User

Woburn International Group

address

 

PO Box 30712

phone

 

+64 (0) 4 569 4861

Email

 

[email protected]

Woburn Assessment form

Full Name

PERSONAL PARTICULARS

1. First Name

2. Middle Name

3. Last Name

4. Have you ever been known by any other name?

5. Gender

6. Date of birth

7. Preferred title:

8. Partnership Status

9. Your current/most recent overseas residential address in your home country:

10. Your current residential address if different from above:

11. Daytime Contact No:

12. Evening Contact No:

13. Mobile Contact No:

14. E-mail Address

15. Nationality:

16. Town/City and Country of Birth:

17. Country of citizenship:

18. Any additional Citizenships held - Please detail below

19. National ID No(s):

20. Do you hold any other nationalities? please provide details *

21. Passport Number

22. Place of issue:

23. Issuing authority:

24. Date of issue:

25. Date of expiry:

26. Any additional Passports held? Please detail below

27. Do you hold a current New Zealand Visa?

28. If you answered Yes to the above questions, please state the type of Visa you hold:

29. Date this visa expires:

30. Why are you looking to come to NZ?

31. If other the the above question, please state

32. Do you intend to stay Permanently in New Zealand?

33. If Not Permanent how long do you hope to be in New Zealand for?

34. Have you ever applied for a visa for New Zealand in the past?

35. If Yes to the above, state the type of visa applied for and the outcome. eg visitor visa for holiday and stayed for 2 months, visitor visa declined, work visa and worked here for one year etc. (please provide client or application number if available):

Any non-declaration of previous declines may result in adverse character findings by Immigration NZ

QUALIFICATIONS AND WORK EXPERIENCE

36. List your qualifications below

Please include for each Qualification the following details:

Name of qualification, including subject;  Date Commenced (DD/MM/YYYY);  Date Obtained (DD/MM/YYYY);  Length of study;  Institution where gained

37. Please list all periods of employment, including self-employment

Include the following:

Name of Employer;  Employed from (DD/MM/YYYY);   Employed to (DD/MM/YYYY);  Location;   Job Title

38. What is your main occupation (Principal Applicant)?

39. Are you, the Principal applicant, currently employed?

40. If yes to the above question, what was your Employment start date

41. Current wage/salary (if employed in NZ)

42. Employer’s Name

43. Employer’s Address

44. Employer’s Telephone

45. Employer’s Email

PARTNER/SPOUSE (incl NZ PARTNER)

46. Spouse/Partner Name

47. Spouse/Partner Surname

48. Relationship

49. Date of Birth

50. Passport Number

51. Does your partner hold any qualifications?

52. Highest Qualification

53. List your partner’s / spouse’s University qualifications below

Please include for each Qualification the following details:

Name of qualification, including subject; Date Commenced (DD/MM/YYYY); Date Obtained (DD/MM/YYYY); Length of study; Institution where gained

54. List all of your partner’s periods of previous employment, including self-employment

Include the following:

Name of Employer; Employed from (DD/MM/YYYY); Employed to (DD/MM/YYYY); Location; Job Title

55. What is your Partner’s / Spouse’s main occupation?

56. How many years experience does your Partner / Spouse have in this type of work?

57. How long have you and your partner been living together at the same address?

58. If you are currently living apart, how long have you been living apart? and for what reasons?

CHILDREN AND OTHER DEPENDANTS

59. First Name

60. Surname

61. Date of Birth

62. Gender

63. Place of birth and Country of Citizenship

64. Passport number

65. Passport Expiry date

66. Will your dependents be in NZ, or coming to NZ to live with you?

ADDITIONAL BACKGROUND INFORMATION - Principal Applicant

67. Have you undertaken any military service in your country?

68. If Yes to the above questions, please provide details

Please provide a chronological account of your military service including

Dates of military service;   Branch of Military & Country;  Position/Rank;  Military ID No


69. Unit(s) that you served in your military role

Please include:

Date From;  Date to;  Rank;  Unit Role

70. Are you presently subject to military service obligations in your country?

71. If NO, are you a citizen of a country in which compulsory military service exists

72. If Applicable, please state why you are exempt from military service:

73. Have you been associated with any intelligence agency or group, or law enforcement agency?

74. If Yes to the above question, please specify

75. List all countries (including your home country) you have visited or lived in for a period of 3 months or more in the last 5 years *

76. List all countries (including your home country) in which you have lived for 12 months or more in the past 10 years (this includes broken periods returning to the same country). *

77. List all countries (including your home country) you have lived in for a period of 5 years or more since attaining the age of 17yrs. (this includes broken periods returning to the same country) *

78. Do you have a close family member living in New Zealand who is a resident or citizen of New Zealand?

79. Do you have any close family member in New Zealand temporary?

80. Do you have other friend or contact living in New Zealand who are a resident or citizen of New Zealand?

81. If you have answered Yes to any of the above, please provide details

Please provide:

Name;   Address;  Relationship to you;  Date of Birth (DD/MM/YYYY);  Phone;  email;  current visa status

ADDITIONAL BACKGROUND INFORMATION - Spouse

82. Have you undertaken any military service in your country?

83. If Yes to the above questions, please provide details

Please provide a chronological account of your military service including

Dates of military service; Branch of Military & Country; Position/Rank; Military ID No

84. Unit(s) that you served in your military role

Please include:

Date From; Date to; Rank; Unit Role

85. Are you presently subject to military service obligations in your country?

86. If NO, are you a citizen of a country in which compulsory military service exists

87. If Applicable, please state why you are exempt from military service:

88. Have you been associated with any intelligence agency or group, or law enforcement agency?

89. If Yes to the above question, please specify

90. List all countries (including your home country) you have visited or lived in for a period of 3 months or more in the last 5 years

91. List all countries (including your home country) in which you have lived for 12 months or more in the past 10 years (this includes broken periods returning to the same country)

92. List all countries (including your home country) you have lived in for a period of 5 years or more since attaining the age of 17yrs. (this includes broken periods returning to the same country)

93. Do you have a close family member living in New Zealand who is a resident or citizen of New Zealand?

94. Do you have any close family member in New Zealand temporary?

95. Do you have other friend or contact living in New Zealand who are a resident or citizen of New Zealand?

96. If you have answered Yes to any of the above, please provide details

Please provide:

Name; Address; Relationship to you; Date of Birth (DD/MM/YYYY); Phone; email; current visa status

HEALTH AND CHARACTER

97. Do you or any member of your family included in this application have any known medical conditions? *

98. Do you or any member of your family require regular health services or special education services? Immigration New Zealand’s health requirements are detailed in link below

99. Are you or any member of your family taking any medication? *

100. If you answered Yes to either of the 3 above questions, please specify

Please provide details of any medical conditions or medication being taken.  Please note WHO the information applies too.  

101. Have you or any member of your family had any medical conditions requiring treatment *

102. Is anyone included in this application pregnant *

103. If you answered yes to either of the 2 questions above, please specify

Please provide details and note WHO the information applies too.  

104. Have you or any member of your family ever been Convicted *

105. Have you or any member of your family ever been Charged *

106. Have you or any member of your family ever been Under Investigation *

107. For any offence(s) against the law of any country, have you ever been declined a visa to enter any country *

108. Have you or any member of your family ever been refused a visa, refused entry, deported or other action taken in relation to immigration matters by any country, including New Zealand *

109. If you answered Yes to any of the above 5 questions, please specify

Please provide details and note WHO the information applies too.  

Any non-declaration of health matters, offences, convictions, declined applications etc, may result in adverse health or character findings by Immigration NZ which will impact on your immigration application(s)

OTHER INFORMATION

110. Please provide any further information you think would be relevant to your visa application

111. Would you like to subscribe to our newsletters?

Thank you for taking the time out to complete this questionnaire.

We will communicate further with you once we have assessed your case.


JUNE RANSON - Licence Number: 200800674

ANN NOLAN - Licence Number: 200800645

MEENA PATEL - Licence Number: 201200726

TONY RARERE - Licence Number: 201900166

SHEILA ELASIN - Licence Number: 202300520

WOBURN INTERNATIONAL ADVISER

112. If you have already been communicating with a Woburn adviser please select their name below.

I hereby declare that the information given by me in this application is true and correct to the best of my knowledge.I understand and agree that any false information, misrepresentation, or omission of facts in this application and the application process may be justification for refusal/ decline.I further understand and agree that all information furnished in this application and the application process may be verified as may be necessary.