Questionnaire 2

Personal Immigration Questionnaire
Work visa (Principal Applicant)

Please read
Please ensure that all the details you provide on this form are true and correct. The information you provide may be used in the preparation of a visa
application. It is an offence under Section 342 of the Immigration Act 2009 to provide, or cause to be provided, documents or information to
Immigration New Zealand which are false, fraudulent or misleading. Significant penalties apply. Providing incorrect information may also result in
your visa application being refused or any visa granted to you cancelled.
Please note that this is not an application form. This questionnaire is for your Immigration Adviser’s use only. Your Immigration Adviser will use the
information you provide in this questionnaire to prepare an assessment and/or your visa application(s). Remember, providing us with accurate
information will help us provide you with the best advice.
Personal details
Name as shown in passport
Family (last name)
Given (first, middle

name)
Preferred title
Mr Mrs
Ms Miss Dr
Other (please specify)
Other names you are or have been known by (eg your maiden name)
Gender Male Female
Day/Month/Year
Date of birth
Place of birth
Town/city
Province
Country
Details from your passport
Passport number
Country of Citizenship
Are you a citizen of any other country?
No
Yes Please list all countries of citizenship

National Identity number
Have you previously applied for any type of New Zealand visa or have a current New Zealand visa application in process (eg visitor,
work, residence etc)?
No
Yes Please provide us with a copy of the visa label
Have you previously requested an NZeTA (New Zealand Electronic Travel Authority)?
No Yes
Have you ever travelled to New Zealand?
No Yes
Do you hold an Australian Permanent Resident visa?
No Yes
Are you currently working with any other immigration adviser?
No
Yes Please state the name of the adviser here
Partnership status
Married/in civil union Single
Partner* Separated
Engaged Divorced
Widowed
* A partner includes a person you are in a relationship with (ie de facto, partner/boyfriend/girlfriend). INZ policy states that
partners can be of the same or opposite sex.
Will your partner or spouse be accompanying you to New Zealand?

No Yes
If you answered yes, please answer the next two questions below:
1. Have you been convicted in the last 7 years of any offence involving domestic violence or of a sexual nature in any country, or are
you currently under investigation for such an offence?
No
Yes Please provide details
2. Do you consent to Immigration New Zealand providing information about you to your partner/intended, if deemed necessary for
the assessment of their application?
No Yes
Contact details
Your current residential address
Street
address
Suburb or
District
Town or city
Region
Post code
Your current telephone numbers
Country Area Number
Phone (landline) ( ) ( )
Phone (mobile)
Email
Name and address for communication about this application (if different from above).
Your passport and original documents will be returned to you at this address (or the one noted above) unless indicated otherwise.
Name
Address
Country Area Number
Phone (mobile) ( ) ( )
Email
Are you currently in New Zealand?
No
Yes Please provide your most recent address outside

New Zealand
Please list the name, address, contact details and relationship of any friends, relatives or contacts you have in New Zealand
Name
Address
Email
DD/MM/YY
Dave of birth Relationship

(if known)
Name
Address
Email
DD/MM/YY

(if known)
Name
Address
Email
DD/MM/YY

(if known)
Travel dates
Day/Month/Year
What date do you intend to

enter New Zealand?
If you are currently in New

Zealand, what was the date
which you first arrived in New
Zealand? (Whether as a
visitor or holding a work visa.)
This information should be on

your entry stamp in your
passport.
Health requirements
Do you have tuberculosis (TB)?
No
Yes Give details
Do you have any medical condition that currently requires, or may require, one of the following during your intended stay in New
Zealand?
Residential care is defined as in-patient care for people with a physical, sensory, intellectual or psychiatric disability or lived-in
facilities for the aged.
Renal dialysis No Yes If yes to any of these
Hospitalisation No Yes questions, please provide

details below
Residential care No Yes
Are you pregnant?
No
Yes Date you are due to give birth:
Please note that if you intend to give birth in New Zealand, you may have to provide evidence that you have at least NZ$9,000 of
funds available if you are not eligible for publicly funded maternity services.
Have you submitted any medical certificates to INZ in the last 36 months?
No
Yes Give details below
Type of visa application
Date application was lodged with INZ
Date medical certificate was issued by

doctor
Please note here any and all medical conditions you have or have had in the past that may or will require medical care or monitoring
in the future.
Have you spent a combined total of three months or more in any country in the past 5-year period, other than your country of
citizenship?
No
Yes Please state the applicable country/countries

Character details
Please list all countries you have lived in for 5 years or more since the age of 17.
Have you submitted any Police Certificates to INZ with any previous application?
No
Yes If yes, please provide the following:
Date police certificate was issued
Date prior application was lodged
Have you ever been convicted at any time of any offence, including any driving offence? (You must include all convictions).
No
Yes Please provide details below
Are you currently under investigation, wanted for questioning, or facing charges for any offence in any country including New
Zealand?
No
Have you ever been expelled, deported, excluded, removed from or refused entry to any country?
No

Have you ever been refused a visa or permit by any country, including New Zealand?
No
Are you currently wanted for questioning for any offence(s) against the law in any country, including New Zealand?
No
Have you had (or currently have) an association with, membership of, or involvement with, any government, regime, group or
agency that has advocated or committed war crimes, crimes against humanity and/or other gross human rights abuses?
No
Have you ever been a member of, or adhered to, any terrorist organisation?
No
Employment
If you are currently employed, provide details
Employer’s name
Employer’s address
- Street address
- Town or city
- Region
- Post code
Country Area Number

Employer’s phone ( ) ( )
Employers email
Your position
Your start date
Give details of all periods of employment starting with your current job or most recent, including self-employment.
Period* Location
Name of
(province/region Type of work/occupation/job title
employer
and country)
MM YY
From 05 2021 STA CLARA SAN ROQUE,BAUAN, BUILDING CONTS.

To 08 2022 INTERNATIONAL CORP. BATANGAS L/M CARPENTER
Please provide a detailed description
of your duties for this role
Build or repair cabinets,doors,frameworks,floor or other wooden fixtures used in buildings,using wood

working machines,hand tools or power tools.
Period* Location
Name of
employer
and country)
MM YY
From 04 2019
To
Period* Location
Name of
employer
and country)
MM YY
From
To
Period* Location
Name of
employer
and country)
MM YY
From
To
Period* Location
Name of
employer
and country)
MM YY
From
To
* If you do not know the exact date, please provide an approximate date.
Give details of all qualifications you currently hold (excluding secondary school)
Date commenced and

completed study* Name of qualification Institution where qualification gained
DD MM YY
From
To
Date commenced and

completed study* Name of qualification Institution where qualification gained
DD MM YY
From
To
From
To
From
To
* If you do not know the exact date, please provide an approximate date.
Additional information
Please include details below:
Section Additional information

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Personal Immigration Questionnaire

Work visa (Principal Applicant)

Family (last name)

Given (first, middle

Gender Male Female

Details from your passport

Are you a citizen of any other country?

Yes Please list all countries of citizenship

Yes Please provide us with a copy of the visa label

Have you ever travelled to New Zealand?

Do you hold an Australian Permanent Resident visa?

Yes Please state the name of the adviser here

Married/in civil union Single

Will your partner or spouse be accompanying you to New Zealand?

Yes Please provide details

Your current telephone numbers

Country Area Number

Country Area Number

Are you currently in New Zealand?

Yes Please provide your most recent address outside

Dave of birth Relationship

Dave of birth Relationship

Dave of birth Relationship

What date do you intend to

If you are currently in New

This information should be on

Yes Give details

Renal dialysis No Yes If yes to any of these

Hospitalisation No Yes questions, please provide

Are you pregnant?

Yes Date you are due to give birth:

Yes Give details below

Type of visa application

Date application was lodged with INZ

Date medical certificate was issued by

Yes Please state the applicable country/countries

Yes If yes, please provide the following:

Date police certificate was issued

Date prior application was lodged

Yes Please provide details below

Yes Please provide details below

Yes Please provide details below

Yes Please provide details below

Yes Please provide details below

Yes Please provide details below

Yes Please provide details below

Country Area Number

Your start date

From 05 2021 STA CLARA SAN ROQUE,BAUAN, BUILDING CONTS.

Build or repair cabinets,doors,frameworks,floor or other wooden fixtures used in buildings,using wood

Date commenced and

Date commenced and

Section Additional information

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