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AdultApplicationforNewZealandCitizenshipKirirarautangaoAotearoa–PakekeTobeeligibleforagrantofcitizenship,youmustmeetthefollowingcriteria*:youareentitledtoresideindefinitelyinNewZealand;ANDyouhavebeenpresentinNewZealand:foratleast1,350dayswithNewZealandresidenceduringthe5yearsimmediatelybeforeyoumakeyourapplication;andforatleast240dayswithNewZealandresidenceineachofthose5years;andfullymetanyconditionsimposedbyImmigrationNewZealand(INZ)inregardtoyourresidencestatus'NewZealandresidence'meansyouhavearesidencevisaorapermanentresidencevisaissuedbyINZoryouareanAustraliancitizenorpermanentresidentoryouareaNewZealandcitizenbydescent.
youareofgoodcharacteryouunderstandtheresponsibilitiesandprivilegesofNewZealandcitizenshipyouareabletounderstandandspeakEnglishyouintendtocontinuetoresideinNewZealand,ifgrantedcitizenshipWhatyouneedtocompletethisapplicationYourbirthcertificateoryourcountry'sequivalent.
Yourcurrentpassport(s)(ormostrecentifithasexpired).
Two(2)identicalrecentcolourphotosofyourself.
Someonetoactasawitnesswhoisaged16yearsoroverandhasavalidNewZealandpassport.
Iflodgingyourapplicationinperson,youmayuseacitizenshipofficerorDIAcustomerservicerepresentative,asyourwitness.
Theapplicationfeeof$470.
20peradult.
Sometimeswemayaskyoutosendusotheroriginaldocuments.
Pleasemakesuretheinformationyouprovideistrueandcorrect.
Ifitislaterfoundthatyouhaveprovidedfalseormisleadinginformation,youmaybedenied/loseNewZealandcitizenship,orfacecriminalcharges,orboth.
Acaseofficercanhelpyoulodgeyourapplication.
Tomakeanappointment,freephone0800225151(NZonly)or+6444620651(outsideNewZealand).
Forfurtherinformation,pleaserefertopage8oftheguidenotesorvisitwww.
govt.
nz/citizenship.
*Refertopage3oftheguidenotesifyoudon'tmeetalltherequirementsforcitizenship.
USETHISFORMifyouare16yearsoroverandareapplyingforagrantofNewZealandcitizenship.
GUIDENOTES11DoyouliveinNewZealandyesgoto2nogoto102AreyouSamoanyesgoto11nogoto33HaveyoulivedinNewZealandwithresidencestatusforfiveyearsormoreyesgoto4nogoto108HaveyoureadandunderstoodtheresponsibilitiesandprivilegesofbeingaNewZealanderyesgoto9nogoto109YouprobablymeettherequirementsforNewZealandcitizenshipbygrant.
Pleaseseetherestoftheguidenotesformoreinformation,visitoneofourpubliccountersorcallusonfreephone0800225151(NZonly)formoreinformationbeforeapplying.
10YoumightnotmeetoneoftherequirementsforNewZealandcitizenshipbygrant.
Youcanapplywhenyoudomeettherequirements,orseethefrontpageoftheseguidenotesifyoustillwishtoapply.
11YouwillneedtofilloutaSamoanform.
PleaseseetheapplicationguideforSamoanadultsandchildrenformoreinformation.
4DuringthelastfiveyearshaveyougoneonanytripsoutofNewZealandthatlastedmorethanfourmonthsyesgoto10nogoto55DoyouwanttocontinuetoliveinNewZealandyesgoto6nogoto107AreyouabletospeakandunderstandEnglishineverydaysituationsyesgoto8nogoto106HaveyoubeenconvictedofANYoffenceinthelastthreeyearsyesgoto10nogoto7Ifyouwanttofindoutmoreaboutyoureligibilityforcitizenshipbygrant,youcancompletetheself-assessmentonlineatwww.
govt.
nz/citizenshipDisclaimer:Thequestionsintheaboveshelftoolarebasedonthelegalrequirementsforacitizenshipbygrantapplication.
Theresultisonlyageneralindicatortogiveyousomeideaofyourabilitytobeeligibleforcitizenshipbygrant.
Thequestionsdonotformpartoftheformalassessmentprocess.
AformalassessmentofyourabilitytomeeteachrelevantrequirementwillbecarriedoutbytheDepartmentofInternalAffairs,shouldyouchoosetoapplyforcitizenship.
Theresultshouldnotbereadaslegaladvice.
Formoredetailedinformation,pleasereadtherestoftheguidenotes.
Forinformationaboutourfeesandrefunds,seepage8oftheguidenotes.
GUIDENOTES2GUIDENOTES31NameChooseatitleandprintyourcurrentname.
2GenderTickifyouaremale,female,non-binaryorintersex.
3WhatisyourdateofbirthPrinttheday,monthandyearyouwereborn.
4WherewereyoubornPrintyourplaceofbirthasitisrecordedinyourbirthdocument.
Youcanusevillages,townsorcities.
5CitizenshipyouhavenowPrintthecountryorcountriesyouareacitizenof.
IfyouareregisteredasaNewZealandcitizenbydescent,youwillneedtosendusyouroriginalcitizenshipcertificate.
6OthercitizenshipIfyouhavebeenacitizenofanycountryotherthantheonesyoulistedinQ.
5,pleaseprinttheminthetablee.
g.
China,Ghana.
PleasenotethatNewZealandallowsdualcitizenship.
7ApplyingforthefirsttimeTickyesifthisisyourfirsttimeapplying.
Ticknoifyouhaveappliedbefore.
8PassportsPrintthedocumentnumbersofallthepassports/traveldocumentsthatyouhaveheldinthelastfiveyearsandthenameofthecountrytheyarefrom.
Includeexpiredpassportsortraveldocuments.
9DriverlicencePrintyourNewZealanddriverlicencenumberifyouhaveone.
10Marriage/CivilunionTick'yes'ifyouareorhaveeverbeenmarried,inacivilunion,divorcedorwidowed.
Otherwise,tick'no'andgotoQ.
12.
11Marriage/CiviluniondetailsPrintthenumberoftimesthatyouhavebeenmarriedorinacivilunionintheboxes.
Printthename(s)ofyourpartner(s)andthedate(s)ofyourmarriage(s)/civilunion(s)inthetableprovided.
12OthernamesWeneedtoknowallthenamesyouhaveeverusedduringyourlife,sowecanverifyyouridentity.
Ifyouhaveeverusedanyothernames,tick'yes'andprinttheminthebox.
Ifyouhaveofficiallychangedyourname,atanytime,youwillneedtoprovideuswithproofofthisnamechange.
Iftheothernamesyouusearenotonanyofficialdocuments,youmustlistthemontheform,butyoudon'tneedtoprovideproofofthem.
13MotherPrintyourmother'sfirstandmiddlenames,surnameandcitizenship(s)intheboxes.
'Mother'meansyourbirthorlegaladoptivemother.
Don'tincludestep-parentsorguardians.
14FatherPrintyourfather'sfirstandmiddlenames,surnameandcitizenship(s)intheboxes.
'Father'meansyourbirthorlegaladoptivefather.
Don'tincludestep-parentsorguardians.
WheredoyoulivePrinttheaddresswhereyouarecurrentlyliving.
16PostaladdressThisiswherewewillsendyourdocuments,papersandletters,ifyoudon'twantthemsenttotheaddressabove.
17WherehaveyoulivedinthelastfiveyearsPrinttheaddress(es)whereyouhavelivedforamonthormore.
Ifyouneedmorespace,pleaseuseanotherpieceofpaperandattachtoyourapplication.
18TravelplansIfyouintendtotraveloutsideNewZealandinthenext12months,tick'yes'andprovideyourtravelplans.
TobeeligibleforNewZealandcitizenshipyoumustplantokeeplivinginNewZealand.
Ifyoudon'tplantoliveinNewZealandonceyouhavecitizenship,youmustintendtoenterinto,orcontinuein,ONEofthefollowing:CrownserviceundertheNewZealandGovernment;ServiceunderaninternationalorganisationofwhichtheNewZealandGovernmentisamember,orServiceintheemploymentofaperson,company,societyorotherbodyofpersonsresidentorestablishedinNewZealand.
PleasenotethatyourapplicationmaynotbecompletedwhileyouareawayfromNewZealand.
19IsEnglishyourfirstlanguageIfyougrewupinanEnglish-speakingcountry,tick'yes'andgotoQ.
21.
IfyoudidnotgrowupinanEnglish-speakingcountry,tick'no'andgotoQ.
20.
20ConversationalEnglishIfyoucanspeakEnglishineverydaysituations,suchastalkingtoyourdoctorordealingwithyourbank,tick'yes'.
YouwillneedtoproveyoucanspeakEnglishineverydaysituations.
Ifyoulodgeyourapplicationinperson,youdonotneedtoprovidedocumentedproofthatyoucanspeakEnglish.
InmostcasesyouwillneedtoshowusyouhavetriedtolearnEnglish.
Theamountoftime,costordifficultyisnotagoodreasontonotlearnEnglish.
Ifyoucan'tspeakEnglishineverydaysituations,yourapplicationmaynotbeapproved,unlessyouwouldsufferunduehardshipifrequiredtolearnsufficientEnglish,forreasonssuchasyourage,levelofeducation,ordisabilityorillness.
21-30Everyoneneedstoanswerallofthesequestionssowecanconfirmthatyouareofgoodcharacter.
Beingofgoodcharacterisarequirementofcitizenship.
Todeterminewhetheryouareofgoodcharacter,wewilldobackgroundcheckswiththeNewZealandPoliceandotheragenciesinNewZealandandoverseas.
Youmayalsobeaskedtoprovideuswithanoverseaspoliceclearance.
GUIDENOTES415Ifyouhavehad100ormoredemeritpointsinthelast2yearsand/oryouhavehadasignificanthistoryofinfringementsandfines,thismayaffecttheoutcomeofyourapplication.
A'yes'answertoanyofthesequestionsdoesnotautomaticallydisqualifyyoufromgettingNewZealandcitizenship.
However,ifyouprovidefalseormisleadinginformationorwithholdrelevantinformationyoumaybedenied/loseNewZealandcitizenship,orfacecriminalcharges,orboth.
You'resaidtohavenocriminalrecord(criminalconvictionhistory)ifallofthefollowingaretrue.
Ifyouhave:hadnoconvictionswithinthelast7yearsneverbeensentencedtoacustodialsentence(suchasprison,correctivetrainingorborstal)neverbeenconvictedofasexualoffence('specifiedoffence')fullypaidanyfine,compensation,reparationorcostsorderedbythecourtinacriminalcaseneverbeenbannedfromdrivinguntilfurthernotice(indefinitedisqualification)neverbeenheldinhospitalbythecourtinacriminalcaseinsteadofbeingsentenced,duetoyourmentalcondition.
Ifyouareeligibleunderthecleanslateact,youcananswer'no'toanyquestionaboutyourcriminalrecord.
Ifyouareuncertainwhetheryouareabletoconcealyourrecord,pleasecontacttheMinistryofJusticeonlineatwww.
justice.
govt.
nz/servicesorcallthemon(+644)9188800foraninformationpamphlet.
21PreviousconvictionsTick'yes'ifyouhavebeenconvictedorfoundguiltyofanoffenceagainstthelawinNewZealandoranyothercountry.
Includeconvictionsevenifyouhavepaidfinesorservedsentencesforthem.
Youmustincludetrafficconvictionswhenansweringthisquestion.
Ifyoutick'yes'youwillneedtoincludealetterofexplanationandattachittoyourapplication.
Weneedtoknowwhathappened,whatsentenceyoureceived,whatcountryithappenedin,andthedateyouwereconvicted.
Pleasenotethat,exceptinveryrarecircumstances,youwillbedisqualifiedfrommeetingthecharacterrequirementif:1.
Youhavebeeninprisonforfiveyearsormoreor2.
Youhavebeensentencedtoanindefinitetermofimprisonmentcapableofrunningforfiveyearsormoreor3.
Withintheprevioussevenyearsyouweresubjecttoatermofimprisonmentoffewerthan5yearsor4.
Withinthepreviousthreeyearsyouwereconvictedofanoffencebutdidnotreceiveasentenceofimprisonment.
22PendingchargesTick'yes'ifyouthinkyouhavecommittedanyoffenceagainstthelawofNewZealandoranothercountryforwhichyouhaveyettobesentencedforincourt.
23ProtectionordersTick'yes'ifyouhaveeverhadaprotectionorderissuedagainstyou.
Theseordersgenerallymeanthatyouhavebeentoldbythepolicetostayawayfromsomeone.
Includeacopyoftheorder,orproofthatithasbeendischargedbyacourt.
24LegalactionagainstyoubyagovernmentagencyReadthelistofagenciescarefully,andtick'yes'ifyouhaveeverbeeninvestigated,reviewedorhadlegalactiontakenagainstyoubythoseorganisationsinNewZealandoranyothercountry.
Includealetterofexplanationandattachittoyourapplication.
25ReturnedmoneytogovernmentagenciesTick'yes'ifyouhaveeverhadtoreturnmoneytoanygovernmentagency(e.
g.
WINZorIRD)andgotoQ.
26tofilloutthedetails.
Examplesofthisincludehavingafraudulentdebtorbeingoverpaidforabenefit,eitheraccidentallyoronpurpose.
Otherwisetick'no'andgotoQ.
27.
26PaymentplanTick'yes'ifyouhavepaidthismoneyback,orarestillpayingthemoneyback.
Youwillneedtogiveusproofofyourpaymentplan,oraletterfromtheagencysayingyouhaverepaidthedebtinfull.
Tick'no'ifyouhavenotpaidanymoneyback.
27-30Everyonemustanswerallofthesequestions27InformationprovidedtoImmigrationNewZealandTick'yes'ifyouhaveeverprovidedfalseormisleadinginformationtoINZ.
ThisincludesnotprovidingortellingINZinformationthatmayhaveresultedinyourvisaapplicationbeingdeclined.
Ifyouhaveticked'yes'youneedtoincludealetterofexplanationandattachittoyourapplication.
28TerrorismTick'yes'ifyouhaveeverbeeninvolvedinanactivitythatmayhavecontributedtoterrorism.
Itisimportanttomentionanythingyouknowthatothersmayregardasterrorism.
Ifyoutick'yes'youwillneedtoincludealetterofexplanationandattachittoyourapplication.
Youneedtotellusaboutyourinvolvement,whattheactofterrorismwas,whenithappened,andwhatorganisationorgroupwasresponsibleforcarryingouttheactivity.
29MakingorusingweaponsTick'yes'ifyouhaveeverhadanyinvolvementinmakingorusingbiological,chemical,nuclearorradiologicalweapons.
Ifyoutick'yes'youwillneedtoincludealetterofexplanationtellingusaboutyourinvolvementinmakingorusingtheweapons,thereasonsforyourinvolvement,whatkindofweaponstheywere,whenithappened,andwhatcountrythishappenedin.
30WarcrimeoracrimeagainsthumanityTick'yes'ifyouhaveevercommittedawarcrimeoracrimeagainsthumanity.
Ifyoutick'yes'youwillneedtoincludealetterofexplanation.
Weneedtoknowwhathappened,whowasinvolved,whereithappenedandwhattheoutcomewas.
31Ceremonies–theoathoraffirmationTheceremonyisanimportantpartofbecomingacitizen.
Duringtheceremonyyouwillbeformallywelcomed–usuallybythemayorofyourlocalarea,oranotherofficialperson.
Almostalladultsmustattendapublicceremonytogetcitizenship.
Duringtheceremonyyouwillreadaloudastatement.
ThestatementsaysyouwillbeloyaltoNewZealand.
Youhaveachoiceoftwostatements–eitheranoathoraffirmation.
OathTheoathofallegianceisreligious,takenonaholybookofyourchoiceandincludesthewords'sohelpmeGod'.
GUIDENOTES5AffirmationTheaffirmationofallegianceisnon-religiousanddoesNOTincludethewords'sohelpmeGod'.
Tickthedeclarationyouwanttomake.
Ifyouareapprovedforthegrantofcitizenshipyouwillbesenttothenextavailableceremonybeingheldinyourlocalarea.
Mostofthetimeyouwillbeabletogotoaceremonywithinfourmonthsofbeingapproved,butsometimesitcanbelonger.
OathandAffirmationStatementsOathofallegiance"I(sayyourname)swearthatIwillbefaithfulandbeartrueallegiancetoHerMajestyQueenElizabeththeSecond,QueenofNewZealand,herheirsandsuccessorsaccordingtolaw,andthatIwillfaithfullyobservethelawsofNewZealandandfulfilmydutiesasaNewZealandcitizen.
SohelpmeGod".
Theoathofallegianceisreligious,andincludesthewords'sohelpmeGod'.
Affirmationofallegiance"I(sayyourname)affirmthatIwillbefaithfulandbeartrueallegiancetoHerMajestyQueenElizabeththeSecond,QueenofNewZealand,herheirsandsuccessorsaccordingtolaw,andthatIwillfaithfullyobservethelawsofNewZealandandfulfilmydutiesasaNewZealandcitizen.
"Theaffirmationofallegianceisnon-religiousanddoesNOTincludethewords'sohelpmeGod'.
32Ceremonies–familyTick'yes'ifyouareapplyingatthesametimeastherestofyourfamilyandyouwanttogotoaceremonytogether.
33SpecialassistanceTick'yes'ifyourequirespecialassistancetoattendanintervieworpublicceremony.
Thiscouldincludeneedingaccessforawheelchair,orhelpifyouarehearingimpaired.
Youwillneedtomakeanoteinthespaceprovided,orwritealetterexplainingwhatspecialassistanceyouneedandattachittoyourapplication.
Tick'no'ifyoudonotrequirespecialassistance.
34DisclosureYoushouldincludeanythingyouthinkmightimpactonyourabilitytomeettherequirementstobecomeacitizen,suchasyourabilitytomeetthe'goodcharacter'requirement,anymattersthatareunclearaboutyouridentity,oranythingelseweshouldknow.
Completethissectionifthereisanythingelseweshouldknowthatmightaffectyourapplication.
35TranslatordeclarationIfsomeoneistranslatingorhelpingyoufillouttheform,tick'yes'andgetthemtowritetheirdetailsandthedateandsignintheboxprovided.
Thisisalegaldeclaration,sothepersontranslatingneedstoreaditcarefullybeforetheysignit.
Thepersonwhotranslatesorhelpsyoufillouttheformmustbeover16yearsold.
36ApplicantDeclarationYoumustsignthisdeclarationif:youhavefilledinyourapplicationformyourselfyoucansignyourownnamebutsomeoneelsehasfilledintheapplicationformforyouSignanddatetheformintheboxesprovided.
BysigningtheApplicantDeclarationonpage8oftheapplicationformyouarestatingthatyouareawareoftheresponsibilitiesandprivilegesofbecomingaNewZealander.
pleasereadthesecarefully.
YourprivacyTheinformationweaskforintheapplicationformisneededtoseeifyoumeettherequirementsforcitizenship,toprocessyourapplication,andforotherlawfulpurposestodowithbecomingaNewZealander.
Youdon'thavetogiveusanyinformationthatyoudon'twantto.
However,ifwedon'thaveenoughinformationtodeterminewhetheryoucanbecomeaNewZealandcitizen,yourapplicationmaynotbeapproved.
TheinformationyougiveusintheformiscollectedandheldbytheDepartmentofInternalAffairs,POBox10680,Wellington,NewZealand.
YouhavearighttoaccessyourinformationandyoucanaskforittobecorrectedifnecessaryundertheInformationPrivacyPrinciplesofthePrivacyAct2020.
Ifacorrectionisnotmade,yourrequestandourresponsewillbeputinyourfile.
InformationheldbytheCitizenshipOfficecanbeusedinauthorisedmatchingprogrammes.
YoucanfindthecurrentlistofagenciesthatcanreceiveinformationfromtheCitizenshipOfficeonourwebsiteatwww.
dia.
govt.
nz.
TheTreatyofWaitangiTeTiritioWaitangiTheTreatyofWaitangi,isthefoundingdocumentofNewZealandAotearoa,itisalsothefirsttodealwithcitizenship.
MoreinformationontheTreatyofWaitangicanbefoundhere:nzhistory.
govt.
nz/politics/treaty-of-waitangi37WitnesssectionPleasegetyourwitnesstoreadthissectionoftheguidenotesbeforetheyfillinsection37.
Yourwitnessmustfillinthissectionintheirownhandwritingandwriteyournameonthebackofonephotoandsignanddatethebackofthephoto.
WhocanbeyourwitnessYouhavetheoptionofhavingeitheravalidNewZealandpassportholderoranInternalAffairsrepresentative(i.
e.
acitizenshipofficerorcustomerserviceofficer)asyourwitness.
TheNewZealandpassportholdermust:haveavalidNewZealandpassporthaveknownyoufor1yearormorebe16yearsofageoroldernotberelatedtoyouorpartofyourextendedfamilygroupnotbeyourspouseorpartnernotliveatthesameaddressasyou.
Thiswitnessneedstoprovidetheirpassportnumber,name,dateofbirthandcontactdetails,includingaday-timephonenumber.
YourwitnesswritesonthebackofonephotoYourwitnessmustwriteyourfullname,theirownsignatureandthedateonthebackofonephoto.
Abusinessthattakespassportphotoswillusuallysupplyonephotowithapre-printedlabelontheback.
WitnessdeclarationYourwitnessmustsignthedeclarationanddateittoshowtheyunderstandtheirobligationsunderthelaw.
GUIDENOTES6PhotoInformationYouneedtogiveustwoidenticalcolourphotosthatarelessthansixmonthsold,andmeetthelistedrequirements.
Westronglyrecommendthatyouobtainyourphotosfromabusinessthatprovidesapassportphotoservice,asthebusinesswillhelpensurethatyourphotosmeetourrequirements.
PhotosthatdonotmeetourrequirementswillNOTbeaccepted.
Tohelpyoutoavoidsomeofthemostcommonproblemswithphotoquality,wehavesummarisedthemainrequirements.
Ifyouneedmoredetailedinformationaboutphotos,goonlinetowww.
govt.
nz/citizenshiporcalluson0800225151.
Photoimagerequirements2identicalcolourphotos,lessthan6monthsold.
Beafullfront,closeupviewoftheheadandshoulderswiththeheadcovering70%to80%ofthephotograph.
Betakenwithaneutralexpression(notsmilingorfrowning)withmouthclosed.
Showyoulookingstraightatthecamera,andyourheadnottilted.
Showyoureyesopenandclearlyvisible,andnohairinyoureyes.
Withoutsunglasses.
Tintedprescriptionglassesmaybewornaslongaseyesarestillvisible.
Atrueimageandnotalteredinanyway.
Clear,sharpandinfocuswithminimumreflectivelightonface.
Noredeye.
Withaplainlightcolouredbackground(notwhite).
Beofgoodqualitycolourandonhighqualityphotographicpaper,withnoinkmarksontheimage(noinkjetprinters).
Passport-sized(45mmx35mm).
Glassesframesmustnotobscuretheeyes.
Donottrimthephotos.
38ChecklistThechecklistwillhelpyourememberalloftheoriginaldocumentsyouneedtogiveuswithyourapplication.
Ifyoudon'tsupplyallthedocumentsthatyouneedto,yourapplicationwillbedelayed.
DON'Tprovidephotocopies.
Allofyouroriginaldocumentswillbereturnedtoyoubycourierorreturnedtoyouataninterview.
IfanydocumentsarenotinEnglishandyoualreadyhaveanauthorisedtranslation,pleasesendthetranslationinwiththeoriginaldocument.
Ifyoudonothaveanauthorisedtranslation,sendinyouroriginaldocumentsandwewillarrangeforthemtobetranslated.
Thereisnochargeforthisunlessyourequireacopyofthetranslationforyourownpurposes.
Ifyourequireacopyofthetranslation,downloada'RequestforTranslation'fromourwebsite(www.
govt.
nz)andincludehiswithyourapplication.
39ArepresentativeIfyouwantsomeoneelsetotalktousonyourbehalf,youwillneedtosendusasignedlettergivingyourconsent(thismeanstheywilltalktousaboutyourapplicationandwewillsendanylettersordocumentstothem).
Youmusttellustheirname,postaladdress,phonenumber,emailaddressandfaxnumberorcellphonenumber(iftheyhaveanyofthese).
Wewillonlycontactyourrepresentativeandallyourdocumentswillbesenttothem.
40ContactwiththeCitizenshipOfficeIfyouchangeyouraddressortraveloverseaswhileweareprocessingyourapplication,youmusttellus.
IftheCitizenshipOfficeisunabletocontactyoubecauseyouhavemovedorareoverseas,oryoudonotrespond,yourapplicationwillbepresentedtotheMinisterofInternalAffairsforadecision,basedontheinformationavailable.
GUIDENOTES7PhotosizeHeadsize(includinghair)35mm(80%)28mm(80%)EYESBETWEEN3mm35mm(width)45mm(height)41LodgingyourapplicationanddocumentsByappointmentYoucanmakeanappointmenttocometooneofouroffices.
Attheofficeyouwillmeetacitizenshipcaseofficerwhowill:HelpyoucompletetheformandactasawitnessPhotocopyandgivebackyourdocumentsWeofferappointmentsinmanytownsandcities.
Foralistyoucanseeourwebsite:www.
govt.
nz/citizenshiporcalluson0800225151.
BypostIfyouwanttopostusyourapplication,weadviseyoutousea'trackandtrace'courierbagfromNewZealandPost(withinNewZealand)orregisteredmail(fromoverseas)tokeeptrackofyouroriginaldocuments.
Wewillsendyourdocumentsbacktoyoubycourier.
Postyourapplicationto:DepartmentofInternalAffairsPOBox10680Wellington6143OfficelocationsForofficelocations,pleasevisitwww.
govt.
nz/citizenshiporcalluson080022515142FeesandpaymentIfyouarepayingforyourselfandanyoneelse,tick'yes'andusethetabletoworkouthowmuchmoneyyouwillneedtopay.
Thentickthepaymentmethodyouwanttouse.
Ifyouarepayingbycreditcard,fillinyourdetailsintheboxesprovided.
Ifanotherapplicantispayingforyou,tick'no'.
WithdrawalsandrefundsIfyoudon'tmeetalltherequirementsforcitizenship,youcanwithdrawyourapplicationandgetapartialrefundofyourapplicationfee.
Generally,wewillrecommendthatyouwithdrawandre-applywhenyouclearlymeetalloftherequirements(youwillbeadvisedofallyouroptionsbyletter).
Partofyourfeeiskepttocoverthecostsoftheinitialprocessingofyourapplication.
Thetablebelowtellsyouhowmuchmoneyyouwillberefunded.
ApplicanttypeApplicantfeeRefundableAmountAdult$470.
20$316.
90Child$235.
10$158.
40GUIDENOTES8Adult(16yearsorolder)Whatisyourdateofbirth3DDMMYYYYWherewereyoubornCity,townorvillagewhereyouwerebornCountrywhereyouwereborn4HowtoansweryoumustanswerallthequestionsonthisformtruthfullyuseablueorblackpentickanswersinboxeslikethisprintanswersinCAPITALletterslikethiswhenyouseethisiconitmeansyouneedtotakeextracarewithyouranswersA1BCWhatisyourfullnameTitle,pleasetickoneofthefollowingoptionsFirstandmiddlenamesSurnameorfamilyname1MrMrsMsMissOther(pleasespecify)Areyou2MaleFemaleYouwillneedtobringorsendyouroriginalbirthdocumentwithyourapplication.
WhichcountryorcountriesareyoucurrentlyacitizenofApartfromtheonesyoulistedinquestion,haveyoueverbeenacitizenofanyothercountry6YesPrintthemhereNogoto75IfyourbirthdocumentisnotinEnglish,itwillneedtobetranslated.
SeeQ.
38oftheguidenotes.
Page1of12ApplicationforNewZealandCitizenshipKirirarautangaoAotearoa–Pakeke5OfficeuseonlyYNNAENGNameNOTESInthelastfiveyears,whatpassports/traveldocumentshaveyouhadPrintthedetailsinthetablebelow.
8Includeallexpiredpassports/traveldocumentsforallcountries.
Passport/traveldocumentnumberWhichcountryisthispassport/traveldocumentfromRemember,ifyouhavetheoriginalpassports,youneedtoincludethemwithyourapplication.
Youwillneedtoprovidealltheoriginaldocumentsofeachmarriage,divorce,orcivilunionwiththisform.
HowmanytimeshaveyoubeenmarriedorinacivilunionPrintthenumberhere.
Printthedetailsofeachinthetablebelow.
11Firstnameofyourwife/husband/civilunionpartnerSurnameofyourwife/husband/civilunionpartner,beforemarriage/civilunionYearofmarriage/civilunionIsthisthefirsttimeyouhaveappliedforNewZealandcitizenship7YesNoIhaveappliedbeforeDoyouhaveacurrentNewZealanddriverlicence9YesPrintyourdriverlicencenumberhereNogoto10Haveyoueverbeenmarriedorjoinedinacivilunion10Yesgoto11Page2of12Nogoto12Nowsomequestionsaboutyourparents.
Yourmother'sdetails.
Mother'sfirstandmiddlenames(pleasecompletethisinformation,evenifyourmotherhasdied.
)Mother'ssurnameorfamilynameMother'scitizenship(s)13Whenwesaymotherorfatherwemeanbirthorlegaladoptivemother,fatherorparents.
Yourfather's/otherparent'sdetails.
Father'sfirstandmiddlenames(pleasecompletethisinformation,evenifyourfatherhasdied.
)Father'ssurnameorfamilynameFather'scitizenship(s)14Peopleusedifferentnamesforallsortsofreasons.
Haveyouusedanyothernamesorfamilynamesduringyourlife12Firstname(s)SurnameorfamilynameWhydidyouusethisnameWhendidyouusethisname(e.
g.
1993-2009)YesPrintyourothernameshereNogoto13Includeallothernamesyouareknownas,orhavebeenknownas.
Forexample:maidennamesnamesusedatschoolorworkmarriednameskunyanamesofficialchangesofnameadoptivenamesEnglishnamesanyothernamesyouhaveusedPage3of12Wherehaveyoulivedinthelastfiveyears17IncludeplacesyouhavelivedinNewZealandandoverseas.
Ifyouneedmorespace,pleaseuseanotherpieceofpaperandattachittoyourapplication.
Number,street,town/cityCountryFromyeartoyear(e.
g.
2007-2009)WheredoyouliveStreetnumberFlatnumberStreetnameSuburbPostcodeTown/cityEmailaddressHomephoneMobilephone15Printthefulladdressinthespacesbelow.
WhatisyourpostaladdressBusinessorAgent'sName(ifrequired)StreetnumberPOBoxnumberStreetnameSuburbPostcodeTown/city16Thisiswherewewillsendyourdocuments,papersandletters.
Sameasabove,whereIlivegotoIwantmydocumentssenttothisaddress.
17Page4of12IsEnglishyourfirstlanguage19YesgotoNogoto2120Ifyouaregrantedcitizenship,doyouintendtotraveloutsideNewZealandinthenext12months18Includetripsyouhaveplanned,explainwhyyouaregoing,forexample:holiday,work,study,tolive.
OnwhatdateareyouleavingNewZealandWhyareyougoingHowlongareyougoingforYesPrintyourtravelplanshereNogoto19CanyouhaveaconversationaboutalotofeverydaythingsinEnglish20YouneedtoproveyoucanspeakEnglishineverydaysituations.
Youshouldsendatleastoneoftheoriginalfollowingdocumentswithyourapplicationiflodgedbypost:proofofEnglishstudyataNewZealandschool,polytechnicoruniversityasignedletterfromapastorcurrentemployer(whohasEnglishasafirstlanguage)anIELTScertificateotherschoolreports,examresults,etcYesNocheckQ.
20oftheguidenotesandgoto21Ifyoucan'tprovideenoughproof,youmayneedtoattendanEnglishlanguageinterview.
HaveyouevercommittedanyoffenceagainstthelawofNewZealandoranyothercountryforwhichyouhavenotyetbeenconvicted22YesYouneedtoincludealetterwiththedetailsofwhathappenedgotoNogoto2323Everyoneneedstoanswerallofthesequestions.
HaveyoueverbeenconvictedorfoundguiltyofanyoffenceagainstthelawofNewZealandoranyothercountry21YesYouneedtoincludealetterwiththedetailsofwhathappenedgotoNogoto2222Yourletterneedstoincludethedate,placeandwhathappened.
PleaseseeQ.
21-24oftheguidenotesformoreinformationaboutwhatmustbeintheseletters.
Includeconvictionsevenifyouhavepaidthefinesorservedsentencesforthem.
YoudonotneedtoincludeanyinformationthatiscoveredbytheCriminalRecords(CleanSlate)Act2004.
Seepage4oftheguidenotesformoreinformation.
Page5of12HaveyoueverhadtoreturnmoneytoanyGovernmentagency(e.
g.
WINZ,IRD,etc.
)25YesgotoNogoto2726Haveyoupaidthismoneybackordoyouhaveapaymentplaninplace26Youwillneedtoincludedocumentsshowingthedetailsofyourpaymentplan,orastatementfromthegovernmentdepartmentoragencysayingyouhaverepaidthedebtinfull.
Amountyouhave/hadtoreturn($)ReasonyouhadtoreturnthemoneyYearYesPrintthedetailsinthetablebelowNogoto27Haveyoueverhadaprotectionorderissuedagainstyou23YesYouneedtoincludeacopyoftheordergotoNogoto2424Tickyesornoforeachofthefollowing.
Areyoubeing,orhaveyoubeen,investigatedorreviewedorhasanyotherlegalactionbeentakenagainstyoubyanyoftheseagenciesinNewZealandoranyothercountryIfyouansweredyestoanyoftheabove,youneedtoincludealetterwithdetailsofwhathappened24HaveyouevergivenanyfalseinformationtoImmigrationNewZealand27YesYouneedtoincludealetterwithadetailedexplanationgotoNogoto2828Page6of12YesNoPoliceCustomsImmigrationNewZealandNZTransportAgencyDepartmentofInternalAffairsPassportIssuingAuthorityWorkandIncome,MinistryofSocialDevelopment(WINZ)InlandRevenue(IRD)MinistryofJusticeOthergovernmentorenforcementagenciesAccidentCompensationCorporation(ACC)ItisanoffenceagainsttheCitizenshipAct1977togiveinformationthatisfalseormisleading.
Ifitislaterfoundthatyouhaveprovidedfalseormisleadinginformation,youmaybedenied/loseNewZealandcitizenship,oryoucouldfacecriminalcharges,orboth.
Haveyouevercommittedawarcrimeoracrimeagainsthumanity30YesYouneedtoincludealetterwithadetailedexplanationgotoNogoto3131Haveyoueverbeeninvolvedinthemakingoruseofweaponssuchasbiological,chemical,nuclearorradiologicalweapons29YesYouneedtoincludealetterwithadetailedexplanationgotoNogoto3030SeeQ.
27-30oftheguidenotesformoreinformation.
Haveyoueverbeeninvolvedinanyactivitythatmayhavecontributedtoterrorism28Ifyoudonotregardsomethingasanactofterrorismbutyouknowthatothersmay,youshouldmentionit.
YesYouneedtoincludealetterwithadetailedexplanationgotoNogoto2929Ifyouareapplyingatthesametimeasotherfamilymembers,doyouwanttogotoaceremonytogether32YesThenextfewquestionsaskaboutthecitizenshipceremony.
Tobecomeacitizenyoumustattendaceremony.
DuringtheceremonyyouwillreadaloudastatementthatsaysyouwillbeloyaltoNewZealand.
Youneedtochoosewhichstatementyouwillsay.
31AreligiousstatementWITHthewords'sohelpmeGod'-calledan'Oath'AstatementNOTusingthewords'sohelpmeGod'-calledan'Affirmation'Formoreinformationabouttheceremonies,seeQ.
31-33oftheguidenotes.
Doyourequireanyspecialassistancesothatyoucanattendanintervieworpublicceremony33Thiscouldincludeneedingaccessforawheelchair,orhelpifyouarehearingimpairedetc.
Yes.
Pleaseprintthedetailshere.
NoIsthereanythingelseweshouldknowthatmightaffectyourapplication34Someexamplesare:Ifyouareplanningtoretiresoontoanothercountry,ifyouhaveeverusedadifferentdateofbirth,ifyouhaveeverbeendeportedfromNewZealandoranyothercountry,ifyouhaveanoutstandingwarrantforyourarrestinanothercountry,oranythingelseweshouldknow.
Page7of12Yes.
Pleaseprintthedetailshere.
Nogoto35NoDidsomeonetranslatethisformforyouorhelpyoutointerpretthisformIofdeclarethatIassistedtheapplicanttocompletethisapplication.
IconfirmthatItrulyandfaithfullyinterpretedandtranslatedallapplicablequestionsintheapplicationform,togetherwiththeanswersgivenbytheapplicantandallotherthingsthatIhavebeenrequiredtointerpretandtranslate.
IalsoconfirmthatIexplainedtheResponsibilitiesandPrivilegesofNewZealandcitizenshipandthattheapplicanthasacknowledgedanunderstandingofthem.
35nameofpersonassistingaddressofpersonassistingThepersonwhoassistsyouininterpreting/translatingtheformMUSTbeover16yearsoldandfillintheirdetailsbelow.
Yes.
Getthemtoprinttheirdetailsbelow.
Nogoto36ApplicantDeclaration36ThisapplicationmustbereceivedbytheDepartmentofInternalAffairswithinthreemonthsofbeingsignedanddated.
IconfirmthatIhavereadandunderstoodtheapplicationguidenotes,includingthesectionrelatingtothePrivacyStatement.
UnlessIhavestatedotherwiseinthisapplicationIintend,ifgrantedNewZealandcitizenship,tocontinuetoresideinNewZealand.
IfthereisanychangeinmycircumstanceswhichaffectstheanswersIhavegiveninthisapplication,IwillsendwrittenadvicetotheDepartmentofInternalAffairsupuntilthepointIhavereceivedmycitizenshipcertificate.
IunderstandthatifIdonotprovidesufficientinformationtoenableaclaimtoNewZealandcitizenship,myapplicationmaybedeclined.
IauthorisethereleasebyanyGovernmentagencyofpersonalinformationwhichmayassisttheMinisterofInternalAffairstodecidewhetherIqualifyforthegrantofcitizenship.
Irecognisethatthisinformationmaybeprovidedbyagenciesincluding,butnotlimitedto:NewZealandPolice,InlandRevenue,NewZealandCustomsService,ImmigrationNewZealand,MinistryofSocialDevelopment,PassportOffice,Births,DeathsandMarriagesRegistry,MinistryofJustice.
IauthorisetheDepartmentofInternalAffairstoreleasemynameandaddresstomylocalMemberofParliamentandlocalcouncillorssothattheycanformallywelcomemetoNewZealandfollowingmygrantofcitizenship.
Iunderstandthisapplicationandwarning.
Thedocumentsprovidedforthisapplicationaregenuineandunaltered.
IunderstandthatbecomingaNewZealandcitizenmayaffectmypresentcitizenship.
IconfirmthatIunderstandtheresponsibilitiesandprivilegesofNewZealandcitizenship.
Responsibilities:thingsthatImustdo1.
ObeyandpromotethelawsofNewZealand.
2.
NottoactinawaythatisagainsttheinterestsofNewZealand.
3.
Registertovote.
4.
Paytax.
5.
BehaveasaresponsibleNewZealander.
Privileges:thingsthatcitizenshipletsmedo1.
HavetherighttoliveinNewZealandindefinitely.
2.
TraveloverseasandreturntoNewZealandonaNewZealandpassport.
3.
StandforParliamentorlocalgovernment.
4.
Havefullaccesstoeducation.
5.
Havefullaccesstoeconomicrights.
6.
RepresentNewZealandinmanyinternationalsports.
Warning:ItisanoffenceagainsttheCitizenshipAct1977toknowinglyorrecklesslygivefalseinformationorconcealanyfactsforthepurposeofgainingNewZealandcitizenshipforoneselforonbehalfofsomeone.
Ifyoudoso,youmaybedenied/loseNewZealandcitizenship,orfacecriminalcharges,orboth.
IdeclarethattheinformationIhavegiveninthisapplicationis,tothebestofmyknowledge,true,completeandcorrect.
Page8of12SignatureofapplicantAPPLICANTSIGNHEREDatesignedDD/MM/YYYYSignatureofassistantASSISTANT/TRANSLATORSIGNHEREDatesignedDD/MM/YYYYBeforecompletingthissectionthewitnessmustreadsection37oftheguidenotes.
Thewitnessmustfillinthissectionandcompletethedetailsonthebackofonephoto.
TickoneoftheboxesbelowtomakesureyoucanbeawitnessWriteyourNewZealandPassportnumberWritehowmanyyearsyouhaveknowntheapplicantyearsWriteyournameSurnameorfamilynameFirstandmiddlenamesWriteyourdateofbirthDD/MM/YYYYWriteyouraddressandcontactdetailsUnitand/orhousenumberStreetnameSuburbCityortownPostcodeStateCountryHomephoneDay-timephoneCOUNTRYCODEAREACODEPHONENUMBERCOUNTRYCODEAREACODEPHONENUMBERSignatureofwitnessWITNESSSIGNHEREDatesignedDD/MM/YYYYNewZealandpassportholderdeclarationIdeclarethatIam16yearsofageorover.
Ihaveknowntheapplicantformorethan1year.
TheinformationIhavegiveniscompleteandcorrecttothebestofmyknowledge.
Thepersoninthisphotoisthepersonapplyingforcitizenship.
Ihavewrittenthefullnameoftheapplicant,signedmynameandwrittenthedateonthebackofonephotograph.
IunderstandthatifIhaveprovidedfalseinformation,Ican,bylaw,befinedorimprisoned.
IholdavalidNewZealandPassportANDtheapplicantisnotrelatedtomeANDwedonotliveatthesameaddressCitizenshipCaseOfficer/DIACustomerServicesOfficerPage9of1237WitnesssectionATTACHPASSPORTPHOTOSHEREATTACHPASSPORTPHOTOSHEREDonot:staple,glueorpaperclipphotostotheapplicationasthismaycausedamage.
Ensureyourphotohasbeencorrectlywitnessedtoavoiddelaysinprocessing.
writefullnameoftheapplicantsignbackofphotowritetoday'sdateChecklistBeforeyoubringorsendusyourapplication,pleasemakesureyouhaveeverythingyouneed.
Everyoneneedstobringorsendthesewiththeirapplication:fullbirthcertificate,orequivalentcurrentpassport(s),traveldocumentsorequivalent(ormostrecentifithasexpired)forthelastfiveyearstwopassportphotos(lessthansixmonthsold)theapplicationfee($470.
20peradult);pleaseseethebackpageofthisformCheckyouranswerstothesequestions;youmightalsoneedtobringorsendthesedocuments:allyourmarriage/civilunion/divorce/namechangedocumentsandifEnglishisnotyourfirstlanguage,proofofyourabilitytospeakEnglish(iflodgedbypost)offences,legalaction,aletterofexplanationforeachtoanythingelseweshouldknowthatmightaffectyourapplicationYoumayalsoneedtobringorsend:authorisedtranslations(ifyouhavethese)a'RequestforTranslation'formifyourequireacopyofthetranslationofyouroriginaldocumentIfyouareunabletogiveusthesedocuments,youwillneedtoexplainwhyinthespacebelow.
Oryoucouldincludealetterwithyourapplication.
38Ifyoudon'tprovidealltheoriginaldocumentsthatyouneedto,yourapplicationwillbedelayed.
Alloriginaldocumentswillbereturnedtoyou.
DON'Tbringorsendphotocopies.
Questionnumbers483742QuestionnumbersSeeQ.
38oftheguidenotesformoreinformationaboutauthorisedtranslations.
213020341012Page10of12Ifyouwantsomeoneelsetotalktousonyourbehalf,youwillneedtoincludeasignedletterthatprovidesthefollowinginformation:1.
Theperson'snameorcompanyname2.
Theirpostaladdress3.
Theircontactphonenumber,emailaddressandfaxnumberorcellphonenumber(iftheyhaveanyofthese).
39FormoreinformationseeQ.
39oftheguidenotes.
HowtocontactusFreephone0800225151(NewZealandonly)or+6444639361DepartmentofInternalAffairsPOBox10680Wellington,6143email:citizenship@dia.
govt.
nzwebsite:www.
govt.
nz/citizenship40Nowpleaseturntothebackpagetofilloutyourpaymentdetails.
Lodgingyourapplicationanddocuments.
ByappointmentYoucanmakeanappointmenttocometooneofouroffices.
Attheofficeyouwillmeetacitizenshipcaseofficerwhowill:HelpyoucompletetheformincludingactingasawitnessandcertifyingyourphotographsPhotocopyandgivebackyourdocumentsWeofferappointmentsinWhangarei,Auckland,Manukau,Hamilton,Rotorua,PalmerstonNorth,Napier,NewPlymouth,Wellington,Nelson,Christchurch,QueenstownandDunedin.
Pleasecallusfreephoneon0800225151tomakeanappointment.
BypostIfyouwanttopostusyourapplication,weadviseyoutousea'trackandtrace'courierbagfromNewZealandPost(withinNewZealand)orregisteredmail(fromoverseas)tokeeptrackofyouroriginaldocuments.
Wewillreturnyourdocumentstoyoubycourier.
Postyourapplicationanddocumentsto:DepartmentofInternalAffairsPOBox10680Wellington614341Page11of12Applicationfeesandpayment.
AreyoumakingthepaymentforyourapplicationUsethetablebelowtohelpyouworkouthowmuchmoneyyouwillneedtopaywiththisapplication.
HowwouldyouliketopayCardnumberCardexpirydateFullnameofcardholderCardholder'ssignatureCARDHOLDERSIGNHEREIauthorisetheDepartmentofInternalAffairstochargethetotalamountabovetomycreditordebitcard.
421234TotalNumberofadults$470.
20$940.
40$1410.
60$1880.
80$.
Numberofchildren$235.
10$470.
20$705.
30$940.
40$.
Thisistheamountyouneedtopay-totalamount$.
Remember,allyourdocumentsmustbetranslatedintoEnglishbyanauthorisedtranslationservice.
Formoreinformation,seeQ.
38oftheguidenotes.
Yes.
Printthedetailsinthetable.
No.
Mypaymentisbeingmadebyanotherapplicant.
Wecannotstartprocessingyourapplicationuntilyouhavepaidyourapplicationfee.
Ifyouchoosetowithdrawyourapplication,youmaybeeligibleforapartialrefund.
Seepg8oftheguidenotes.
CreditcardDebitcardMoneyorder(notavailableinNewZealand)MMYYSupportingDocumentsINPCINPCINPCBCCTPhotosx2PPTTRANSFEEMCFOREIGNDCENGNCLETNODOCCOIOTHERFAMOFFICEUSEONLYDatereceived:Cashwitnessedby:Completedby:Approvedby:NOTES1December2020Page12of12