Visitor Visa Application (INZ 1017) - New Zealand Immigration Service

When filling in this form, please write clearly using CAPITAL LETTERS. 

Application checklist 

All applicants must provide: 

Completed, signed application form. 

Appropriate fee. 

Two passport-sized colour photographs for 

everyone included in the application. 

Passport or travel document for everyone included 

in the application. 

Medical or chest X-ray certificates if required 

by Section E: Health for everyone included in the 

application. 

Evidence of financial support consisting of: 

• a completed Sponsorship Form For Temporary Entry 

(INZ 1025), or 

• evidence showing you have sufficient funds in your 

name to support yourself. 

Evidence that you have the means to leave 

New Zealand consisting of: 

• a completed Sponsorship Form For Temporary Entry 

(INZ 1025), or 

• pre-purchased travel out of New Zealand, or 

• evidence showing you have sufficient funds in your 

name to purchase travel out of New Zealand. 

If your partner and/or dependent children are 

included in this application: 

• evidence of your relationship with your partner 

and evidence that you are currently living together 

in a genuine and stable partnership and/or 

• evidence that you are the parent or legal guardian 

of the children included in this application 

Applicants for specific visa types must provide the 

documents listed below. 

Applicants who are... Must provide... 

Tourists or 

visiting family 

or friends 

Visiting for 

business 

2 – Visitor Visa Application - July 2012 

Evidence that you are 

a bona fide visitor, for 

example: 

• evidence that you intend 

to return to your home 

country at the end of 

your stay 

• evidence that you are 

genuinely visiting for the 

purpose of holidaying, 

sightseeing or visiting 

family or friends 

Evidence of your employment 

Evidence of the business you 

will undertake in New Zealand 

Guardians of 

students 

Dependent 

children of 

New Zealand 

citizens, 

residents, or 

temporary visa 

holders 

Parents and 

grandparents 

of New Zealand 

citizens or 

residents 

Evidence that you are the 

parent or legal guardian 

of the student you are 

accompanying and evidence 

you provided care for the 

student in your home country. 

Evidence of your 

relationship with your 

parent or legal guardian. 

If you are a dependent child 

of an Essential Skills visa 

holder, evidence that your 

parent meets the minimum 

income threshold. 

If you are a dependent child 

of a Religious worker visa 

holder, either: 

• evidence that your parent 

meets the minimum 

income threshold, or 

• a completed Sponsorship 

Form For Temporary Entry 

(INZ 1025) indicating that 

the religious organisation 

sponsoring my parent will 

support me. 

Sponsorship form completed 

by your New Zealand child or 

grandchild. 

Evidence of your relationship 

with your child or grandchild. 

Note: Detailed information about the type of documents 

you should provide in support of your application 

is available from the Immigration New Zealand 

branch where you will submit your application. Go to 

www.immigration.govt.nz/contactus and select the 

appropriate branch. 

If your circumstances are not covered in the 

above list, refer to the Immigration New Zealand 

website, www.immigration.govt.nz/visit, or the 

Immigration New Zealand Operational Manual, 

www.immigration.govt.nz/opsmanual, for information 

about the documents you must provide. 

Returning your documents 

Please tick one of the following options 

Please return all documents to me by secure post 

at the address given at B3 . 

I wish to collect my documents when ready. 

Note: This option is not available in all branches, see your branch 

website at www.immigration.govt.nz/contactus to check if you 

can collect your documents

OFFICE USE ONLY Client no.: Date received: / / Application no.: 

Which type of visitor visa are you applying for? 

General (tourist) Business Dependent child Parent or grandparent Guardian of a student 

Other 

Section A Principal applicant’s personal details 

Attach two colour passport-size photographs of yourself here. 

The photographs must be less than six months old. 

Write your full name on the back of both photographs. 

For more information about the questions in this section, see ‘Completing 

Sections A, C, and D: Personal details’ in the Visitor Visa Guide. 

A1 Name as shown in passport 

Family/last name 

Given/first name(s) 

A2 Preferred title Mr Mrs Ms Miss Dr other (specify) 

A3 Other names you are known by or have ever been known by 

A4 Gender Male Female A5 Date of birth 

A6 Town/city of birth 

Country of birth 

A7 Passport details 

Number 

Country 

A8 Other citizenships you hold 

Expiry date 

A9 Partnership status Single Separated Partner Divorced 

Married/in civil union Engaged Widowed 

Section B Contact details 

B1 Your current residential address. 

Address 

Telephone (landline) 

Email 

Telephone (mobile) 

B2 If you are currently in New Zealand, your most recent overseas address. 

Address 

4.5cm 

4.5cm 

3.5cm 3.5cm 

Visitor Visa Application - July 2012 – 3


B3 Name and address for communication about this application. 

Same as address at B1 , or as below 

Family/last name Given/first name(s) 

Company name (if applicable) and address 

Telephone (daytime) Telephone (evening) 

Email 

B4 Do you authorise the person stated at B3 to act on your behalf? Yes No 

B5 Have you received immigration advice on this application? 

You can find a definition of immigration advice at www.immigration.govt.nz/advice. 

Yes Make sure that your immigration adviser completes Section J: Immigration adviser’s details. 

No 

B6 Names and addresses of any friends, relatives, or contacts you have in New Zealand (if applicable) 

Name 

Address 

Relationship Date of birth (if known) 

Name 

Address 

Relationship Date of birth (if known) 

B7 List all periods of employment, including self-employment 

Date from 

(DD/MM/YY) 


Date to 

(DD/MM/YY) 

/ / / / 

/ / / / 

/ / / / 

/ / / / 

/ / / / 

Name of employer Location Type of work/occupation/job title

Section C Partner’s personal details 

If you selected ‘Married/in civil union’, ‘Partner’ or ‘Engaged’ in question A9 , you must complete this section, whether 

or not your partner is travelling with you. 

If applicable, attach two colour passport-size photographs of your 

partner here. The photographs must be less than six months old. 

Write your partner’s full name on the back of both photographs. 

C1 Partner’s name as shown in passport 



C2 Other names your partner is known by or has ever been known by 

For more information about this question, see ‘Completing Sections A, C, and D: Personal details’ in the Visitor Visa Guide. 

C3 Partner’s gender Male Female C4 Partner’s date of birth 

C5 Partner’s town/city of birth 

Partner’s country of birth 

C6 Partner’s passport details 

Number 

Country Expiry date 


C7 Other citizenships your partner holds 

C8 Is your partner included in this application? Yes No 

4.5cm 

4.5cm 

3.5cm 3.5cm 



Section D Dependent children’s personal details 

You must complete this section with the details of each dependent child included in this application. If you wish to include 

more than four dependent children in your application, use the form Additional Dependants for a Visitor Visa (INZ 1205). 

Dependent child one 

Attach two recent colour passport-size photographs of the child 

here. The photographs must be less than six months old. 

Write the child’s full name on the back of both photographs. 

D1 Child’s name as shown in passport 



D2 Child’s gender Male Female D3 Child’s date of birth 

D4 Child’s country of birth 

D5 Child’s passport details 

Number 


D6 Other citizenships child holds 


Dependent child two 

Attach two recent passport-size photographs of the child here. 

The photograph must be less than six months old. 








Number 

Country 



4.5cm 

4.5cm 

3.5cm 3.5cm 

Expiry date 

4.5cm 

4.5cm 

3.5cm 3.5cm

Dependent child three 


The photographs must be less than six months old. 








Number 



Dependent child four 


The photograph must be less than six months old. 








Number 

Country 


4.5cm 

4.5cm 

3.5cm 3.5cm 

Expiry date 

4.5cm 

4.5cm 

3.5cm 3.5cm 



Section E Health 

For more information about the questions in this section, see ‘Completing Section E: Health’ in the Visitor Visa Guide. 

E1 Do you or any person included in this application have tuberculosis (TB)? Yes No 

E2 Do you or any person included in this application have any medical condition that requires, or may require, one of the 

following during your stay in New Zealand? 

• Renal dialysis Yes No 

• Hospital care Yes No 

• Residential care Yes No 

Residential care is long-term care provided in live-in facilities for the aged or for people with physical, sensory, 

intellectual, or psychiatric disabilities. 

E3 If you have answered Yes to any of the questions in E1 and E2 , please provide details. 

E4 Are you or any person included in this application pregnant? 

Yes Date the pregnant applicant is due to give birth 

No Go to E6 


Go to E5 

E5 If the applicant who is pregnant intends to give birth in New Zealand, please indicate how the cost of maternity 

health services will be paid for and provide the relevant evidence. 

Not applicable as the applicant who is pregnant does not intend to give birth in New Zealand. 

The applicant who is pregnant is, or will be eligible for publicly-funded maternity health services and has 

provided evidence of her eligibility. 

The applicant who is pregnant will cover the cost of maternity health services and has attached copies (not 

originals) that they have at least NZ$9000 of funds available. 

The sponsor of the applicant who is pregnant has guaranteed to cover the cost and a completed Sponsorship 

Form for Temporary Entry (INZ 1025) is attached. 

Medical certificates you must provide 

Select the appropriate option to indicate whether you and the other people included in this application are required 

to provide medical certificates. Medical certificates must be less than three months old when you submit them to 

Immigration New Zealand 

E6 Are you applying for a parent/grandparent visitor visa? 

Yes You must complete a General Medical Certificate (INZ 1007) and Chest X-Ray Certificate (INZ 1096). Go to E10 . 

No Go to E7 . 

E7 Will you be in New Zealand for more than six months in total? 

Yes You may have to provide a General Medical Certificate (INZ 1007) or Chest X-ray Certificate (INZ 1096) if indicated at E8 . 

No You do not have to provide a chest X-ray certificate or a medical certificate. Go to Section F: Character 

E8 How long do you intend to stay in New Zealand? If you are in New Zealand, this includes time you have already spent here. 

More than six months but not more than 12 months. You must provide a Chest X-ray Certificate (INZ 1096) if you are from a 

place that is not listed as having a low incidence of tuberculosis. See notes below E9 , then go to E10 . 

More than 12 months. You must provide a General Medical Certificate (INZ 1007) and a Chest X-ray Certificate (INZ 1096).

E9 Are you applying for a visitor visa as the dependent child of a New Zealand citizen or resident? 

Notes: 

Yes You may be able to provide a Limited Medical Certificate (INZ 1201) rather than a General Medical Certificate (INZ 1007). 

Refer to the Visitor Visa Guide (INZ 1018) for further information. See notes below, then go to E10 . 

No See notes below, then go to E10 

• Refer to Completing Section E: Health in the Visitor Visa Guide (INZ 1018) for the ‘List of countries, areas and territories with a low incidence 

of tuberculosis’. 

• Pregnant women and children under the age of 11 are not required to have an X-ray, unless a special report is required. 

• You do not need to provide a chest X-ray certificate if you have provided one which was issued less than 36 months ago, with a previous 

Immigration New Zealand application, unless your health has deteriorated since your previous certificate was issued, or unless you have spent 

six consecutive months since your previous application, in a place not listed as having a low incidence of tuberculosis. 

• You do not need to provide a medical certificate if you have provided one which was issued less than 36 months ago, with a previous Immigration 

New Zealand application, unless your health has deteriorated since your previous certificate was issued. 

E10 Tick the option below which applies to you: 

I attach both a Chest X-ray Certificate (INZ 1096) and a General Medical Certificate (INZ 1007) or a Limited 

Medical Certificate (INZ 1201). Go to Section F: Character 

I have attached only a Chest X-ray Certificate (INZ 1096) because: 

I am staying between six to 12 months and I am from, or have visited for more than three months, a place 

that is not listed as having a low incidence of tuberculosis, or 

I have previously provided a chest X-ray certificate; however: 

it was dated by the radiologist more than 36 months ago, or 

my health has deteriorated since my last certificate was issued, or 

I have spent six consecutive months since my previous application, in a place not listed as having a low 

incidence of tuberculosis. Go to Section F: Character 

I am required to provide a Chest X-ray Certificate (INZ 1096), however, as I am pregnant or under 11 years of 

age, I am not required to have an X-ray; and: 

I am not required to provide a General Medical Certificate (INZ 1007) at this stage; or 

I have therefore provided only a General Medical Certificate (INZ 1007) or a Limited Medical Certificate 

(INZ 1201). Go to Section F: Character. 

I attach only a General Medical Certificate (INZ 1007) or a Limited Medical Certificate (INZ 1201) because I have 

previously provided a medical certificate, however: 

it was dated by the medical examiner more than 36 months ago; or 

my health has deteriorated since my last certificate was issued. Go to Section F: Your character. 

I do not have to provide a Chest X-ray Certificate (INZ 1096) and either a General Medical Certificate (INZ 1007) 

or a Limited Medical Certificate (INZ 1201) at this stage because: 

• I have provided a medical certificate and chest X-ray certificate which were issued less than 36 months ago, 

with a previous Immigration New Zealand application; and 

• my health has not deteriorated; and 

• I have not spent six consecutive months in a place which is not listed as having a low incidence of tuberculosis 

since my previous application. Go to Section F: Your character. 



Section F Character 

All applicants must complete this section. Note: if your application is declined for character reasons, Immigration 

New Zealand may place a notation in your passport indicating that you applied for a visa for New Zealand. 

For more information about the questions in this section, see ‘Completing Section F: Character’ in the Visitor Visa Guide. 

F1 Have you or any other person included in this application been: 

• convicted Yes No 

• charged Yes No 

• under investigation Yes No 

for any offence(s) against the law in any country including New Zealand? 

F2 Have you or any other person included in this application been: 

• excluded (refused entry) from Yes No 

• refused a visa by Yes No 

• removed or deported from 

any country including New Zealand? 

Yes No 

If you have answered Yes to any of the questions in F1 and F2 , please provide details below. 

Continue on a separate piece of paper if necessary. 

10 – Visitor Visa Application - July 2012

Section G Visa type 

G1 Are you outside New Zealand? 

Yes Estimated date of arrival in New Zealand 

Estimated date of departure from New Zealand 

No Estimated date of departure from New Zealand 

G2 If you are applying for a visitor visa, what is the purpose of your visit to New Zealand? 

G3 If you are applying for a limited visa, what is the ‘express purpose’ for visiting New Zealand? If you are applying for a 

further limited visa, also give the reasons why you need to stay in New Zealand for longer. 

Date your ‘express purpose’ starts/started 

Date your ‘express purpose’ will be completed 

See the Visitor Visa Guide (INZ 1018) for more information about the restrictions imposed on limited visas. 

G4 Is your visa application dependent on another person who is either in New Zealand or holds a visa to be in New Zealand? 

No Go to Section H: Financial support while you are in New Zealand. 

Yes Indicate the relationship with the other person. Note you must provide evidence of that relationship. 

I am the guardian of a student visa holder. 

I am the parent or grandparent of a New Zealand citizen or resident who has sponsored me. 

I am the dependent child of a New Zealand citizen, resident or temporary visa holder. 

Other (specify) 

Please provide details of the other person: 


Date of birth 

Section H Financial support while you are in New Zealand 

For more information about this section and acceptable evidence of funds, see ‘Completing Section H: Financial support while you are in 

New Zealand’ in the Visitor Visa Guide. 

H1 Are you using your own funds for your visit to New Zealand or are you being sponsored? 

Own funds – attach copies of evidence you have sufficient funds to support yourself and evidence you either 

have arranged travel out of New Zealand or have sufficient funds * to do so. 

Sponsored – attach completed sponsorship form. 

* Sufficient funds for support means at least NZ$1000 per month you intend to stay in New Zealand per person included in your 

application, or NZ$400 if you have accommodation. Funds must be in your own name. 



Section I 


Declaration by applicant 

All of the people included in this application must complete this section. 

I have provided true and correct answers to the questions in this form. 

I will inform Immigration New Zealand of any relevant fact or change of circumstances (including a change in my 

employment or partnership status) that may (i) affect the decision on my application for a visa, or (ii) affect the decision 

to grant entry permission based on the visa for which I am applying. 

I agree to leave New Zealand before my visa expires. If I remain in New Zealand after my visa has expired, I may be 

deported by Immigration New Zealand. 

I agree that if I am not entitled to free health care in New Zealand, I will pay for any health care or medical assistance 

I may require in New Zealand. 

I understand that if I have received immigration advice from an immigration adviser and if that immigration adviser 

is not licensed under the Immigration Advisers Licensing Act 2007 when they should be, Immigration New Zealand will 

return my application. 

I authorise Immigration New Zealand to provide information about my health and my immigration status to any health service 

agency. I authorise any health service agency to provide information about my health to Immigration New Zealand. 

I authorise Immigration New Zealand to make any necessary enquiries about information on this form and/or 

accompanying documentation. I authorise any agency whether in New Zealand or overseas, including but not limited to 

border or immigration agencies, education providers, financial institutions, foreign embassies, government authorities, 

health care providers, police or other law enforcement agencies, that holds information (including personal information) 

related to information on this application form and/or accompanying documentation to disclose that information to 

Immigration New Zealand. so that they can: 

• make a decision on this application 

• answer enquiries about my immigration status once my application has been decided. 

I authorise any agency that holds information (including personal information) related to those matters to disclose that 

information to Immigration New Zealand. 

If I am granted a visa with the condition that I accompany a student, I agree to live with that student. I understand that both the 

student and I may be liable for deportation if I do not meet this condition. 

If I am granted a limited visa, I agree that I will leave New Zealand on or before the expiry date of that visa . If I do not 

leave New Zealand, I may be immediately deported from New Zealand without the right of appeal. 

I have provided all the documents required by the checklist on page 2. 

Signature of principal applicant Date 

Signature of partner Date 

Signature of accompanying dependent children over 18 years of age (if applicable) 

Child one Date 

Child two Date 

Child three Date 

Child four Date 

Note that a parent or guardian may sign on behalf of a child under 18 years. 

This form has been approved under section 381 of the Immigration Act 2009

Section J Immigration adviser’s details 

This section must be completed by the applicant’s immigration adviser. If the applicant does not have an immigration 

adviser, this section does not have to be completed. 

J1 If you are a licensed adviser, please provide your licence details. 

Licence type full provisional limited List conditions specified in the register 

Licence number 2 0 Go to Section K: Declaration by person assisting the applicant 

J2 If you are exempt from licensing, tick one box below to show why you are exempt from licensing then go to 

Section K: Declaration by person assisting the applicant. 

I provided immigration advice in an informal or family context only, and I did not provide the advice systematically 

or for a fee. 

I have provided immigration advice in the course of my work (employed or volunteer) and that work exempts me 

from the requirement to be licensed. Indicate the reason for your exemption below. 

Lawyer with current New Zealand practicing certificate Community Law Centre Citizens Advice Bureau 

New Zealand Member of Parliament or staff New Zealand public servant Foreign Diplomatic/Consular 

See www.immigration.govt.nz/adviserlicensing for more information about who is exempt from licensing. 

Section K Declaration by person assisting the applicant 

This section must be completed and signed by the applicant’s immigration adviser, or by any person who has assisted 

the applicant by providing immigration advice, explaining, translating, or recording information on the form for the 

applicant. If the applicant does not have an immigration adviser, and no one helped the applicant to fill in this form, this 

section does not have to be completed. 

If you are not exempt under the Immigration Advisers Licensing Act 2007, it is an offence for you to provide immigration advice without holding a license, 

and Immigration New Zealand will refuse to accept your client’s application. More information about immigration adviser licensing can be obtained from 

the Immigration Advisers Authority website www.iaa.govt.nz, via email [email protected] or by telephone on 0508 422 422. 

Name and address of person assisting applicant. Same as address given at B3 , or as below. 


Company name (if applicable) and address 

Telephone (daytime) 

Fax Email 

Telephone (evening) 

I understand that after the applicant has signed this form it is an offence to change or add further information, change 

any documents attached to the form, or attach any further documents to the form. 

I note 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. However, if changes are needed, the person making the changes must state on the form what information 

or documents have been changed and give reasons for the changes. 

I certify that the applicant asked me to help them complete this form and any additional forms. I certify that the applicant 

agreed that the information provided was correct before signing the declaration. 

I have assisted the applicant as an interpreter/translator 

I have assisted the applicant with recording information on the form 

I have assisted the applicant in another way. Specify 

I have provided immigration advice (as defined in the Immigration Advisers Licensing Act 2007) and my details in 

Section J: Immigration adviser’s details are correct. 

Signature of person assisting Date D D M M Y Y Y Y 




About the information you provide 

Deciding whether you are eligible for a visa 

Immigration New Zealand collects the information 

about you on this form to decide whether you are eligible 

for a visitor visa or a limited visa. We may also use the 

information to contact you for research purposes or to 

advise you on immigration matters. 

Collecting the information is authorised by the 

Immigration Act 2009 and the Immigration Regulations 

made under that Act. You do not have to provide the 

information, but if you do not we are likely to decline 

your application. 

Deciding whether you are eligible to board a flight 

to New Zealand 

The information we collect may also be used to 

determine whether you are allowed to board a flight to 

New Zealand. We will not share your personal information 

with airline check-in agents; however, we will send a 

boarding message to the airline check-in agent based on 

the information you have provided in this form. 

Immigration New Zealand may also share the information 

you have provided with other government agencies that 

are entitled to it by law, or with other agencies (as you 

have agreed in the declaration). 

You are able to ask for the information we hold about you 

and have any of it corrected if you think it is necessary. 

The address of Immigration New Zealand is PO Box 

3705, Wellington, New Zealand. This is not where your 

application should be sent. 

Other documents we may need 

Sometimes we may ask for additional documents or 

information to consider with an application. 

You may wish to send other documents or information 

so that we can consider it with this application. Send 

photocopies only (not original documents), as these 

documents will not be returned to you. If we need to see 

an original document, we will ask you to produce it later. 

For more information 

If you have questions about completing the form: 

• see our website www.immigration.govt.nz/contactus 

• phone our call centre on 0508 558 855 (within New Zealand). 

Section L Paying your application fee 

To find out how much the fee is and where to send 

your application, use our office and fees finder at 

www.immigration.govt.nz/fees. 

Note: some offshore branches do not accept credit cards. 

The office and fees finder contains information about 

alternative methods of payment. 

Your application fee 

Amount you are paying: 

Currency 

Application number 

(office use only) 

Preferred methods of payment 

We recommend that you use one of the following methods 

of payment for better security and faster processing: 

Bank cheque/bank draft 

Credit card (choose one) 

Mastercard Visa 

SWITCH card (UK only) 

Name of cardholder 

Card number 

CVC/CVV number 

SWITCH card issue number 

Note: Your CVC/CVV number is the three-digit number found on the 

signature strip on the back of your credit card. 

Expiry date 

Signature of cardholder 

Date 

Other methods of payment 

Personal cheque. Note that we will hold your application for 

10 working days to allow the cheque to be cleared. 

Cash. Our New Zealand branches do not accept cash. Most of our 

branches outside New Zealand do not accept cash. 

EFTPOS. Note this option is only available for applications lodged in 

person in one of our New Zealand offices. 

We do not accept money orders.

Visitor Visa Application (INZ 1017) - New Zealand Immigration Service

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