Application For Visiting New Zealand (To Travel To New Zealand Or To Be In New Zealand To Visit) Page 3

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Section A
Personal details
Principal applicant
Client number:
A1
Name as shown in passport
Family:
Given:
Attach one
A2
Preferred title
Mr
Mrs
Ms
Miss
Dr
Other
recent passport size
photograph of
(please specify)
yourself here.
A3
Other names you are known by
Write your name
on the back.
A4
Your name in ethnic script
A6
A5
Gender
Male
Female
Date of birth
day
month
year
A7
Place and country of birth
Place:
Country:
A8
Passport details
Number:
Country:
Expiry Date:
day
month
year
A9
Your citizenship
A10
Other citizenships currently held
A11
Do you identify with a particular ethnic group? If so, please specify.
A12
Partnership status
Married
Never married
Partner
Separated
Engaged
Widowed
Divorced
Additional information
Principal applicant, please complete for yourself and on behalf of any accompanying family members.
A13
I may be contacted at this New Zealand residential address and telephone number:
Email
Telephone
A14
Name and address of any friends, relatives or contacts I have in New Zealand are:
Name
Relationship
Address
Name
Relationship
Address
Name
Relationship
Address
3

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