Expression of Interest Form: Principal Applicant

FOR NZIS USE
EOI reference number
Date received
Expression of Interest form SKILLED MIGRANT CATEGORY
If you are interested in migrating to New Zealand as a skilled migrant, and if you have the skills we need, then completing this Expression
of Interest is your first step.
When you submit this Expression of Interest, you may be considered for an Invitation to Apply for residence in New Zealand only if you
meet the following requirements:
• Character • Health
• English language • Age
• Meet the minimum threshold of 100 points for employability and capacity building factors
The criteria for each of these requirements are explained in this form as per the Government’s Residence Policy (Skilled Migrant Category).
If you are unsure about whether you meet the prerequisites, use the Skilled Migrant Quick Check and the Points Indicator on the New
Zealand Immigration Service website at www.immigration.govt.nz to get an idea of whether it’s worth completing an Expression of Interest.
You must complete all the questions in the form, unless the form specifically directs you straight to another question or section further on.
If a question does not apply to you, mark it N/A or Not Applicable.
If you leave questions that qualify for the award of points blank, this will be interpreted as a ’no‘ answer. If you fail to answer any
questions or to clearly mark them as ‘N/A’ or ‘not applicable’, we may send the incomplete form back to you and it will not be submitted
into the Expression of Interest Pool until all the necessary information is provided.
Expressions of Interest must be accompanied by the correct Expression of Interest Fee.
Do not send supporting documentation with your Expression of Interest form. Include only any additional sheets required to
complete questions in the form.
Detailed explanations to assist you to fill out this form can be found in the Expression of Interest Guide or on the New Zealand
Immigration Service website at www.immigration.govt.nz
If you are found to have provided false information or to have omitted any relevant information in your Expression of Interest, any subsequent
application may be declined and you will lose the right to appeal any decision to decline your application.
Principal applicant
Section A: Identity
In this section we need to confirm that you are who you say you are. Please provide the following information about
yourself.
A 1 Family name
A 2 Given name(s)
A 3 Please provide all other names you are/or have been known by.
Expression of Interest form – Principal applicant – NZIS 1100 pg 1

A 4 Preferred title Mr Mrs Ms Miss Dr
Other (please specify)
A 5 Gender Male Female

POINTS
A 6 Date of birth
You are eligible for points for your age up to the age of 56. If you are D D MM Y Y
aged 56 and over your Expression of Interest will not be accepted into the CLAIMED
Pool and you should not complete any further questions. Section SM18
of the Skilled Migrant Category Policy refers.
A 7 Country of birth
Country
A 8 Please provide your Birth Certificate number and the name of the issuing authority.
Birth Certificate number
Name of issuing authority
A 9 Please state your main country of citizenship/nationality.
A 10 Please provide details of all passports currently held.
Passport number
Country
Family name
Given name(s)
Date of issue D D MM Y Y Date of expiry D D MM Y Y

Place of issue
Passport number
Country
Family name
Given name(s)
Place of issue
Passport number
Country
pg 2 Expression of Interest form – Principal applicant – NZIS 1100

Family name
Given name(s)
Place of issue
A 11 Please list any other citizenships currently held.
A 12 Where applicable, please provide the following details.
Driver Licence
Name(s) as shown on driver licence
Driver licence number
Valid for which country/state/area
Expiry date D D MM Y Y
Taxation number
Taxation number
Country
Social Security number
Country

A 13 Please list all countries, including all countries of citizenship, you have lived in for a total of 12 months or more in
the last 10 years. Include all countries where your stay has been broken by any departures.
From MM Y Y To M M Y Y Country
A 14 Please provide your residential address and contact details. This will be considered your permanent place of
residence for tax purposes.
Number and street name
Suburb City
County/Province/State PIN/ZIP
Country
Telephone Phone/day Phone/night
Cellular
(Country code/Area code/Telephone number)

(eg+12 3 456 7890)
Email
If different from your residential address, please provide your mailing address.
If you are in New Zealand and list a New Zealand address, this will be your New Zealand address for the purpose of
the New Zealand Immigration Act.

Number and street name/PO Box
Suburb
City, PIN/ZIP code
Country
A 15 What is your current partnership status? (Select only one)
Married De facto Separated Divorced Widowed Never married
A 16 Do you meet the minimum requirements for recognition of partnerships? Refer to the Yes No
Guide under Partner in the section Summary of Terms.
A 17 Will your partner be included in your residence application? Yes No
A 18 How many children do you have? This includes biological, adopted, step-children from previous marriages/
relationships.
Will any of these children be included in your residence application? Yes No
For each DEPENDENT child who will be included in your residence application, please complete a Child Supplement Expression
of Interest Form (NZIS 1103). Please refer to the Summary of terms - Dependent Children in the Skilled Migrant Category
Expression of Interest Guide (NZIS 1101).
If you are separated or divorced and bringing a child under 16 years of age with you to New Zealand, we will
need to see proof of their right to leave their home country and your right to remove them before any residence
application can be granted. Section F5.20 of the Government’s Residence Policy refers.
A 19 What is your main occupation?
PLEASE NOTE: Your main occupation is the job you spent most hours doing in the last 12 months. If you have not
worked in the last 12 months, please state your previous occupation. If you have not worked for the past five years
or more, please state “Not applicable”.
A 20 What industry is your main occupation in (i.e. the main activity of the place where you work)?
A 21 If you have an agent acting on your behalf, or someone assisting you to complete this Expression of Interest, please
provide the following details for this person.
Please refer to the Guide to see who can assist you fill out your Expression of Interest.
Name
Number and street name/PO Box
Suburb and city

Country
Phone/day Phone/night
(Country code/Area code/Telephone number) (Country code/Area code/Telephone number)
Phone/cellular
(Country code/Area code/Cellular number)
Email
A 22 Do you authorise the person listed in Question A21 to act on your behalf in relation to this Yes No
Expression of Interest?
A 23 Please indicate who you prefer the New Zealand Immigration Service to communicate directly with. Select only one.
You
You and a copy to the person listed in Question A21 where communication is made by way of email or a letter
The person listed in Question A21 only.

PLEASE NOTE: The NZIS reserves the right to contact the principal applicant directly on any matter relating to this
Expression of Interest.
A 24 What is your preferred means of communication in relation to this Expression of Interest? Email Letter
Section B: Character
In this section we need to confirm that you are of good character which is a prerequisite of the Skilled Migrant Category. Please
provide the following details about your character. Section A5 of the Government’s Immigration Policy refers.
Questions B1 to B9 relate to section 7(1) of the Immigration Act (persons prohibited from being granted
a residence permit). People described in section 7(1) of the Immigration Act cannot ordinarily be granted
residence in New Zealand.
Questions B10 to B20 relate to other character requirements. People described in questions B10 to B20
require a character waiver to be granted residence.
B 1 Have you ever been sentenced to imprisonment for a term of five years or more (including Yes No
any expunged criminal records)?
B 2 Have you been sentenced to imprisonment for a term of 12 months or more Yes No
within the last 10 years (including any expunged criminal records)?
B 3 Do you have a removal order from New Zealand currently in force against you? Yes No
B 4 Have you ever been deported from any country, including New Zealand? Yes No
B 5 Have you been involved in any terrorist activities or supported similar violent activities? Yes No
B 6 Have you been a member of, or belonged to, any terrorist group? Yes No
B 7 Have you been involved in any drug trading or trafficking? Yes No
B 8 Have you been a member of, or belonged to, any group with criminal objectives? Yes No
B 9 Have you been a member of, or belonged to, any group that has engaged in or supported Yes No
criminal activities?

If you answered ‘yes’ to any of questions B1 to B9, you must provide a full explanation about the
surrounding circumstances. If, having considered your explanation, the NZIS assesses that you are a person
to whom section 7(1) of the Immigration Act applies, your Expression of Interest cannot be accepted into
the Pool.
B 10 Are you currently under investigation, or wanted, by any law enforcement agency in any country? Yes No
B 11 Have you ever been convicted or found guilty of any offence(s) against the law in any country? Yes No
B 12 Have you been convicted of an offence (including a traffic offence), committed within Yes No
the last five years, involving dangerous driving, driving having consumed excessive alcohol
(including drunk driving and driving with a blood or breath alcohol content in excess of a
specified limit) or driving having consumed drugs?
B 13 Have you ever been charged with any offence against the law in any country? Yes No
B 14 Have you ever been removed from any country, including New Zealand? Yes No
B 15 Have you ever been refused entry to any country, including New Zealand? Yes No
B 16 Have you ever been refused a visa/permit for any country, including New Zealand? Yes No
B 17 Have you been involved in any people trafficking? Yes No
B 18 Have you been a member of, or belonged to, any group of people that had/has objectives Yes No
or principles based on hostility against people or groups of people on the basis of colour,
race, ethnic or national origins?
B 19 Have you been a member of, or belonged to, any group of people that had/has objectives Yes No
or principles based on an assumption that persons of a particular race or colour are
inherently inferior or superior to other races or colours?
B 20 Have you, in the course of applying for a New Zealand visa/permit, made any statement Yes No
or provided any information, evidence or submission that was false, misleading or forged, or
withheld material information?
If you answered ’yes‘ to any of questions B10 to B20, you must provide a full explanation about the
surrounding circumstances. If your Expression of Interest is selected from the Pool, you may be asked
to provide a police certificate or other relevant information to enable the NZIS to fully consider those
circumstances.
Please attach additional sheets if necessary.

Section C: Health
In this section we need to confirm that you neet a minimum standard of health, which is a prerequisite of the Skilled
Migrant Category. Providing accurate information about your health status is very important. Please provide the
following details about your health.
Quesitons C1 to C4 list medical conditions for which a medical waiver cannot be granted. People with these
conditions cannot ordinarily be granted residence in New Zealand. Please read the Health Requirements
Leaflet (NZIS 1121) for further details.
Questions C5 to C7 relate to other health requirements. People described in questions C5 to C7 require a
health waiver to be granted residence. Please read the Health Requirements Leaflet (NZIS 1121) for further
details.
C 1 Do you require or are you likely to require dialysis treatment in the immediate future? Yes No
C 2 Do you have active tuberculosis (TB)? Yes No
C 3 Do you have a mental disorder or intellectual disability that has needed care in a hospital or
supervised residence for more than 90 days in the last two years? Yes No
C 4 Do you have a physical incapacity that requires full-time care? Yes No
If you answered ‘Yes’ to any of questions C1 to C4, you must provide an explanation of your medical
condition. If, having considered your explanation, the NZIS assesses that your medical condition is one for
which a medical waiver cannot be granted, your Expression of Interest cannot be accepted into the Pool.
C 5 Have you been exposed to, or diagnosed with, any infectious or communicable diseases? Yes No
C 6 Are you receiving, or have received, any treatment for any psychiatric condition or
developmental disorder? Yes No
C 7 Do you have any condition that is likely to require ongoing treatment or medication? Yes No
If you answered “yes” to any of questions C5 to C7, you must provide an explanation of your medical
condition. If your Expression of Interest is selected from the Pool, you may be asked to provide a medical
certificate to confirm this information to enable the NZIS to fully consider those circumstances.

Section D: English language ability
In this section we ask you to confirm that you meet the minimum standard of English language, which is a
prerequisite of the Skilled Migrant Category. Please provide the following details about your English language
ability. Section SM5 of the Skilled Migrant Category policy refers.
D 1 Please indicate how you meet the minimum standard of English, as defined in the Guide under English Language
Requirements in the section Summary of Terms. (Select one only)
An IELTS Test Report with an overall band score of 6.5 or more ] Go to Q D3
Study for a recognised qualification conducted entirely in English ] Go to Q E1
Current skilled employment in New Zealand for 12 months or more ] Go to Q E1
Otherwise meet the minimum standard, as defined in the Guide ] Go to Q D2
PLEASE NOTE: If you selected one of the last three options, you may be asked to provide an IELTS certificate.
If you cannot demonstrate that you meet the minimum standard of English, your Expression of Interest
cannot be accepted into the Pool. You should not complete any further questions.
D 2 Please provide details explaining why you meet the minimum standard, as defined in the Guide under
English Language Requirements in the section Summary of Terms.
D 3 If you have an IELTS certificate, what is your IELTS Test Report Form number?
D 4 What was the date you sat your test? D D MM Y Y
Overall IELTS band score
The following sections outline the factors which qualify for points. To submit your Expression of Interest,
you must meet the minimum threshold of 100 points.

Section E: Skilled employment in New Zealand
In this section you qualify for points and bonus points, depending on whether you have current skilled employment
in New Zealand or an offer of skilled employment in New Zealand. Please provide the following details about
your employment. Sections SM6, SM7, SM8, SM9 and SM19 of the Skilled Migrant Category Policy refer.
E 1 Are you claiming points for skilled employment, and declare that you meet policy criteria for any of the following?
Refer to the Guide under Skilled Employment in the section Summary of Terms. Select only one.
POINTS
Current skilled employment in New Zealand for 12 months or more

CLAIMED
Current skilled employment in New Zealand for less than 12 months
Offer of skilled employment in New Zealand
None of the above ] Go to Q F1
E 2 What is your job title?
What industry is your main occupation in (i.e. the main activity of the place where you work)?
E 3 Please indicate why your job is skilled. You should explain what type of expertise it requires and whether it is relevant
to your recognised qualification or your previous work experience. If your job is not relevant to your recognised
qualification and is not included in Appendix 11, you need to explain:
• whether the level of expertise required by your job is comparable to the expertise required for an occupation in
Appendix 11, or
• how your employment will contribute to New Zealand’s future growth and skill base, or
• how your employment will enhance the quality of New Zealand’s accomplishments and participation in that
occupational field.
For more information, refer to the Guide under Skilled Employment in the section Summary of Terms.
E 4 Please provide the following details for the skilled employment listed above.
Employer contact name (manager)
Business/organisation name

Suburb City
Country
Telephone
(Country code/Area code/Telephone number eg+12 3 456 7890)
Email Website
E 5 To do your job in New Zealand, do you require full or provisional occupational registration? Refer to the Guide under
Occupational Registration in the section Summary of Terms. POINTS
No Yes, please provide the following:

CLAIMED
New Zealand Occupational Registration Number (if applicable)
Name of the New Zealand Occupational Registration Body
E 6 Is your skilled employment outside Auckland? Refer to the Guide under Employment outside Auckland in the section
Summary of Terms. POINTS
Yes No
CLAIMED
E 7 Is your skilled employment in one of the identified future growth areas? If yes, please provide the growth area name.
Refer to the Guide under Identified Future Growth Area in the section Summary of Terms for the future growth area
names. POINTS
Yes No ] Go to Q E8 CLAIMED
Growth area name
E 8 Is your skilled employment in one of the identified clusters? If yes, please provide the cluster name. Refer to the
Guide under Cluster in the section Summary of Terms for cluster names. POINTS
Yes No ] Go to Q E9
CLAIMED
Cluster name
E 9 Is your skilled employment in one of the areas of absolute skills shortage? If yes, please provide the absolute skills
shortage occupation name. Refer to the Long Term Skill Shortage List formerly the Priority Occupations List (POL) on
our website www.immigration.govt.nz or request a copy of the List from your nearest NZIS branch. POINTS
Yes No ] Go to Q F1
CLAIMED
Absolute skills shortage occupation name
PLEASE NOTE: If you are invited to apply for residence your employer will need to confirm your claims in relation to
questions E8 and E9.

Section F: Recognised qualification(s)
In this section you qualify for points and bonus points if you have a recognised qualification(s). Please provide
the following details about your qualification(s). Sections SM14, SM15 and SM16 of the Skilled Migrant
Category Policy refer.
POINTS
F 1 Are you claiming points for a recognised qualification(s) and declaring that you meet policy criteria? Refer
to the Guide under Recognised Qualification in the section Summary of Terms
CLAIMED
Yes No
How many qualifications are you submitting?
Please answer questions F2 to F6 for each of your qualifications. You should attach additional sheets if
necessary; you may wish to photocopy this section to use.
F 2 Please provide the details of the recognised qualification(s) for which you are claiming points.
Name of qualification
Date obtained D D MM Y Y Major area of study
Date commenced studies D D MM Y Y Date completed studies D D MM Y Y
Institution name
Suburb City
Country
Telephone Student ID#

(eg+12 3 456 7890)
F 3 Is this qualification(s) included on the List of Recognised Qualifications, (refer to form NZIS 1080) or has an
Occupational Registration Body assessed your qualification(s) as comparable to a New Zealand qualification that is
on the List of Recognised Qualifications?
Yes No ] Go to Q F4 Please provide level
F 4 Has your qualification been assessed by the New Zealand Qualifications Authority (NZQA)?
Yes No ] Go to Q F7
PLEASE NOTE: If you have answered ‘no’ to question F3 and F4, this qualification does not qualify for points as a
recognised qualification.

F 5 What is the level assessed by the NZQA? Refer to the guide under New Zealand Qualifications in section Summary of Terms.
Level
F 6 What are the reference number, type and level assessed by the NZQA? Refer to the Guide under Qualifications
Assessment Report in the section Summary of Terms.
Reference number
Type Preliminary (Pre-Assessment) Interim Full
Level
What New Zealand qualification(s) was your qualification(s) assessed as being comparable with?
F 7 Do you have a recognised New Zealand qualification(s) gained after two or more years of study in New Zealand?POINTS
No ] Go to Q F9 Yes, please provide the following details:

CLAIMED
How many New Zealand qualifications are you submitting?
Please answer questions F8 for each of our New Zealand qualifications. You should attach additional sheets if
necessary; you may wish to photocopy this section to use.
F 8 Name of qualification(s)
Institution name
Suburb City
Country

(eg+12 3 456 7890)
Qualifications and bonus points
PLEASE NOTE: A qualification(s) in an identified future growth area or cluster only qualifies for bonus points if you are also
claiming points for current skilled employment or an offer of skilled employment in an identified future growth area or cluster.
Only complete Questions F9 and F10 if you are claiming points for current skilled employment or an offer of skilled employment.
F 9 Is your qualification(s) in one of the identified future growth areas? If yes, please provide the growth area name.
Refer to the Guide under Identified Future Growth Area in the section Summary of Terms for growth area names.
Yes No ] Go to Q F10

Name of your qualification this applies to
Growth area name

F 10 Is your qualification(s) in one of the identified clusters? If yes, please provide the cluster name. Refer to the Guide
under Cluster in the section Summary of Terms for cluster names.
Yes No ] Go to Q F11
Name of your qualification this applies to
Cluster name
F 11 Is your qualification(s) in one of the areas of absolute skills shortage? If yes, please provide the absolute skills
shortage occupation name. Refer to the Long Term Skill Shortage List formerly Priority Occupations List (POL) on our
website at www.immigration.govt.nz or request a copy of the List from your nearest NZIS branch.
Yes No ] Go to Q G1
Section G: Recognised work experience
In this section we recognise the importance of skills and experience gained through your previous employment that:
• are readily transferable; and
• will enable you to get skilled employment in New Zealand; and
• will help you to contribute to New Zealand socially and economically.
Please provide the following details about the recognised work experience for which you are claiming points.
Sections SM11, SM12 and SM13 of the Skilled Migrant Category Policy refer.
PLEASE NOTE: If you do not have current skilled employment in New Zealand or an offer of skilled employment in
New Zealand, you can only qualify for points for your work experience if it is recognised, and was gained legally
in a labour market that is comparable to New Zealand. Refer to the Guide under Comparable Labour Market in the
section Summary of Terms.
G 1 How many separate periods of work experience are you claiming for?
Please answer this section for each separate period of work experience. You should attach additional sheets
if necessary; you may wish to photocopy this section to use.
Work experience
From D D M M Y Y To D D M M Y Y
Type of business/industry
Your job title/position held
Name of employer
Suburb City
Country

Type of business Position held
Country employer is domiciled in
Telephone Contact name

(eg+12 3 456 7890)
Please indicate why you believe this work experience should be recognised. Refer to the Guide under Recognised Work Experience
in the section Summary of Terms. (For example, it is relevant to your recognised qualification, or your skilled employment.)
G 2 Please indicate the total number of years of work experience in New Zealand. Refer to the the Guide under
Recognised Work Experience in the section Summary of Terms.
POINTS
2 but less than 4 years 4 but less than 6 years

CLAIMED
6 years or more None of the above
G 3 Please indicate the total number of years of recognised work experience. Refer to the Guide under Recognised Work
Experience in the section Summary of Terms. Include any New Zealand work experience indicated in QG2.
POINTS
2 but less than 4 years 4 but less than 6 years
6 but less than 8 years 8 but less than 10 years CLAIMED
10 years or more None of the above
G 4 Please indicate the total number of years of work experience in an identified future growth area. Refer to the Guide
under Identified Future Growth Area in the section Summary of Terms. You need to note that work experience in
an identified future growth area only qualifies for bonus points if you are also claiming points for current skilled
employment or an offer of skilled employment in an identified future growth area.
POINTS
2 but less than 6 years 6 years and over

CLAIMED
None of the above
Growth area name
G 5 Please indicate the total number of years of work experience in an identified cluster. Refer to the Guide under
Cluster in the section Summary of Terms. You need to note that work experience in an identified cluster only
qualifies for bonus points if you are also claiming points for current skilled employment or an offer of skilled
employment in an identified cluster.
POINTS

CLAIMED
None of the above
Cluster area name

G 6 Please indicate the total number of years of work experience in an area of absolute skills shortage. Refer to the
Guide under Area of Absolute Skills Shortage in the section Summary of Terms. POINTS

CLAIMED
None of the above
Section H: Partner’s identity
In this section we need to gather and confirm your partner’s personal details. Please provide the following
information about your partner. You need to provide this information even if your partner is not intending
to apply for residence with you.
H 1 Family name
H 2 Given name(s)
H 3 Please provide all other names your partner is/or has been known by.
H 4 Preferred title Mr Mrs Ms Miss Dr
Other (please specify)
H 5 Gender Male Female H 6 Date of birth D D MM Y Y

H 7 Country of birth
H 8 Please provide your partner’s Birth Certificate number and the name of the issuing authority.
Birth Certificate number
Name of issuing authority
H 9 Please provide your partner’s main country of citizenship/nationality.
H 10 Please provide details of all passports currently held by your partner.
Passport number
Country
Family name
Given name(s)

Place of issue

Passport number
Country
Family name
Given name(s)
Place of issue
Passport number
Country
Family name
Given name(s)
Place of issue
H 11 Please list any other citizenships currently held.
H 12 Where applicable, please provide the following details:
Driver Licence

Taxation number
Taxation number
Country
Country
H 13 Please list all countries, including all countries of citizenship, your partner has lived in for a total of 12 months or
more in the last 10 years. Include all countries where their stay has been broken by any departures.
Section I: Partner’s character
In this section we need to confirm that your partner is of good character which is a prerequisite of the Skilled
Migrant Category. Please provide the following details about your partner’s character. Section A5 of the
Government’s Residence Policy refers.
Questions I1 to I9 relate to section 7(1) of the Immigration Act (persons prohibited from being granted a permit).
People described in section 7(1) of the Immigration Act cannot ordinarily be granted residence in New Zealand.
Questions I10 to I20 relate to other character requirements. People described in questions I10 to I20 require
a character waiver to be granted residence.
I 1 Has your partner ever been sentenced to imprisonment for a term of five years or more Yes No
(including any expunged criminal records)?
I 2 Has your partner been sentenced to imprisonment for a term of 12 months or more within Yes No
the last 10 years (including any expunged criminal records)?
I 3 Does your partner have a removal order from New Zealand currently in force against them? Yes No

I 4 Has your partner ever been deported from any country, including New Zealand? Yes No
I 5 Has your partner ever been involved in any terrorist activities or supported similar Yes No
violent activities?
I 6 Has your partner been a member of, or belonged to, any terrorist group? Yes No
I 7 Has your partner been involved in any drug trading or trafficking? Yes No
I 8 Has your partner been a member of, or belonged to, any group with criminal objectives? Yes No
I 9 Has your partner been a member of, or belonged to, any group that has engaged in or Yes No
supported criminal activities?
If you answered ‘yes’ to any of questions I1 to I9, you must provide a full explanation about the surrounding
circumstances. If, having considered your explanation, the NZIS assesses that you are a person to whom
section 7(1) of the Immigration Act applies, your Expression of Interest cannot be accepted into the Pool.
I 10 Is your partner currently under investigation, or wanted, by any law enforcement agency Yes No
in any country?
I 11 Has your partner ever been convicted or found guilty of any offence(s) against the law Yes No
in any country?
I 12 Has your partner been convicted of an offence (including a traffic offence), committed Yes No
within the last five years, involving dangerous driving, driving having consumed excessive
alcohol (including drunk driving and driving with a blood or breath alcohol content in excess
of a specified limit) or driving having consumed drugs?
I 13 Has your partner ever been charged with any offence against the law in any country? Yes No
I 14 Has your partner ever been removed from any country, including New Zealand? Yes No
I 15 Has your partner ever been refused entry to any country, including New Zealand? Yes No
I 16 Has your partner ever been refused a visa/permit for any country, including New Zealand? Yes No
I 17 Has your partner been involved in any people trafficking? Yes No

I 18 Has your partner, been a member of, or belonged to, any group of people that had/has Yes No
objectives or principles based on hostility against people or groups of people on the basis
of colour, race, ethnic or national origins?
I 19 Has your partner been a member of, or belonged to, any group of people that had/has Yes No
objectives or principles based on an assumption that persons of a particular race or colour
are inherently inferior or superior to other races or colours?
I 20 Has your partner, in the course of applying for a New Zealand visa/permit, made any Yes No
statement or provided any information, evidence or submission that was false, misleading
or forged, or withheld material information?

If you answered ’yes‘ to any of questions I10 to I20, you must provide a full explanation about the surrounding
circumstances. If your Expression of Interest is selected from the Pool, you may be asked to provide a police
certificate or other relevant information to enable the NZIS to fully consider those circumstances.
Section J: Partner’s health
In this section we need to confirm that your partner meets a minimum standard of health, which is a prerequisite
of the Skilled Migrant Category. Providing accurate information about your partner’s health status is very important.
Please provide the following details about your partner’s health.
Questions J1 to J4 concern medical conditions for which a medical waiver cannot be granted. People with
these conditions cannot ordinarily be granted residence in New Zealand. Please read the Health Requirements
Leaflet (NZIS 1121) for further details.
J 1 Does your partner require or are they likely to require dialysis treatment in the immediate future? Yes No
J 2 Does your partner have active tuberculosis? Yes No
J 3 Does your partner have a mental disorder or intellectual disability that has needed care in
hospital or supervised residence for more than 90 days in the last two years? Yes No
J 4 Does your partner have a physical incapacity that requires full-time care? Yes No
If you answered ‘Yes’ to any of questions J1 to J4, you must provide an explanation of your partner’s medical
condition. If, having considered your explanation, the NZIS assesses that your partner’s medical condition is one
for which a medical waiver cannot be granted, your Expression of Interest cannot be accepted into the Pool.
Questions J5 to J7 relate to other health requirements. People described in questions J5 to J7 require a health
waivwer to be granted residence.
J 5 Has your partner been exposed to, or diagnosed with, any infectious or communicable diseases? Yes No
J 6 Is your partner receiving, or have they received, any treatment for any psychiatric condition or
developmental disorder? Yes No
J 7 Does your partner have any condition that is likely to require ongoing treatment or medication? Yes No
If you answered “yes” to any of questions J5 to J7, you must provide an explanation of your partner’s medical
condition. If your Expression of Interest is selected from the Pool, you may be asked to provide a medical
certificate to confirm this information to enable the NZIS to fully consider those circumstances.

Section K: Partner’s English language ability
The information you provide in this section will give us an indication of your partner’s English language ability.
Meeting the minimum standard of English language will assist your partner to settle successfully in New Zealand.
Please provide the following details about your partner’s English language ability. Section SM5 of the Skilled
Migrant Category Policy refers.
K 1 Does your partner meet the minimum standard of English, listed below? Refer to the Guide under English Language
Requirements in the section Summary of Terms. Select only one.
An IELTS Test Report with an overall band score of 5 or more ] Go to Q K3
An IELTS Test Report with an overall band score of 6.5 or more if you are claiming
points for your partner’s skilled employment, offer of skilled employment or
recognised qualification(s). ] Go to Q K3
Study for a recognised qualification conducted entirely in English ] Go to Q L1
Completed qualifications that meet the minimum standard, as defined in the Guide ] Go to Q L1
Current skilled employment in New Zealand for 12 months or more ] Go to Q L1
Otherwise meets the minimum standard, as defined in the Guide ] Go to Q K2
None of the above
PLEASE NOTE: Unless you are claiming points for your partner’s recognised qualification, skilled employment or offer of
skilled employment, partners must pre-purchase English for Speakers of Other Languages (ESOL) tuition if they do not
meet the minimum standard of English. They will need to attend English language classes once they arrive in New Zealand.
K 2 Please provide details explaining why your partner meets the minimum standard. Refer to the Guide under English
Language Requirements in the section Summary of Terms.
K 3 If your partner has an IELTS certificate, what is the Test Report Form number?
K 4 What was the date that your partner sat their test and the score? D D MM Y Y
Overall IELTS band score
Section L: Partner’s skilled employment
In this section you can qualify for bonus points if your partner has current ongoing skilled employment in New
Zealand or an offer of ongoing skilled employment in New Zealand. Your partner will only be able to claim points
for an offer of skilled employment in New Zealand if they meet the English language requirements for principal
applicants. Refer to the Guide under English Language Requirements in the section Summary of Terms.

Furthermore, if your partner has an offer of employment in an occupation which requires registration, your partner will only
be able to claim points for this offer of employment if they have the required registration. Occupations requiring registration
can be found in the Guide under Occupational Registration in the section Summary of Terms. Please provide the following
details about your partner’s skilled employment. Section SM10 of the Skilled Migrant Category Policy refers.
L 1 Are you claiming points for your partner’s skilled employment? Refer to the Guide under Skilled Employment in the
section Summary of Terms. Select only one.
Offer of skilled employment in New Zealand
Current skilled employment in New Zealand for more than 12 months POINTS
Current skilled employment in New Zealand for less than 12 months

CLAIMED
None of the above ] Go to Q M1

L 2 What is your partner’s job title?
L 3 Please indicate why this job is skilled employment. You should explain what type of expertise it requires and whether
it is relevant to your partner’s recognised qualification or previous work experience. If this job is not relevant to your
partner’s recognised qualification and is not included in Appendix 11, you need to explain:
• whether the level of expertise required by your partner’s job is comparable to the expertise required for an
occupation in Appendix 11, or
• how this employment will contribute to New Zealand’s future growth and skill base, or
• how this employment will enhance the quality of New Zealand’s accomplishments and participation in that
occupational field.
For more information, refer to the Guide under Skilled Employment in the section Summary of Terms.
L 4 Please provide the following details for the skilled employment detailed above.
Employer contact name (manager)
Business/organisation name
Suburb City
Country
Telephone
(eg+12 3 456 7890)
Email Website

Section M: Partner’s recognised qualification(s)
In this section we need to confirm whether your partner’s qualification(s) will be recognised in New Zealand.
PLEASE NOTE: Your partner will only be able to claim points for their qualification(s) if they meet the English
language requirements for principal applicants. Refer to the Guide under English language requirements
in the section Summary of Terms. Please provide the following details about your partner’s recognised
qualification(s). Section SM17 of the Skilled Migrant Category Policy refers.
POINTS
M 1 Are you claiming points for your partner’s recognised qualification(s)? Refer to the Guide under
Recognised Qualification in the section Summary of Terms.
CLAIMED
Yes No
How many qualifications is your partner submitting?
Please answer questions M2 to M6 for each of your partner’s qualifications. You should attach additional
sheets if necessary; you may wish to photocopy this section to use.
M 2 Please provide the details of the recognised qualification for which your partner is claiming points:
Institution name
Suburb City
Country

(eg+12 3 456 7890)
M 3 Is this qualification included on the List of Recognised Qualifications (refer to form NZIS 1080)?
Yes No ] Go to Q M5
M 4 Has this qualification been assessed by the NZQA?
Yes No ] Go to Q N1
M 5 What is the level assessed by the NZQA, as defined in the Guide?
Level
M 6 What is the reference number, type and level assessed by the NZQA? Refer to the Guide under Qualifications
Assessment Report in the section Summary of Terms.
Reference number

Type Preliminary (Pre-Assessment) Interim Full
Level
What New Zealand qualification(s) was this qualification(s) assessed as being comparable with?
Section N: Other family
Children
N 1 How many children do you have? This includes biological, adopted and step-children from previous marriages/
relationships.
Please provide the following details for your children (including biological, adopted and step-children from previous
marriages/relationships).
Full name
Gender Male Female Date of birth D D MM Y Y
Partnership status
Married De facto Separated Divorced Widowed Never Married
Country of residence
Will this child be included in your application for residence? Yes No
Full name

Partnership status
Full name

Partnership status
Full name
Partnership status
Full name
Partnership status
Full name
Gender Male Female Date of birth D D M M Y Y
Partnership status
Full name

Partnership status

For each DEPENDENT child who will be included in your residence application, please complete a Child Supplement
Expression of Interest Form (NZIS 1103). Please refer to the Summary of terms - Dependent Children in the Skilled
Migrant Category Expression of Interest Guide (NZIS 1101).
If you are separated or divorced and bringing a child under 16 years of age with you to New Zealand, we will
need to see proof of their right to leave their home country and your right to remove them. Section F5.20
of the Government’s Residence Policy refers.
N 2 The Skilled Migrant policy recognises that the presence of close family in New Zealand enhances long term
prospects for employability and settlement. Do you have a close family member living in New Zealand who is a
resident or citizen of New Zealand? For more details please refer to the Guide under Close Family in New Zealand.
Yes No
If you answered Yes to question N2 please indicate for which family member points are being claimed, from the
family members detailed in question N3.
N 3 Give details of ALL your family, including those adopted legally or by custom. It is not necessary to list deceased family
members. Family includes your biological, adoptive and step parents, siblings and children.
Full name
Partnership status
Relationship to you Points claimed for this family member
Full name
Partnership status

Full name
Partnership status
Full name
Partnership status
Full name
Partnership status
Full name
Partnership status

Full name
Partnership status
Full name
Partnership status
Full name
Partnership status
Full name
Partnership status

Section O: Partner’s family
Children
O 1 How many children does your partner have? This includes biological, adopted and step-children from previous
marriages/relationships. Do not include children already listed under N1.
None
Please provide the following details for your partner’s children (including biological, adopted and step-children from
previous marriages/relationships).
Full name
Partnership status
Full name
Partnership status
Full name
Partnership status

Full name

Partnership status
Full name

Partnership status
Full name

Partnership status
For each DEPENDENT child who will be included in your residence application, please complete a Child Supplement
Expression of Interest Form (NZIS 1103). Please refer to the Summary of terms - Dependent Children in the Skilled
Migrant Category Expression of Interest Guide (NZIS 1101).
If your partner is separated or divorced and bringing a child under 16 years of age with them to New
Zealand, we will need to see proof of their right to leave their home country and your partner’s right to
remove them. Section F5.20 of the Government’s Residence Policy refers.

O 2 The Skilled Migrant policy recognises that the presence of close family in New Zealand enhances long term prospects for
employability and settlement. Does your partner have a close family member living in New Zealand who is a resident or
citizen of New Zealand? For more details please refer to the Guide under Close Family in New Zealand.
Yes No
If you answered Yes to question O2 please indicate for which family member points are being claimed, from the
family members detailed in question O3.
O 3 Give details of ALL your partner’s family, including those adopted legally or by custom. It is not necessary to list deceased
family members. Family includes your biological, adoptive and step; parents, siblings and children.
Full name
Partnership status
Relationship to your partner Points claimed for this family member
Full name
Partnership status
Full name
Partnership status
Full name

Partnership status
Full name
Partnership status
Full name

Partnership status
Full name
Partnership status
Full name

Partnership status
Full name
Partnership status
Full name
Partnership status

Declaration
This section must be signed by the principal applicant on behalf of all people included in this Expression of Interest.
Make sure you understand the declarations below before you sign and agree to them.
Important
■ I understand that if I make any false statements, or provide any false or misleading Yes
information, or have changed or altered this form (including the Child Supplement form)
in any material way, my Expression of Interest may not be accepted, any residence visa
or permit application my be declined and I may lose any right of appeal. Any residence
visa or permit may later be revoked. I may also be committing an offence and liable to
prosecution.
■ I understand the notes and questions in this form (including the Child Supplement Yes
form), and I declare the information given about myself, my partner and any children is
true and complete.
■ I declare that I have listed all my family members, including any adopted by law or by Yes
custom and my grandparents or legal guardians (if any) if both my parents are deceased,
and understand that the non-declaration of any family members may result in that
family member not being recognised as part of my family in future applications.
■ I declare that I will inform the New Zealand Immigration Service (NZIS) of any relevant Yes
fact or any change of circumstances that may: (i) affect the decision on my Expression
of Interest and any application for a permit, or (ii) affect the decision to grant a permit
that relies on the visa for which I am expressing interest and applying.
■ I declare that there are no matters or warrants outstanding, or investigations of any kind, Yes
which could have any current or future effect on the assessment of my good character, or
the good character of any other persons included in this Expression of Interest.
■ I authorise the NZIS to make any enquiries it deems necessary regarding the information Yes
provided on this form (including the Child Supplement form), and to share this
information with other Government agencies (including overseas agencies) to the
extent necessary to make decisions about my immigration status. I also consent to any
organisation providing relevant information to the NZIS about me.
■ I authorise the NZIS to provide information about my state of health and my Yes
immigration status to any health service agency. I authorise any health service agency
to provide information about my state of health to the NZIS.
■ I accept that any advice given to me by the NZIS before expressing interest and submitting Yes
this form (including the Child Supplement form) was intended to assist me, and acting on
that does not mean that any later application for residence will be granted.
■ I understand that in order to work in certain occupations in New Zealand, registration is Yes
required by law. I accept that the grant of residence does not guarantee that registration
will be granted.
■ I have not included any documents with this Expression of Interest. Yes
Signature of principal
applicant D D MM Y Y

Declaration for person assisting the applicant to complete
To be completed and signed by any person who has assisted the applicant to complete this form by explaining,
translating or filling in the form for the applicant.
Full name of person assisting
Address of person assisting
I understand that after the applicant has signed this form (including the Child Supplement form) it is an offence to
alter or enter further information on it, alter any material attached to it, or attach any further material to it, unless
the person making the alteration or addition states on the form what information or material has been altered or
attached, why, and by whom. 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 I have assisted in the completion of this form and any additional forms at the request of the applicant
and that the applicant understood the content of the form(s) and agreed that the information provided is correct
before signing the declaration. I have assisted the applicant as a:
lawyer agent, consultant or representative translator friend or family member
other please specify
Signature of D D MM Y Y
person assisting
Privacy Act
The information about you and your family in this form is being collected to determine whether we will invite you
to apply for residence in New Zealand and may also be used to contact you for research or marketing purposes or
to advise you on immigration matters. This information may also be used to determine your entitlement to board
a flight to come to or return to New Zealand. Your personal information will not be shared with airline check in
agents, however a boarding message will be returned to the airline check in agent based on information you have
supplied on this form.
The main recipient of the information is the New Zealand Immigration Service of the Department of Labour, but
it may also be shared with other Government agencies that are entitled to this information under applicable
legislation. In particular, the Ministry of Social Development (Work and Income) may be given information about
your personal resources.
The collection of the information is authorised by the Immigration Act 1987 and the Immigration Regulations made
under that Act. The supply of the information is voluntary, but if you do not supply the mandatory information
required by the Expression of Interest form, then your Expression of Interest cannot be accepted.
You will, if you are in New Zealand, have the right to see the information about you held by the New Zealand
Immigration Service, and to ask for any of it to be corrected if you think that is necessary. The addresses of the
New Zealand Immigration Service can be found on our website at www.immigration.govt.nz

Payment details
Details on the fee payable to submit your Expression of Interest are available on our website at www.immigration.
govt.nz and in our leaflet New Zealand Immigration Fees.
Payment must be in New Zealand dollars. The only exception is a USD bank draft. No other currency will be accepted.
Do not send cash.
I enclose (amount) NZ$ or USD
Bank cheque Bank draft
Credit card (specify type) MasterCard Visa
Name of cardholder
Card number Expiry date D D M M Y Y
C.V.C Number
Signature D D MM Y Y
PLEASE NOTE: If we determine that your Expression of Interest does not meet the minimum criteria for submission,
your fee may not be refunded. To meet the minimum submission requirements, you should ensure that you have
completed this form correctly by answering all relevant questions, that you meet the prerequisites and qualify
for more than 100 points. If you wish to check your eligibility before submitting your Expression of Interest, we
recommend that you complete your Expressions of Interest online through our website at www.immigration.govt.nz.
Submitting an Expression of Interest online is cheaper and you will know immediately whether your Expression of
Interest has been accepted into the Pool.
Submitting your Expression of Interest
If you are not completing an Expression of Interest online, send your Expression of Interest to:
Expression of Interest Team
New Zealand Immigration Service
DX SR57164
Level 1, Unisys House
The Terrace
P O Box 3705
Wellington
New Zealand
This form is approved under s132(1) of the Immigration Act 1987. 04/05

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FOR NZIS USE

EOI reference number

Expression of Interest form SKILLED MIGRANT CATEGORY

Expression of Interest form – Principal applicant – NZIS 1100 pg 1

Other (please specify)

A 5 Gender Male Female

Birth Certiﬁcate number

Name of issuing authority

A 9 Please state your main country of citizenship/nationality.

A 10 Please provide details of all passports currently held.

Date of issue D D MM Y Y Date of expiry D D MM Y Y

Date of issue D D MM Y Y Date of expiry D D MM Y Y

pg 2 Expression of Interest form – Principal applicant – NZIS 1100

Date of issue D D MM Y Y Date of expiry D D MM Y Y

A 11 Please list any other citizenships currently held.

A 12 Where applicable, please provide the following details.

Name(s) as shown on driver licence

Driver licence number

Valid for which country/state/area

Name(s) as shown on driver licence

Driver licence number

Valid for which country/state/area

Name(s) as shown on driver licence

Driver licence number

Valid for which country/state/area

Social Security number

Social Security number

Expression of Interest form – Principal applicant – NZIS 1100 pg 3

Number and street name

Telephone Phone/day Phone/night

(Country code/Area code/Telephone number)

pg 4 Expression of Interest form – Principal applicant – NZIS 1100

City, PIN/ZIP code

A 15 What is your current partnership status? (Select only one)

Married De facto Separated Divorced Widowed Never married

Will any of these children be included in your residence application? Yes No

Number and street name/PO Box

Suburb and city

Expression of Interest form – Principal applicant – NZIS 1100 pg 5

The person listed in Question A21 only.

B 7 Have you been involved in any drug trading or trafﬁcking? Yes No

pg 6 Expression of Interest form – Principal applicant – NZIS 1100

B 17 Have you been involved in any people trafﬁcking? Yes No

Please attach additional sheets if necessary.

Expression of Interest form – Principal applicant – NZIS 1100 pg 7

C 2 Do you have active tuberculosis (TB)? Yes No

C 4 Do you have a physical incapacity that requires full-time care? Yes No

pg 8 Expression of Interest form – Principal applicant – NZIS 1100

An IELTS Test Report with an overall band score of 6.5 or more ] Go to Q D3

Study for a recognised qualiﬁcation conducted entirely in English ] Go to Q E1

Current skilled employment in New Zealand for 12 months or more ] Go to Q E1

Otherwise meet the minimum standard, as deﬁned in the Guide ] Go to Q D2

D 4 What was the date you sat your test? D D MM Y Y

Overall IELTS band score

Expression of Interest form – Principal applicant – NZIS 1100 pg 9

Current skilled employment in New Zealand for 12 months or more

Offer of skilled employment in New Zealand