User

Beverley International

address

 

Po Box 77029

phone

 

+642102444618

Details as shown in Passport

Preferred Title

First Name as shown in passport *

Middle Name (if you have)

Family Name as shown in passport *

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

Date Of Birth (dd-mm-yyyy)

Gender

Country Passport Issued

Town/City Passport Issued

Passport Number

Passport Expiry Date

Current Visa type

Visa Expiry Date

Birth Place: Country

Birth Place: State

Birth Place: Town

Overseas Address

National ID number

Partnership Status

Contact Details (Current Residential Address)

Flat No

Entrance No

Building No

Street No and Name

Suburb

Post Code

Telephone(Landline)

Telephone(Mobile)

Email

Financial Support Details (For Study Visa)

A third Party (relative,friend or a supporting organisation)is providing a financial undertaking

You have sufficient funds equivalent to NZ S15,000 for a full year of study,or NZ 1,250 pm

You have sufficient funds to pay your tution fee

You are fully funded by the award of a full scholarship

You have sponsorship for temporary entry by an acceptable sponsor

Financial Support Details (For Work/Visit Visa)

How will you be financially supporting your stay in New Zealand ? 

You have sufficient funds to support your stay ?

Your sponsor is financially supporting your stay?

Your employer or another third party is supporting your stay?

Principal applicant’s family details

Partner information
Full Name Gender Date of Birth Partnership Status Country of Residence Occupation Birth Place
Brothers and sisters (including half, step and adopted brothers and sisters).
Full Name Gender Date of Birth Partnership Status Country of Residence Occupation Birth Place

Children (including biological, adopted and step-children,
including those from previous marriages/relationships).
Full Name Gender Date of Birth Partnership Status Country of Residence Occupation Birth Place

Friends, relatives or contacts in New Zealand

First Name

Middle Name

Last Name

Address Line 1

Address Line 2

Relationship

Telephone

Email

DOB

Educational History

Education history, including English language studies (if applicable)
Qualification Start Date End Date Name of Institute Address

Health and Character Details

Have you been convicted for any type of offence, including any driving offence?

Have you ever been under investigation in any country, including NZ?

Have you ever been excluded,refused,deported from any country including New Zealand?

Have you ever been refused entry Or any visa to any country (Including New Zealand) Please provide details

If You Have Any Health Condition That Is Likely To Require Ongoing Treatment Or Medication, Please Provide Details

Are you submitting your medical certificate with this visa application? if yes, provide code

When did you submit your last General Medical (dd-mm-yy)?

When did you submit your last X-ray (dd-mm-yy)?

When did you submit your Police certificate(dd-mm-yy)?

Have you previously applied for a visa for New Zealand?

If yes then client number

Are you pregnant?

Do you have tuberculosis (TB)?

Do you have any Renal Disease?

If you have TB or Renal Disease please provide details

Would you like to add your Work History?

Application Fee Details

Card Type

Card Holder Name

Card No

CVC/CVV No

Expiry Date

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.