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

November 2017 INZ 1001

Additional Dependants for

Residence in New Zealand
to be submitted with the Residence Application (INZ 1000)

For help completing this form

For help completing this form see the Residence Guide (INZ 1002). When you have completed all the sections you need
to, staple this form to your Residence Application (INZ 1000) (at the end of ‘Section F: Dependent Children’), then
continue to complete the application form.

Photographs
You must attach two recent passport-size photographs of each dependent child to this form at the places shown.
The photographs must be less than six months old. Write the child’s full name on the back of the photographs.

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

Dependent Child 7 Attach two recent passport-sized photographs of the

child below. Write the name of the child on the back of
A1 Child’s family/surname as shown in passport each photograph.

LOPEZ ZAPATA
Child’s given/first names as shown in passport

ANTONIA
4.5cm 4.5cm
A2 Gender Male Female
25 11 2 0 1 7
A3 Date of birth D D M M Y Y Y Y

A4 Country of birth 3.5cm 3.5cm

CHILE
A8 Partnership status
A5 Passport number For a definition of partner, see ‘Completing Section D: Partner’s
personal details’ in the Residence Guide (INZ 1002). ). A person is
F47253420 single if they are not living with a partner in a genuine and stable
partnership.
A6 Country as shown on passport Single Separated
Partner/De facto Divorced
CHILE
Married/in civil union Engaged
Widowed
A7 Other citizenships currently held
A9 Does this child have children of his/her own?
Yes No

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

Dependent Child 8 Dependent Child 9

Attach two recent passport-sized photographs of the Attach two recent passport-sized photographs of the
child below. Write the name of the child on the back of child below. Write the name of the child on the back of
each photograph. each photograph.

4.5cm 4.5cm 4.5cm 4.5cm

3.5cm 3.5cm 3.5cm 3.5cm

A10 Child’s family/surname as shown in passport A19 Child’s family/surname as shown in passport

Child’s given/first names as shown in passport Child’s given/first names as shown in passport

A11 Gender Male Female A20 Gender Male Female

A12 Date of birth D D M M Y Y Y Y

A21 Date of birth D D M M Y Y Y Y

A13 Country of birth A22 Country of birth

A14 Passport number A23 Passport number

A15 Country as shown on passport A24 Country as shown on passport

A16 Other citizenships currently held A25 Other citizenships currently held

A17 Partnership status A26 Partnership status

Single Separated Single Separated
Partner/De facto Divorced Partner/De facto Divorced
Married/in civil union Engaged Married/in civil union Engaged
Widowed Widowed

A18 Does this child have children of his/her own? A27 Does this child have children of his/her own?
Yes No Yes No

2 – Additional Dependants for Residence in New Zealand – November 2017

Dependent Child 10 Dependent Child 11
Attach two recent passport-sized photographs of the Attach two recent passport-sized photographs of the
child below. Write the name of the child on the back of child below. Write the name of the child on the back of
each photograph. each photograph.

4.5cm 4.5cm 4.5cm 4.5cm

3.5cm 3.5cm 3.5cm 3.5cm

A28 Child’s family/surname as shown in passport A37 Child’s family/surname as shown in passport

Child’s given/first names as shown in passport Child’s given/first names as shown in passport

A29 Gender Male Female A38 Gender Male Female

A30 Date of birth D D M M Y Y Y Y

A39 Date of birth D D M M Y Y Y Y

A31 Country of birth A40 Country of birth

A32 Passport number A41 Passport number

A33 Country as shown on passport A42 Country as shown on passport

A34 Other citizenships currently held A43 Other citizenships currently held

A35 Partnership status A44 Partnership status

Single Separated Single Separated
Partner/De facto Divorced Partner/De facto Divorced
Married/in civil union Engaged Married/in civil union Engaged
Widowed Widowed

A36 Does this child have children of his/her own? A45 Does this child have children of his/her own?
Yes No Yes No

Additional Dependants for Residence in New Zealand – November 2017 – 3

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

Dependent Child 12 Dependent Child 13

Attach two recent passport-sized photographs of the Attach two recent passport-sized photographs of the
child below. Write the name of the child on the back of child below. Write the name of the child on the back of
each photograph. each photograph.

4.5cm 4.5cm 4.5cm 4.5cm

3.5cm 3.5cm 3.5cm 3.5cm

A46 Child’s family/surname as shown in passport A55 Child’s family/surname as shown in passport

Child’s given/first names as shown in passport Child’s given/first names as shown in passport

A47 Gender Male Female A56 Gender Male Female

A48 Date of birth D D M M Y Y Y Y

A57 Date of birth D D M M Y Y Y Y

A49 Country of birth A58 Country of birth

A50 Passport number A59 Passport number

A51 Country as shown on passport A60 Country as shown on passport

A52 Other citizenships currently held A61 Other citizenships currently held

A53 Partnership status A62 Partnership status

Single Separated Single Separated
Partner/De facto Divorced Partner/De facto Divorced
Married/in civil union Engaged Married/in civil union Engaged
Widowed Widowed

A54 Does this child have children of his/her own? A63 Does this child have children of his/her own?
Yes No Yes No

4 – Additional Dependants for Residence in New Zealand – November 2017 This form has been approved under section 381 of the Immigration Act 2009