Section G 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 understand that if false or misleading information is submitted, my application may be declined without further warning.
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 understand that Immigration New Zealand may provide information about my entitlement to work to potential
employers via the online VisaView system. If I undertake a course of study while in New Zealand, I authorise
Immigration New Zealand to provide information about my immigration status to my education provider, including
via VisaView.
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 applicant Date
Signature of parent or guardian if applicant is 16 or 17 years of age
Date