Immigration Inquiry - Dynasty Tours & Travels

New Zealand Pre-Assessment Questionnaire

Please complete the following questionnaire to better assist you in your pathway for successful immigration to New Zealand.

*Once completed please return this questionnaire by email. In accordance with the Immigration Advisers Authority (IAA) Code of Conduct, all information collected in this form will be held with the strictest confidentiality and will not be divulged to any other party without the written consent of the person providing this information

A. Principal Applicant Details

Name*

Title

Full Legal Given Names

Full Legal Surname

Contact information

Physical Address and Country of Residence*

Home telephone

Mobile telephone

Email address*

Please state what your immigration objective is and planned migration date.*

Have you ever been issued a visa to New Zealand?*

Yes

If yes, please give details (date of issue and type – visitor, work, student, etc.)*

Do you have any family or friends in New Zealand?*

Yes

If yes, please define the relation (e.g., friend, brother, cousin etc.) and their status in New Zealand (e.g. citizen, permanent resident, work visa, etc.)*

Please provide details of your occupation (if applicable) along with details of your work history starting with the most current one

Occupation/Job Title

Row 1

Month and year of Commencement

Row 1

Month and year of Resignation

Row 1

Name of Organisation/Employer

Row 1

Full time/ Part time

Row 1

Add Another Record

Occupation/Job Title

Row 2

Month and year of Commencement

Row 2

Month and year of Resignation

Row 2

Name of Organisation/Employer

Row 2

Full time/ Part time

Row 2

Add Another Record

Occupation/Job Title

Row 3

Month and year of Commencement

Row 3

Month and year of Resignation

Row 3

Name of Organisation/Employer

Row 3

Full time/ Part time

Row 3

Please provide details of all persons to be included in your visa application in the following order: 1) Principal Applicant; 2) Spouse/Partner; 3) Dependent Child 1; 4) Dependent Child 2; etc

Full Name

Row 1

Date of Birth (DD/MM/YY)

Row 1

Citizenship(s)

Row 1

City and Country of Birth

Row 1

Male/Female

Row 1

Add Another Record

Full Name

Row 2

Date of Birth (DD/MM/YY)

Row 2

Citizenship(s)

Row 2

City and Country of Birth

Row 2

Male/Female

Row 2

Add Another Record

Full Name

Row 3

Date of Birth (DD/MM/YY)

Row 3

Citizenship(s)

Row 3

City and Country of Birth

Row 3

Male/Female

Row 3

Add Another Record

Full Name

Row 4

Date of Birth (DD/MM/YY)

Row 4

Citizenship(s)

Row 4

City and Country of Birth

Row 4

Male/Female

Row 4

Primary Applicant: please indicate your marital status*

If you are in a de facto relationship, please indicate the date it began

If you are divorced, is the divorce legal and final?

Yes

If yes, please provide date

If separated, please provide date of separation

For all persons to be included in this application, aged 17 or over: Have you ever resided outside your country of citizenship for 12 months (cumulatively) or more in the last 10 years? If so, please list below.

Country/Countries

Approximate Duration of Residence (months or years)

Add another country

Country/Countries

Approximate Duration of Residence (months or years)

Add another country

Country/Countries

Approximate Duration of Residence (months or years)

Add another country

Country/Countries

Approximate Duration of Residence (months or years)

Add another country

Country/Countries

Approximate Duration of Residence (months or years)

Add another country

Country/Countries

Approximate Duration of Residence (months or years)

In the case of a child being included in your visa application, he/she must be: Single and

17 or younger

Aged 18-20 with no child(ren) of their own

Aged 20-24 with no child(ren) of their own and totally or substantially reliant on an adult for financial support

Are all your dependent children single and without children of their own?

Yes

If not, please provide details or attach an additional sheet if necessary:

Will any of your children be immigrating with you?

Yes

If no, please indicate why:

For all persons included in this visa application: is English your first language?

Yes

If English is not your first language, please advise whether you have sat for an IELTS or TOEFL iBT or PTE Academic test and detail the applicable scores:

Details of all complete qualification(s) (e.g. degree, diploma, or trade qualification) held by you and your spouse – do not include details of short courses or incomplete studies that have not led to a qualification. Please attach additional sheets if necessary.

Primary Applicant

Name of Qualification

Date Awarded

Name of Institution

Period of Study (Years/Months)

Full Time /Part Time

Add other qualification details

Name of Qualification

Date Awarded

Name of Institution

Period of Study (Years/Months)

Full Time /Part Time

Add other qualification details

Name of Qualification

Date Awarded

Name of Institution

Period of Study (Years/Months)

Full Time /Part Time

Upload (qualification(s))

Spouse/Partner

Name of Qualification

Date Awarded

Name of Institution

Period of Study (Years/Months)

Full Time /Part Time

Add other qualification details

Name of Qualification

Date Awarded

Name of Institution

Period of Study (Years/Months)

Full Time /Part Time

Add other qualification details

Name of Qualification

Date Awarded

Name of Institution

Period of Study (Years/Months)

Full Time /Part Time

B. INZ Mandatory Questions

The following questions apply to all persons to be included in your visa application

Have you ever been arrested or charged or convicted for any offence anywhere in the world?*

Yes

Have you ever been detained, jailed or imprisoned in any country?*

Yes

Email address*

Are there any criminal or civil proceedings pending against you in any country?*

Yes

Are you under investigation in any country?*

Yes

Have you ever been reused a visa or denied entry to any country, including New Zealand?*

Yes

Have you ever been removed, deported, or excluded from any country including New Zealand?*

Yes

If you have answered yes to any of the above questions, please provide additional information in the space below and attach any additional sheets if necessary:

Upload (Mandatory Questions)

Do you or any person to be included in your visa application have any medical conditions or chronic illnesses?*

Yes

If yes, please provide additional information in the space below and attach any additional sheets if necessary:

Upload (medical conditions or chronic illnesses)

Please include here any additional information that you feel is important or pertinent to your visa application to New Zealand; attach additional sheets if necessary

Declaration

I hereby state that the information I have provided in this pre-assessment questionnaire is an accurate and true representation of my current and past situation. I also accept that the information given in this declaration will be used – in part - as the basis for a visa application and that the decision to issue such a visa or permit is the sole decision of Immigration New Zealand authorities.

Signature of Applicant*

Date*

Signature of Applicant partner/spouse (if applicable)

Date

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