your visa.G1

Name of parent/legal guardian as shown in their passport

Family/last name Given/first name(s)

G2 Other names your parent/legal guardian is known by

G3 Gender Male Female G4 Date of birth

D

M

Y

Y

M

Y

D

Y

G5 Place of birth

Country of birth

This form has been approved under section 381 of the Immigration Act 2009

Student Visa Application - July 2015– 11

G6 Passport details Number

Country

Expiry date

D M Y Y M Y D Y

G7 Other citizenships your parent or legal guardian holds

G8 Relationship to you:

Mother

Father Legal guardian

G9

Please indicate whether you are a full-fee-paying or domestic student

I am a full-fee-paying student and my parent or legal guardian is applying for a guardianship visitor visa to accompany me.

I am a domestic student because I am dependent on my parent or legal guardian and they are a New Zealand citizen, resident or the holder of a temporary visa that entitles me to domestic status.

Note: For more information about domestic status see the Student Visa Guide.

I have provided true and correct answers to the questions in this form.

I agree to tell Immigration New Zealand about any changes to my circumstances that occur after making this application. I agree to leave New Zealand before my visa expires. If I remain in New Zealand after my visa has expired, I may be liable for deportation.

I agree that if I am not entitled to free health care in New Zealand, I will pay for any health care or medical assistance I may require in New Zealand.

I understand that if I have received immigration advice from an immigration adviser and if that immigration adviser is not licensed under the Immigration Advisers Licensing Act 2007 when they should be, Immigration New Zealand will return my application.

I understand that Immigration New Zealand may provide information about my entitlement to work to potential employers including via the online VisaView system.

I authorise Immigration New Zealand to provide information about my health and my immigration status to any health service agency. I authorise any health service agency to provide information about my health to Immigration New Zealand.

I authorise Immigration New Zealand to make any necessary enquiries about information on this form and/or accompanying documentation.

I authorise any agency whether in New Zealand or overseas, including but not limited to border or immigration agencies, education providers, financial institutions, foreign embassies, government authorities, health care providers, insurance providers, police or other law enforcement agencies, that holds information (including personal information) related to information on this application form and/or accompanying documentation to disclose that information to Immigration New Zealand.

I authorise Immigration New Zealand to provide information about my immigration status to my past, present or future education provider, including via VisaView. I authorise Immigration New Zealand to provide information about the status of my student visa application to my present education provider. I authorise Immigration New Zealand to provide information about my immigration status to the International Education Appeal Authority.

If I am granted a student visa with the condition that I am accompanied by a legal guardian, I agree to live with my legal guardian. I understand that both I and my legal guardian could be made liable for deportation if this condition is not met.If I am granted a limited visa, I agree that I will leave New Zealand on or before the expiry date of that visa. If I do not leave New Zealand, I may be immediately deported from New Zealand without the right of appeal.

If I am granted a student visa with the condition that I hold acceptable insurance, I understand the requirements regarding insurance that I have agreed to at C20.Signature of applicant

Date

D

M

Y

Y

M

Y

D

Y

Signature of parent or guardian if applicant is under 18 years of age

Date

D

M

Y

Y

M

Y

D

Y

12 – Student Visa Application - July 2015

When filling in this form, please write clearly using CAPITAL LETTERS.

This section must be completed by the applicant’s immigration adviser. If the applicant does not have an immigration adviser, this section does not have to be completed.

I1 If you are a licensed adviser, please provide your licence details. Licence type full provisional limited List conditions specified in the register

Licence number 20

Go to Section J: Declaration by person assisting the applicant

I2 If you are exempt from licensing, tick one box below to show why you are exempt from licensing then go to

Section J: Declaration by person assisting the applicant.

I provided immigration advice in an informal or family context only, and I did not provide the advice systematically or for a fee.

I provided immigration advice offshore in relation to applications or potential applications for student visas only.

I have provided immigration advice in the course my work (employed or volunteer) and that work exempts me from the requirement to be licensed. Indicate the reason for your exemption below.

Lawyer with current New Zealand practicing certificate Community Law Centre Citizens Advice Bureau New Zealand Member of Parliament or staff New Zealand public servant Foreign Diplomatic/Consular

See https://www.sodocs.net/doc/ff10738502.html,/adviserlicensing for more information about who is exempt from licensing

.

This section must be completed and signed by any person who has assisted the applicant by providing

immigration advice, explaining, translating, or recording information on the form for the applicant; or by the applicant’s immigration adviser. If the applicant does not have an immigration adviser, and no one helped the applicant to fill in this form, this section does not have to be completed.

If you are not exempt under the Immigration Advisers Licensing Act 2007, it is an offence for you to provide immigration advice without holding a license, and Immigration New Zealand will refuse to accept your client’s application. More information about immigration adviser licensing can be obtained from the Immigration Advisers Authority website https://www.sodocs.net/doc/ff10738502.html, , via email info@https://www.sodocs.net/doc/ff10738502.html, or by telephone on 0508 422 422.

Name and address of person assisting applicant. Same as address given at B3, or as below.

Family/last name

Given/first name(s)Company name (if applicable) and address

Telephone (daytime) Telephone (evening)

Fax Email or change or add any documents attached to the form, without making a statement identifying what information or material has been changed, added or attached and by whom. If I make these changes or additions, I must state on the form what they were, who made them and the reason they were made.

I understand that the maximum penalty for this offence is a fine of up to NZ$100,000 and/or a term of imprisonment of up to seven years.

I certify that the applicant asked me to help them complete this form and any additional forms. I certify that the applicant agreed that the information provided was correct before signing the declaration. I have assisted the applicant as an interpreter/translator

I have assisted the applicant with recording information on the form I have assisted the applicant in another way. Specify

I have provided immigration advice (as defined in the Immigration Advisers Licensing Act 2007) and my details in Section I: Immigration adviser’s details are correct.Signature of person assisting

Date

D M Y Y M Y D Y