Visa Assessment Form

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Family Name*

First Name*

Email Address*

Sex*

DOB*

Place of Birth*

Citizenship*

Country of Permanent Legal Residence*

What is your home address?*

New Zealand Address (if applicable)

To what addresss do you want your correspondence sent?*

Telephone Number:*

Business Number*

Mobile Number

Partner / Spouse*

P/S Family Name:

P/S First Name

P/S Sex

P/S DOB

P/S Place of Birth

P/S Citizenship

P/S Country of Permanent Legal Residence

How long have you & your partner physically lived together?

Please provide details of any children:

Name, DOB, Place of Birth

Please advise the names of those children NOT coming to New Zealand with you:

Do you or your Partner/Spouse have any parents, adult children in NZ?

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