Application For Visiting New Zealand (To Travel To New Zealand Or To Be In New Zealand To Visit) Page 11
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16I have read the Health Requirements Leaflet (NZIS 1121) and I am aware of the health
F4
information I need to provide with this application.
Yes
No
Are you, or any person included in the application from a country that is not on
F5
the list of low incidence TB countries?
Yes
No
Have you, or any person included in the application spent three months or more in the
F6
past five years in a country that is not on the list of low incidence TB countries?
Yes
No
If you have answered Yes to F5 or F6, please provide details below. For a list of low incidence TB countries,
F7
refer to the Health Requirements Leaflet (NZIS 1121).
F8
How long do you intend to visit in New Zealand?
Have you submitted a medical certificate with another Immigration New Zealand
application in the past 24 months?
Yes
(go to question F9)
No
(go to question F10)
F9
Please provide details of the type and date of the previous application:
Type of application:
Date of application:
day
month
year
We will advise you if we need you to submit further information, such as tests, reports, or a new
certificate at a later date.
F10
Have you attached a completed Temporary Entry Chest X-ray Certificate (NZIS 1096)? Yes
No
OR
F11
Have you attached a completed Medical and Chest X-ray Certificate (NZIS 1007)?
Yes
No
Please note: All immigration visa and permit holders who access health services in New Zealand should carry a
current passport to enable health providers to document eligibility status. We strongly recommend that you have
comprehensive health insurance for the duration of your visit. For more information visit the Ministry of Health
website at
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