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

July 2019 INZ 1012

Student Visa
Application
for a temporary stay in New Zealand

Apply for your visa online – it’s faster & easier

The fastest and easiest way to apply for a student visa is online. Once you have your documents prepared, it should
take less than 15 minutes to complete the online application form.

Explore your options and apply online at www.immigration.govt.nz/study.

Refer to the Student Visa Guide

The Student Visa Guide (INZ 1013) contains important information about the requirements for a student visa and how
to complete the form. It can be downloaded from www.immigration.govt.nz/forms.

Documents required
Use the checklist on page 2 of this form to find out which documents you must provide. If you have not provided the
correct documents, we will return your application.

Immigration Advisers Licensing Act 2007

Under the Immigration Advisers Licensing Act 2007 it is an offence to provide immigration advice without being
licensed or exempt. If your immigration adviser is not licensed when they should be, Immigration New Zealand will
return your application.

For more information and to view the register of licensed advisers, go to the Immigration Advisers Authority website
www.iaa.govt.nz or email [email protected].

Lawyers provide immigration advice and are exempt from licensing under the Immigration Advisers Licensing Act.
For more information and to view the register of immigration lawyers, go to the New Zealand Law Society website
www.lawsociety.org.nz.

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

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

Application checklist Accompanied by Evidence of your relationship with

a parent or legal your parent or legal guardian.
Information and documents you must supply guardian Evidence that your parent or legal
guardian cares for you in your
Completed, signed application form.
home country.
Appropriate fee and levies. Domestic Evidence of your domestic
Two passport-size colour photographs. students student status.
Passport or travel document*. If you are a dependent child
Medical or chest X-ray certificates if required by of an Essential Skills visa holder,
evidence that your parent is
Section C: Your health.
eligible to support your visa –
Police certificates if required by Section D: see www.immigration.govt.nz/
Your character. work-support-child.
Applicants in the circumstances below must provide the If you are a dependent child
relevant documents (more than one section may apply to you). of a Religious worker visa
Must provide... holder, either:
Applicants who are...
evidence that your parent is
Foreign fee- An offer of place(s) from
eligible to support your visa –
paying students an approved New Zealand
see www.immigration.govt.nz/
education provider(s)
work-support-child.
A Confirmation of Enrolment if
a signed and completed
you are a student returning to
sponsorship form indicating
the same provider and studying
that the religious organisation
the same programme.
sponsoring your parent will
If you are applying for a pathway support you.
student visa, a letter from your
education provider(s) stating In year 12 or 13 Permission to work 20 hours
they support your application for at secondary per week and/or full-time during
a pathway student visa. school, wishing the summer holiday period from
to work your:
Evidence that your tuition fees: parents, and
have been paid education provider (not required
are covered by a foreign if you are over 18 and at
government loan, or secondary school and wish to
will be paid by your home work during the summer holiday
country government. period), and
Exchange Provider Organisation
are covered by a study abroad or
(if you are an exchange student,
non-award scheme
e.g. AFS, Rotary).
If you are applying from outside
New Zealand, evidence that you/ Exchange Evidence from the scheme
your family have sufficient funds students organiser that you have been
to pay your tuition fees after accepted to an approved student
your visa application is approved exchange scheme.
in principle. New Zealand Evidence that you receive funding
If you are already studying in scholarship from the New Zealand
New Zealand, evidence of: students funded Government under one of the
by the Ministry New Zealand scholarship
previous student performance of Foreign schemes.
and progress, and Affairs and
attendance records. Trade (MFAT)
Evidence of your financial Foreign Evidence that your home country
support, as described in Section government- government will fully fund your
F: Fee-paying PhD and supported stay and study in New Zealand.
scholarship students. students
Foreign fee- Evidence of pre-purchased
paying students outward travel, or *While you can provide a certified copy of your passport with your
Evidence of sufficient funds application, we highly recommend you provide your original passport.
to purchase outward travel This will enable us to process your application faster and it may
(additional to your living funds), be needed to complete your application. Please note during the
or processing of an application an immigration officer may request any
document, including your original passport
Either a sponsorship form or
a financial undertaking form
guaranteeing to cover the cost of
outward travel from New Zealand.

2 – Student Visa Application – July 2019

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)).

If your circumstances are not covered in the above list, refer to the INZ website, www.immigration.govt.nz, or
Operational Manual, www.immigration.govt.nz/opsmanual, for information about the documents you must provide.

Which type of student visa are you applying for?

Foreign fee-paying Domestic Exchange MFAT funded New Zealand scholarship student Limited visa

Other, please specify

Section A Principal applicant’s personal details

Attach two colour passport-size photographs of yourself
here. The photographs must be less than six months old.
Write your full name on the back of both photographs.

For more information about the questions in this section, see ‘Completing
Section A: Principal applicant’s personal details’ in the Student Visa Guide.
4.5cm 4.5cm
A1 Name as shown in passport
Family/last name

3.5cm 3.5cm

Given/first name(s)

A2 Preferred title Mr Mrs Ms Miss Dr other (specify)

A3 Other names you are known by or have ever been known by

A4 Gender Male Female A5 Date of birth D D M M Y Y Y Y

A6 Town/city of birth

Country of birth

A7 Passport details

Number

Country
Expiry date D D M M Y Y Y Y

A8 Other citizenships you hold

A9 Partnership status Single Separated Partner/De facto Divorced

Married/in civil union Engaged Widowed

Student Visa Application – July 2019 – 3

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

Section B Contact details

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

Name of contact person

Organisation name (if applicable) and address

New Zealand Business Number (for New Zealand businesses only)

For help search: www.nzbn.govt.nz

Telephone (daytime) Telephone (evening)

Email

B4 Do you authorise the person stated at B3 to act on your behalf? Yes No

B5 Do you authorise all other licensed immigration advisers or persons exempt from licensing who work for the
organisation named at B3 to act on your behalf (if applicable)?
Yes Note: the person identified at B3 will receive all communication from Immigration New Zealand.

No Only the person indicated at B3 may act on my behalf.

B6 Have you received immigration advice on this application?

You can find a definition of immigration advice at www.immigration.govt.nz/advice.

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

No

B7 Names and addresses of any friends, relatives, or contacts you have in New Zealand (if applicable)

Name

Address

Relationship Date of birth (if known) D D M M Y Y Y Y

Name

Address

Relationship Date of birth (if known) D D M M Y Y Y Y

4 – Student Visa Application – July 2019

 B8 List all periods of employment, including self-employment

Date from Date to Name of employer New Zealand Location Type of work/occupation/
(DD/MM/YY) (DD/MM/YY) Business Number job title
/ / / /
/ / / /
/ / / /
/ / / /
/ / / /

The New Zealand Business Number (NZBN) is for New Zealand businesses only. For help search: www.nzbn.govt.nz.

Section C Your health

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

C1 Do you have tuberculosis (TB)? Yes No

C2 Do 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.
C3 Have 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

C4 If you have answered Yes to any of the questions in C1 to C3 , provide details.

C5 Are you pregnant?

Yes Date you are due to give birth D D M M Y Y Y Y Go to C6

No Go to C7

C6 If 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 2019 – 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 MFAT funded NZ scholarship students should answer
questions C7 to C12 . Foreign fee-paying students must go to C13 . All applicants required to provide
a medical or X-ray certificate must answer question C19 .
C7 Will 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

C8 Will you be in New Zealand for more than six months and less than 12 months?

Yes Go to C9

No Go to C10

C9 Are 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.

C10 Have 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

C11 Have 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.

C12 Have 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 2019

Only foreign fee-paying students (excluding PhD, exchange and MFAT funded NZ scholarship
students) should answer the questions C13 to C20 .
C13 Will 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

C14 Have 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

C15 Are 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 You do not need to provide a chest X-ray certificate. Go to C18

C16 Have 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

C17 Have 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

C18 Have 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

C19 Tick 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 2019 – 7

 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.
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.
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.

I agree with the declaration

Section D Your character

All applicants must complete this section.

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, excluding New Zealand?

D4 Have you ever been refused a visa/permit to visit, work, study or reside in any country, excluding New Zealand?
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.

8 – Student Visa Application – July 2019

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.

Section E Your visa

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 D M M Y Y Y Y

Applying for a student visa while inside New Zealand.

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 D M M Y Y Y Y

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

Student Visa Application – July 2019 – 9

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

Section F Fee-paying, PhD, pathway and scholarship students

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

Your programme(s) of study

F1 Are you applying for a pathway student visa? Yes No

F2 Details of your programme(s) of study

Programme of study/ Qualification Education Provider/Location Start date End date

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

Your financial support

F4 Tick one or more of the following boxes below.

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 evidence (copies only) that I have access to sufficient funds to support myself throughout
the intended length of my pathway student visa.
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.

10 – Student Visa Application – July 2019 This form has been approved under section 381 of the Immigration Act 2009
 Section G Your parent or legal guardian
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 D M M Y Y Y Y

G5 Place of birth

Country of birth

G6 Passport details

Number

Country Expiry date

D D M M Y Y Y Y

G7 Other citizenships your parent or legal guardian holds

G8 Relationship to you: Mother Father Legal guardian

G9 Please indicate your parent or legal guardian’s intended immigration status in New Zealand while you
are studying.
My parent or legal guardian is applying for a guardian visitor visa to accompany me.
My parent or legal guardian is a New Zealand citizen, resident or the holder of a temporary visa that entitles
me to domestic student status. (Note: For more information about domestic student status see the Student Visa Guide.)
Other – please explain:

Student Visa Application – July 2019 – 11

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

Section H Declaration by applicant

I have provided true and correct answers to the questions in this form. I understand that if false or misleading
information is submitted, my application may be declined without further warning.
I understand that if this application is found to contain false or misleading information after the grant of my visa,
sufficient reason may exist for me to be made liable for deportation under section 157 of the Immigration Act 2009.
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 and outcome of my student visa application to the education provider named in this application.
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 D M M Y Y Y Y

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

Date D D M M Y Y Y Y

12 – Student Visa Application – July 2019

 Section I Immigration adviser’s (licensed and exempt) details
This section must be completed by the applicant’s immigration adviser. If the applicant has authorised all
advisers within an organisation to act on their behalf at B5 , only the person named at B3 must complete this
section. If the applicant does not have an immigration adviser or offshore education agent, 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 2 0 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 e.g. offshore education agents.
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 www.immigration.govt.nz/adviserlicensing for more information about who is exempt from licensing.

Student Visa Application – July 2019 – 13

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

Section J Declaration by person assisting the applicant

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 www.iaa.govt.nz, via email [email protected] or by telephone on 0508 422 422.

Name and address of person assisting applicant.  Same as name and address given at B3 , or  as below.
Family/last name Given/first name(s)

Organisation name (if applicable) and address

New Zealand Business Number (for New Zealand businesses only)

For help search: www.nzbn.govt.nz

Telephone (daytime) Telephone (evening)

Fax Email

I understand that after the applicant has signed this form it is an offence for me to change or add further information,
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 (licensed or exempt) details are correct.

Signature of person assisting Date D D M M Y Y Y Y

14 – Student Visa Application – July 2019

 Paying your application fee
About the information you provide Section K
and levies
Deciding whether you are eligible for a visa To find out much to pay, where to send your
application, and how long a decision may take,
Immigration New Zealand collects the information see www.immigration.govt.nz/fees.
about you on this form to decide whether you are
eligible for a student visa or a limited visa. We may
also use the information to contact you for research Your application fee and levies
purposes or to advise you on immigration matters.
Amount you are paying:
Collecting the information is authorised by
the Immigration Act 2009 and the Immigration Amount
Regulations made under that Act. You do not have
to provide the information, but if you do not we Currency
are likely to decline your application. (e.g. NZD, USD, RMB)

Deciding whether you are eligible to board Application number

(office use only)
a flight to New Zealand
The information we collect may also be used to Preferred methods of payment
determine whether you are allowed to board a flight
to New Zealand. We will not share your personal We recommend that you use one of the following methods
information with airline check-in agents; however, of payment for better security and faster processing:
we will send a boarding message to the airline
check-in agent based on the information you have Bank cheque/bank draft
provided in this form. Credit card (choose one)
Immigration New Zealand may also share the
Mastercard Visa
information you have provided with other
government agencies that are entitled to it by SWITCH card (UK only) SWITCH card issue number
law, or with other agencies (as you have agreed
Name of cardholder
in the declaration).
You are able to ask for the information we hold
about you and have any of it corrected if you Card number
think it is necessary. The address of Immigration
New Zealand is PO Box 1473, Wellington 6140,
New Zealand. This is not where your application
should be sent. CVC/CVV number

For more information Note: your CVC/CVV number is the three-digit number found on the
signature strip on the back of your credit card.
If you have questions about completing the form: Expiry date D D M M Y Y Y Y
• see our website
www.immigration.govt.nz/contactus Signature of cardholder
• telephone our call centre on 0508 558 855
(within New Zealand).

Date D D M M Y Y Y Y

Returning your documents

Please return documents to me by secure post at the Other methods of payment
address given at:
B1 Personal cheque. Note that we will hold your application for
10 working days to allow the cheque to be cleared.
B2 We do not accept money orders.
B3

Student Visa Application – July 2019 – 15

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

16 – Student Visa Application – July 2019