Immigration Questionnaire

Please answer all questions in English.

Contact Information
Email Address: Date:
Your Family Name: Given Names:
Date of Birth: Citizenship(s) Held:
Country of Birth: Marital Status:
Home Phone Number: Work Phone Number:
Facsimile Number: Cellphone Number:
Full Postal Address: Date of Arrival in New Zealand:
Type of permit held:

Student Work
Visitor

 Expiry date of your current permit:
Spouses/Partner Details
How long have you been living together?
Family Name: Given Names:
Date of Birth: Citizenship(s) Held:
Country of Birth:

Have you or your spouse/partner been divorced?

If yes, who and when?

Yes No

Countries Lived In - Please list all countries you and your spouse/partner have lived in for a total of 12 months or longer in the past 10 years. Please list the countries and the dates you/your spouse were there.
You: Your Spouse:

Has any person associated with this application ever been convicted of any criminal offence of any kind excluding parking tickets?

Yes No

If the answer is yes please provide FULL details of the offence, the punishment and the year committed & convicted.

Children
Please list the names of all children ever born to you and your spouse / partner or adopted by you and your spouse / partner, including any and all children from previous marriages. We also need to know whether you have custody of the children listed.

Name of Child:

 Date of Birth: Sex: Country of Residence: Country of Citizenship: Do you have custody?
Spouses Children
Spouse/Partners Children (if different from above)

Name of Child:

 Date of Birth: Sex: Country of Residence: Country of Citizenship: Do you have custody?

Family Details
Please list all your living immediate family i.e. parents, brothers, sisters and half brothers and sisters:

Include their:
Name | Date of Birth | Sex | Country of Normal Residence | Citizenship

Spouse's Family Details
Spouse/Partner's Family Details - please list all your living immediate family i.e. parents, brothers, sisters and half brothers and sisters:

Include their:
Name | Date of Birth | Sex | Country of Normal Residence | Citizenship

New Zealand Family?
Do you or your spouse / partner have any immediate family currently living in New Zealand holding either Permanent Residence or New Zealand Citizenship? 		Yes No

Education & Qualifications

Please indicate if you or your spouse have completed any of the following. Please tick the appropriate qualifications

Trade Certificate or Diploma Degree Technikon/Technical College Apprenticeship

If you attended a Technical College what exactly did you study? E.g. Toolmaker, Carpentry, Fitting and Turning. What Qualifications did you obtain? E.G. NTC, I, II, III etc

Qualification Type(Degree or Diploma)

 Majors Name of Institution Graduation Date Normal Completion Date
Spouses Education Record

Qualification Type(Degree or Diploma)

 Majors Name of Institution Graduation Date Normal Completion Date

Work Experience
Exact Dates of Employment dd/mm/yy Company Name Job Title and Description
to
to
to
to
Spouses Work Experience
Exact Dates of Employment dd/mm/yy Company Name Job Title and Description
to
to
to
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Financial Resources

We seek this information from you because for certain categories of migration your personal net worth and the ability to transfer funds MAY help you to qualify. Please tick the appropriate answer.

Do you believe that within six months of your application being approved in principle you would be able to transfer a minimum of NZD$100,000 in cash to New Zealand if your residence application was approved? Allow a minimum of six months for a decision to have been made on your application.
Yes No

Are you willing to transfer this amount?
Yes No

Do you believe that within six months of your application being approved in principle you would be able to transfer a minimum of NZD$200,000 in cash to New Zealand if your residence application was approved? Allow a minimum of six months for a decision to have been made on your application
Yes No

Are you willing to transfer this amount?
Yes No

Can you (and are you willing to) transfer more than $200,000 to New Zealand?
Yes No

If yes please specify how much, in

Medical Information

Do you or any person associated with this application have any medical problems for which medication is being taken? If yes please list the details of the condition and current treatment including the medication and the dosage. This is very important

Has any person associated with this application spent time in the past five years in hospital for any reason what so ever? If yes please give FULL details of the nature of the visit.

English Language

Is English your mother tongue? Yes

If English is not your mother tongue how would you describe your/your spouses/partners English language ability?

Your English Is:

Fluent Conversational Limited

Yours spouses/partners English is:

Fluent Conversational Limited

Have you or your spouse/partner sat the IELTS test within the last two years? Yes No

If yes, what date and what were the individual section scores?

If no, do you and your spouse/partner believe that you could both achieve level 5.0 or higher in an IELTS test? Yes No

 

Thank you for completing this form. Now click on the submit button and your details will be transferred to MK Immigration for evaluation.