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QUICK CHECK ELIGIBILITY ASSESSMENT FORM

For a FREE preliminary assessment, please complete and return this form. Our experienced Client Services Agents will assess your eligibility to apply for residence visas and will respond within 2 days providing you with an initial indication of whether or not you qualify for immigration. Note: This is not an official form. The confidentiality of your details will be protected and you are not obliged to proceed further with immigration or the services of this company. PLEASE TICK ( ) YOUR PREFERRED DESTINATION COUNTRY(IES) Australia New Zealand Canada USA United Kingdom Personal details Family name First names Title Age Nationality(ies) Is English your Mother Tongue? If not, please indicate your English level (circle one) Other languages? Are you?: Single Married Yourself (Principal Applicant) Your partner/spouse (if applicable)

Mr/ Mrs/ Ms/ Dr (Delete as applicable)

Mr/ Mrs/ Ms/ Dr (Delete as applicable)

Yes / No (delete as applicable) Fluent / Average / Beginner / Non-existent

Yes / No (delete as applicable) Fluent / Average / Beginner / Non-existent

Separated Widowed / Divorced Yourself (Principal Applicant)

Same sex relationship De Facto (living together) Your partner/spouse (if applicable)

Educational & Employment History Highest Qualification Achieved No. of years of study Occupation Briefly outline your work duties /job description (max 30 words) No. of years of experience Financial Details Please indicate your personal financial worth (eg. assets, shares, savings, property, business interests) DEDUCT debts or other liabilities. Please specify currency Additional Information Please provide any further details that may affect your application (eg. job offers, family sponsors, previous residency, criminal convictions) Contact Details Street Address City Postcode State/Province/County Country Telephone Number E-mail Postal Address (if different)

Yourself (Principal Applicant)

Your partner/spouse (if applicable)

Yourself (Principal Applicant)

Your partner/spouse (if applicable)

Yourself (Principal Applicant)

Your partner/spouse (if applicable)

Have you already spoken to a Migration Bureau consultant? Yes / No (delete as applicable). If your answer is Yes, please specify consultants name: How did you hear about Migration Bureau? (If possible, please list the publication/media) If eligible, when do you want to proceed with a residence visa application?
Immediately Within ..months Undecided

Please complete & return this form as soon as possible. This service is provided free of charge. Please do not send any monies, CVs/resumes or other documents.
Migration Bureau, Ibis House (Level 2), 183 Hereford Street, PO Box 13-120, Christchurch, New Zealand. Tel: +64 (0)3377 4411 E-mail: info@migrationbureau.com / Website: www.migrationbureau.com

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