Formular Emigrare NZ 1100

Section A: Identity

Expression of Interest form

Principal applicant

If you are interested in migrating to New Zealand as a skilled migrant, and if you have the skills we need, then completing this Expressionof Interest is your first step.

When you submit this Expression of Interest, you may be considered for an Invitation to Apply for residence in New Zealand only if youmeet the following requirements:• Character • Health• English language • Age• Meet the minimum threshold of 100 points for employability and capacity building factors

The criteria for each of these requirements are explained in this form as per the Government’s Residence Policy (Skilled Migrant Category).

If you are unsure about whether you meet the prerequisites, use the Skilled Migrant Quick Check and the Points Indicator on the New ZealandImmigration Service website at www.immigration.govt.nz to get an idea of whether it’s worth completing an Expression of Interest.

You must complete all the questions in the form, unless the form specifically directs you straight to another question or section further on.

If a question does not apply to you, mark it N/A or Not Applicable.

If you leave questions that qualify for the award of points blank, this will be interpreted as a ’no‘ answer. If you fail to answer any otherquestions or to clearly mark them as ‘N/A’ or ‘not applicable’, we may send the incomplete form back to you and it will not be submittedinto the Expression of Interest Pool until all the necessary information is provided.

Expressions of Interest must be accompanied by the correct Expression of Interest Fee.

Do not send supporting documentation with your Expression of Interest form. Include only any additional sheets required to completequestions in the form.

Detailed explanations to assist you to fill out this form can be found in the Expression of Interest Guide or on the New ZealandImmigration Service website at www.immigration.govt.nz

If you are found to have provided false information or to have omitted any relevant information in the Expression of Interest, or anysubsequent application(s), your application may be declined and you will lose the right to appeal the decision to decline your application.

Family name

Given name(s)

Please provide all other names you are/or have been known by.

Preferred title Mr Mrs Ms Miss Dr

Other (please specify)

1

2

3

4

In this section we need to confirm that you are who you say you are. Please provide the following informationPlease provide the following informationPlease provide the following informationPlease provide the following informationPlease provide the following informationabout yourself.about yourself.about yourself.about yourself.about yourself.

SKILLED MIGRANT CATEGORY

A

A

A

A

Expression of Interest form – Principal applicant – NZIS 1100 pg 1

FOR NZIS USE

EOI reference number

Date received

Expression of Interest form – Principal applicant – NZIS 1100pg 2

D D M M YY

Gender Male Female5

6

7

8

9

Date of birthYou are eligible for points for your age up to the age of 56. If you areYou are eligible for points for your age up to the age of 56. If you areYou are eligible for points for your age up to the age of 56. If you areYou are eligible for points for your age up to the age of 56. If you areYou are eligible for points for your age up to the age of 56. If you areaged 56 and over your Expression of Interest will not be accepted into theaged 56 and over your Expression of Interest will not be accepted into theaged 56 and over your Expression of Interest will not be accepted into theaged 56 and over your Expression of Interest will not be accepted into theaged 56 and over your Expression of Interest will not be accepted into thePool and you should not complete any further questions. Section SM18Pool and you should not complete any further questions. Section SM18Pool and you should not complete any further questions. Section SM18Pool and you should not complete any further questions. Section SM18Pool and you should not complete any further questions. Section SM18of the Skilled Migrant Category Policy refers.of the Skilled Migrant Category Policy refers.of the Skilled Migrant Category Policy refers.of the Skilled Migrant Category Policy refers.of the Skilled Migrant Category Policy refers.Country of birth

Country

Please provide your Birth Certificate number and the name of the issuing authority.

Birth Certificate number

Name of issuing authority

Please state your main country of citizenship/nationality.

Please provide details of all passports currently held.

Passport number

Country

Family name

Given name(s)

Date of issue Date of expiry

Place of issue

Passport number

Country

Family name

Given name(s)


Place of issue

Passport number

Country

Family name

D D M M YY D D M M YY

10


A

A

A

A

A

POINTS

CLAIMED

A



D D M M YY

11

12

D D M M YY

D D M M YY

Given name(s)


Place of issue

Please list any other citizenships currently held.

Where applicable, please provide the following details.

Driver licence

Name(s) as shown on driver licence

Driver licence number

Valid for which country/state/area

Expiry date




Expiry date




Expiry date

Taxation number

Taxation number

Country

Social Security number


Country

A

A


13

M M YY M M YY

M M YY M M YY

Please list all countries, including all countries of citizenship, you have lived in for a total of 12 months or more 12 months or more 12 months or more 12 months or more 12 months or more inthe last 10 years. Include all countries where your stay has been broken by any departures.

From To Country

From To Country

From To Country

From To Country

From To Country

From To Country

From To Country

From To Country

From To Country

From To Country

14

A

A

M M YY M M YY

M M YY M M YY

M M YY M M YY

M M YY M M YY

M M YY M M YY

M M YY M M YY

M M YY M M YY

M M YY M M YY

Please provide your residential address and contact details. This will be considered your permanent place ofresidence for tax purposes.

Number and street name

Suburb City

County/Province/State PIN/ZIP

Country

Telephone

(Country code/Area code/Telephone number)(eg+12 3 456 7890)

Email

If different from your residential address, please provide your mailing address.

If you are in New Zealand and list a New Zealand address, this will be your New Zealand address for the purpose ofthe New Zealand Immigration Act.


15

Phone/night

(Country code/Area code/Telephone number)

A

Number and street name/PO Box

Suburb

City, PIN/ZIP code

Country

What is your current partnership status? (Select only one)

Married De facto Separated Divorced Widowed

Never married

Do you meet the minimum requirements for recognition of partnerships? Refer to the Yes NoGuide under Partner in the section Summary of Terms.

Will your partner be included in your residence application? Yes No

How many children do you have? This includes biological, adopted, step-children from previous marriages/relationships.

Will any of these children be included in your residence application? Yes No

For each DEPENDENT child who will be included in your residence application, please complete a Child SupplementFor each DEPENDENT child who will be included in your residence application, please complete a Child SupplementFor each DEPENDENT child who will be included in your residence application, please complete a Child SupplementFor each DEPENDENT child who will be included in your residence application, please complete a Child SupplementFor each DEPENDENT child who will be included in your residence application, please complete a Child SupplementExpression of Interest Form. Please refer to the Guide under Dependent Children in the section Summary of Terms.Expression of Interest Form. Please refer to the Guide under Dependent Children in the section Summary of Terms.Expression of Interest Form. Please refer to the Guide under Dependent Children in the section Summary of Terms.Expression of Interest Form. Please refer to the Guide under Dependent Children in the section Summary of Terms.Expression of Interest Form. Please refer to the Guide under Dependent Children in the section Summary of Terms.

If you are separated or divorced and bringing a child under 16 years of age with you to New Zealand, we will need toIf you are separated or divorced and bringing a child under 16 years of age with you to New Zealand, we will need toIf you are separated or divorced and bringing a child under 16 years of age with you to New Zealand, we will need toIf you are separated or divorced and bringing a child under 16 years of age with you to New Zealand, we will need toIf you are separated or divorced and bringing a child under 16 years of age with you to New Zealand, we will need tosee proof of their right to leave their home country and your right to remove them. Section F5.20 of the Government’ssee proof of their right to leave their home country and your right to remove them. Section F5.20 of the Government’ssee proof of their right to leave their home country and your right to remove them. Section F5.20 of the Government’ssee proof of their right to leave their home country and your right to remove them. Section F5.20 of the Government’ssee proof of their right to leave their home country and your right to remove them. Section F5.20 of the Government’sResidence Policy refers.Residence Policy refers.Residence Policy refers.Residence Policy refers.Residence Policy refers.

What is your main occupation?

PLEASE NOTE: Your main occupation is the job you spent most hours doing in the last 12 months. If you have notworked in the last 12 months, please state your previous occupation. If you have not worked for the past five yearsor more, please state "Not applicable".

If you have an agent acting on your behalf, or someone assisting you to complete this Expression of Interest, pleaseprovide the following details for this person.

Please refer to the Guide to see who can assist you fill out your Expression of Interest.

Name

Number and street name/PO Box

Suburb and city

Country

Phone/day

(Country code/Area code/Telephone number)

18A

16A

17A

19A

20A


Section B: Character

In this section we need to confirm that you are of good character which is a prerequisite of the Skilled Migrant Category.....Please provide the following details about your character. Section A5 of the Government’s Immigration Policy refers.

Questions B1 to B9 relate to section 7(1) of the Immigration Act (persons prohibited from being granted a residencepermit). People described in section 7(1) of the Immigration Act cannot ordinarily be granted residence in NewZealand.

Have you ever been sentenced to imprisonment for a term of five years or more (including Yes Noany expunged criminal records)?

Have you been sentenced to imprisonment for a term of 12 months or more Yes Nowithin the last 10 years (including any expunged criminal records)?

Do you have a removal order from New Zealand currently in force against you? Yes No

Have you ever been deported from any country, including New Zealand? Yes No

Have you been involved in any terrorist activities or supported similar violent activities? Yes No

Have you been a member of, or belonged to, any terrorist group? Yes No

Have you been involved in any drug trading or trafficking? Yes No

Have you been a member of, or belonged to, any group with criminal objectives? Yes No

Have you been a member of, or belonged to, any group that has engaged in or supported Yes Nocriminal activities?

Are you currently under investigation, or wanted, by any law enforcement agency in any country? Yes No

Have you ever been convicted or found guilty of any offence(s) against the law in any country? Yes No

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2

3

4

5

6

7

8

9

10

B

B

B

B

B

B

B

B

B

B

B

Phone/cellular

(Country code/Area code/Cellular number)

Email

Do you authorise the person listed in Question A19 to act on your behalf in relation to this Yes NoExpression of Interest?

Please indicate who you prefer the New Zealand Immigration Service to communicate directly with. Select only one.

You

You and a copy to the person listed in Question A15 where communication is made by way of email or a letter

The person listed in Question A15 only.

PLEASE NOTE: The NZIS reserves the right to contact the principal applicant directly on any matter relating to thisExpression of Interest.

What is your preferred means of communication in relation to this Expression of Email LetterInterest?

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22

A

A

23A

11


Have you been convicted of an offence (including a traffic offence), committed within Yes Nothe last five years, involving dangerous driving, driving having consumed excessive alcohol(including drunk driving and driving with a blood or breath alcohol content in excess of aspecified limit) or driving having consumed drugs?

Have you ever been charged with any offence against the law in any country? Yes No

Have you ever been removed from any country, including New Zealand? Yes No

Have you ever been refused entry to any country, including New Zealand? Yes No

Have you ever been refused a visa/permit for any country, including New Zealand? Yes No

Have you been involved in any people trafficking? Yes No

Have you been a member of, or belonged to, any group of people that had/has objectives Yes Noor principles based on hostility against people or groups of people on the basis of colour,race, ethnic or national origins?

Have you been a member of, or belonged to, any group of people that had/has objectives Yes Noor principles based on an assumption that persons of a particular race or colour areinherently inferior or superior to other races or colours?

Have you, in the course of applying for a New Zealand visa/permit, made any statement Yes Noor provided any information, evidence or submission that was false, misleading or forged, orwithheld material information?

If you answered ‘yes’ to any of questions B1 to B9, you must provide a full explanation about thesurrounding circumstances. If, having considered your explanation, the NZIS assesses that you are a personto whom section 7(1) of the Immigration Act applies, your Expression of Interest cannot be excepted intothe Pool.

If you answered ’yes‘ to any of questions B9 to B20, you must provide a full explanation about thesurrounding circumstances. If your Expression of Interest is selected from the Pool, you may be asked toprovide a police certificate or other relevant information.

Please attach additional sheets if necessary.

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20

Section C: Health

B

B

B

B

B

B

B

B

B

In this section we need to confirm that you meet a minimum standard of health, which is a prerequisite of theSkilled Migrant Category. Providing accurate information about your health status is very important. Pleaseprovide the following details about your health. Section A4 of the Government’s Immigration Policy refers.

Questions C1 to C4 concern medical conditions for which a medical waiver cannot be granted. People withthese conditions cannot ordinarily be granted residence in New Zealand.

Do you or are you likely to require dialysis treatment in the immediate future? Yes No

Do you have active tuberculosis? Yes No

1

2

3

C

C

12

13

14

15

16

17

18


Section D: English language ability

1

In this section we ask you to confirm that you meet the minimum standard of English language, which is aprerequisite of the Skilled Migrant Category. Please provide the following details about your English languageability. Section SM5 of the Skilled Migrant Category policy refers.

Please indicate who you meet the minimum standard of English, as defined in the Guide under English LanguageRequirements in the section Summary of Terms. (Select one only)

An IELTS Test Report with an overall band score of 6.5 or more ] Go to Q] Go to Q] Go to Q] Go to Q] Go to Q D3D3D3D3D3

Study for a recognised qualification conducted entirely in English ] Go to Q] Go to Q] Go to Q] Go to Q] Go to Q E1E1E1E1E1

Current skilled employment in New Zealand for 12 months or more ] Go to Q] Go to Q] Go to Q] Go to Q] Go to Q E1E1E1E1E1

Otherwise meet the minimum standard, as defined in the Guide ] Go to Q] Go to Q] Go to Q] Go to Q] Go to Q D2D2D2D2D2

PLEASE NOTE: If you selected one of the last three options, you may be asked to provide an IELTS certificate.

If you cannot demonstrate that you meet the minimum standard of English, your Expression of Interestcannot be accepted into the Pool. You should not complete any further questions.

D

Do you have a mental disorder or intellectual disability that has needed care in a hospital Yes Noor supervised residence for more than 90 days in the last two years?

Do you have a physical incapacity that requires full-time care? Yes No

Have you been exposed to, or diagnosed with, any infectious or communicable disease? Yes No

Are you receiving, or have received, any treatment for any psychiatric condition or Yes Nodevelopmental disorder?

Do you have any condition that is likely to require ongoing treatment or medication? Yes No

If you answered ‘yes’ to any of questions C1 to C4, you must provide an explanation of your medicalcondition. If, having considered your explanation, the NZIS assesses that your medical condition is one forwhich a medical waiver cannot be granted, your Expression of Interest cannot be accepted into the Pool.

If you answered ‘yes’ to any of questions C5 to C7, you must provide a full explanation of your medicalcondition. If your Expression of Interest is selected from the Pool, you may be asked to provide a medicalcertificate to confirm this information.


C

C

C

5

6

7

C

C

3

4


2

3

4 D D M M YY

D

D

D

Please provide details explaining why you meet the minimum standard, as defined in the Guide underEnglish Language Requirements in the section Summary of Terms.

If you have an IELTS certificate, what is your IELTS Test Report Form number?

What was the date you sat your test?

Overall IELTS band score

The following sections outline the factors which qualify for points. To submit your Expression of Interest,you must meet the minimum threshold of 100 points.

Section E: Skilled employment

In this section you qualify for points and bonus points, depending on whether you have current skilled employment inNew Zealand or an offer of skilled employment in New Zealand. Please provide the following details about youremployment. Sections SM7, SM8, SM9 and SM19 of the Skilled Migrant Category Policy refer.

Are you claiming points for skilled employment, and declare that you meet policy criteria for any of the following?Refer to the Guide under Skilled Employment in the section Summary of Terms. Select only one.

Current skilled employment in New Zealand for 12 months or more

Current skilled employment in New Zealand for less than 12 months

Offer of skilled employment in New Zealand

None of the above ] Go to Q F1] Go to Q F1] Go to Q F1] Go to Q F1] Go to Q F1

What is your job title?

Please indicate why you believe this job is skilled employment. For example, what specialist, technical or managementexpertise this job requires. Refer to the Guide under Skilled Employment in the section Summary of Terms.


Please provide the following details for the skilled employment listed above.

Employer contact name (manager)

3

2E

E

POINTS

CLAIMED

1E

4E


Business/organisation name


Suburb City


Country

Telephone

(Country code/Area code/Telephone number eg+12 3 456 7890)

To do your job in New Zealand, do you require full or provisional occupational registration? Refer to the Guide underOccupational Registration in the section Summary of Terms.

No Yes, please provide the following:

New Zealand Occupational Registration Number (if applicable)

Name of the New Zealand Occupational Registration Body

Is your skilled employment outside Auckland? Refer to the Guide under Employment outside Auckland in the sectionSummary of Terms.

Yes No

Is your skilled employment in one of the identified future growth areas? If yes, please provide the growth areaname. Refer to the Guide under Identified Future Growth Area in the section Summary of Terms for the futuregrowth area names.

Yes No ] Go to Q E8] Go to Q E8] Go to Q E8] Go to Q E8] Go to Q E8

Growth area name

Is your skilled employment in one of the identified clusters? If yes, please provide the cluster name. Refer to theGuide under Cluster in the section Summary of Terms for cluster names.

Yes No ] Go to Q E9] Go to Q E9] Go to Q E9] Go to Q E9] Go to Q E9

Cluster name

Is your skilled employment in one of the areas of absolute skills shortage? If yes, please provide the absolute skillsshortage occupation name. Refer to the Priority Occupations List (POL) on our website www.immigration.govt.nz orrequest a copy of the List from your nearest NZIS branch.

Yes No ] Go to Q F1] Go to Q F1] Go to Q F1] Go to Q F1] Go to Q F1

Absolute skills shortage occupation name

PLEASE NOTE: If you are invited to apply for residence your employer will need to confirm your claims in relation toquestions E8 and E9.

E

E

E

E

5E

POINTS

CLAIMED

POINTS

CLAIMED

POINTS

CLAIMED

POINTS

CLAIMED

POINTS

CLAIMED

6

7

8

9


Section F: Recognised qualification(s)

1

2

D D M M YY

In this section you qualify for points and bonus points if you have a recognised qualification(s). Please providethe following details about your qualification(s). Sections SM14, SM15 and SM16 of the Skilled MigrantCategory Policy refer.

Are you claiming points for a recognised qualification(s) and declaring that you meet policy criteria? Referto the Guide under Recognised Qualification in the section Summary of Terms

Yes No

Please provide the details of the recognised qualification(s) for which you are claiming points.

Name of qualification

Date obtained Major area of study

Date commenced studies Date completed studies

Institution name

Address

Phone Student ID#


Is this qualification(s) included on the List of Recognised Qualifications, (refer to form NZIS 1080) or has anOccupational Registration Body assessed your qualification(s) as comparable to a New Zealand qualification that ison the List of Recognised Qualifications?

Yes No ] Go to Q F2c ] Go to Q F2c ] Go to Q F2c ] Go to Q F2c ] Go to Q F2c Please provide level

If your qualification is a level 4 acceptable trade, please provide the name of the acceptable trade.

Has your qualification(s) been assessed by the NZQA?

Yes No ] Go to Q F3] Go to Q F3] Go to Q F3] Go to Q F3] Go to Q F3

PLEASE NOTE: If you have answered ‘no’ to questions F2a and F2b, this qualification does not qualify for points as aPLEASE NOTE: If you have answered ‘no’ to questions F2a and F2b, this qualification does not qualify for points as aPLEASE NOTE: If you have answered ‘no’ to questions F2a and F2b, this qualification does not qualify for points as aPLEASE NOTE: If you have answered ‘no’ to questions F2a and F2b, this qualification does not qualify for points as aPLEASE NOTE: If you have answered ‘no’ to questions F2a and F2b, this qualification does not qualify for points as arecognised qualification(s).recognised qualification(s).recognised qualification(s).recognised qualification(s).recognised qualification(s).

What is the level assessed by the New Zealand Qualifications Authority (NZQA)? Refer to the guide under NewZealand Qualifications in section Summary of Terms.

Level

What are the reference number, type and level assessed by NZQA? Refer to the Guide under QualificationsAssessment Report in the section Summary of Terms.

Reference number

F

F

POINTS

CLAIMED


F

F

F

F

2a

2b

2c

2d


4

5

F

F

Type Preliminary Interim Full

Level

What New Zealand qualification(s) was your qualification(s) assessed as being comparable with?

Do you have a recognised New Zealand qualification(s) gained after two or more years of study in New Zealand?

No ] Go to Q F4] Go to Q F4] Go to Q F4] Go to Q F4] Go to Q F4 Yes, please provide the following details:

Name of qualification(s)



Institution name


Suburb City


Country

Telephone Student ID#


Qualifications and bonus points

PLEASE NOTE: A qualification(s) in an identified future growth area or cluster only qualifies for bonus points if youare also claiming points for current skilled employment or an offer of skilled employment in an identified futuregrowth area or cluster.

Only complete Questions F4 to F6 if you are claiming points for current skilled employment or an offer of skilled employment.

Is your qualification(s):

Is your qualification(s) in one of the identified future growth areas? If yes, please provide the growth area name.Refer to the Guide under Identified Future Growth Area in the section Summary of Terms for growth area names.

Yes No ] Go to Q] Go to Q] Go to Q] Go to Q] Go to Q F5F5F5F5F5

Growth area name

Is your qualification(s) in one of the identified clusters? If yes, please provide the cluster name. Refer to the Guideunder Cluster in the section Summary of Terms for cluster names.

Yes No ] Go to Q] Go to Q] Go to Q] Go to Q] Go to Q F6F6F6F6F6

Cluster name

3

D D M M YY


FPOINTS

CLAIMED


7

D D M M YY

If this qualification(s) is not the qualification(s) for which you claimed points for in questions F2 to F4, pleaseprovide the following details about qualification(s).

Name of qualification



Institution name

Address

Phone Student ID#


Is this qualification(s) included on the List of Recognised Qualifications, (refer to form NZIS 1080) or has anOccupational Registration Body assessed your qualification(s) as comparable to a New Zealand qualification that ison the List of Recognised Qualifications?

Yes No Please provide level

If your qualification is a level 4 acceptable trade, please provide the name of the acceptable trade.

Has your qualification(s) been assessed by the NZQA?

Yes No

PLEASE NOTE: If you have answered ‘no’ to questions F7a and F7b, this qualification does not qualify for points as aPLEASE NOTE: If you have answered ‘no’ to questions F7a and F7b, this qualification does not qualify for points as aPLEASE NOTE: If you have answered ‘no’ to questions F7a and F7b, this qualification does not qualify for points as aPLEASE NOTE: If you have answered ‘no’ to questions F7a and F7b, this qualification does not qualify for points as aPLEASE NOTE: If you have answered ‘no’ to questions F7a and F7b, this qualification does not qualify for points as arecognised qualification(s).recognised qualification(s).recognised qualification(s).recognised qualification(s).recognised qualification(s).

What is the level assessed by the New Zealand Qualifications Authority (NZQA)? Refer to the guide under NewZealand Qualifications in section Summary of Terms.

Level

What are the reference number, type and level assessed by NZQA? Refer to the Guide under QualificationsAssessment Report in the section Summary of Terms.

Reference number


Level

F


F

F

F

F

7a

7b

7c

7d

Is your qualification(s) in one of the areas of absolute skills shortage? If yes, please provide the absolute skillsshortage occupation name. Refer to the Priority Occupations List (POL) on our website at www.immigration.govt.nzor request a copy of the List from your nearest NZIS branch.

Yes No ] Go to Q] Go to Q] Go to Q] Go to Q] Go to Q G1G1G1G1G1


6F


Section G: Recognised work experience

In this section we recognise the importance of skills and experience gained through your previous employmentthat:• are readily transferable; and• will enable you to get skilled employment in New Zealand; and• will help you to contribute to New Zealand socially and economically.

Please provide the following details about the recognised work experience for which you are claimingpoints. Sections SM11, SM12 and SM13 of the Skilled Migrant Category Policy refer.

PLEASE NOTE: If you do not have current skilled employment in New Zealand or an offer of skilled employment inNew Zealand, you can only qualify for points for your work experience if it is recognised, and was gained legally ina labour market that is comparable to New Zealand. Refer to the Guide under Comparable Labour Market in thesection Summary of Terms.

1


G Work experience 1

From To

Name of employer


Suburb City


Country

Type of business Position held

Country employer is domiciled in

Telephone Contact name


Please indicate why you believe this work experience should be recognised. Refer to the Guide under RecognisedWork Experience in the section Summary of Terms. (For example, it is relevant to your recognised qualification, oryour skilled employment.)

What New Zealand qualification(s) was your qualification(s) assessed as being comparable with?



Work experience 2

From To

Name of employer


Suburb City


Country







Work experience 3

From To

Name of employer


Suburb City


Country








2

3

4

Please indicate the total number of years of work experience in New Zealand. Refer to the the Guide underRecognised Work Experience in the section Summary of Terms.

2 but less than 4 years 4 but less than 6 years

6 years or more None of the above

Please indicate the total number of years of recognised work experience. Refer to the Guide under Recognised WorkExperience in the section Summary of Terms. Include any New Zealand work experience indicated in QG2.



10 years or more None of the above

Please indicate the total number of years of work experience in an identified future growth area. Refer to the Guideunder Identified Future Growth Area in the section Summary of Terms. You need to note that work experience in anidentified future growth area only qualifies for bonus points if you are also claiming points for current skilledemployment or an offer of skilled employment in an identified future growth area.

2 but less than 6 years 6 years and over

None of the above

Growth area name

Please indicate the total number of years of work experience in an identified cluster. Refer to the Guide underCluster in the section Summary of Terms. You need to note that work experience in an identified cluster onlyqualifies for bonus points if you are also claiming points for current skilled employment or an offer of skilledemployment in an identified cluster.


None of the above

Cluster area name

G

G

G

POINTS

CLAIMED

POINTS

CLAIMED

POINTS

CLAIMED

5G

POINTS

CLAIMED


10H

H

In this section we need to gather and confirm your partner’s personal details. Please provide the followinginformation about your partner. You need to provide this information even if your partner is not intendingto apply for residence with you.

Family name

Given name(s)

Please provide all other names your partner is/or has been known by.

Preferred title Mr Mrs Ms Miss Dr

Other (please specify)

Gender Male Female Date of birth

Country of birth

Please provide your partner’s Birth Certificate number and the name of the issuing authority.

Birth Certificate number

Name of issuing authority

Please provide your partner’s main country of citizenship/nationality.

Please provide details of all passports currently held by your partner.

Passport number

Country

Family name

Given name(s)


Section H: Partner’s identity

1H

3

4

H

H

H

H

H

H

D D M M YY

6 Please indicate the total number of years of work experience in an area of absolute skills shortage. Refer to theGuide under Area of Absolute Skills Shortage in the section Summary of Terms.


None of the above


G

POINTS

CLAIMED


2H

5

7

8

6

9


Place of issue

Passport number

Country

Family name

Given name(s)


Place of issue

Passport number

Country

Family name

Given name(s)


Place of issue

Please list any other citizenships currently held.

Where applicable, please provide the following details:

Driver Licence




Expiry date




Expiry date



D D M M YY



D D M M YY

11

12

H

H


Section I: Partner’s character

In this section we need to confirm that your partner is of good character which is a prerequisite of the SkilledMigrant Category. Please provide the following details about your partner’s character. Section A5 of the. Please provide the following details about your partner’s character. Section A5 of the. Please provide the following details about your partner’s character. Section A5 of the. Please provide the following details about your partner’s character. Section A5 of the. Please provide the following details about your partner’s character. Section A5 of theGovernment’s Residence Policy refers.Government’s Residence Policy refers.Government’s Residence Policy refers.Government’s Residence Policy refers.Government’s Residence Policy refers.

Questions I1 to I9 relate to section 7(1) of the Immigration Act (persons prohibited from being granted a permit).Questions I1 to I9 relate to section 7(1) of the Immigration Act (persons prohibited from being granted a permit).Questions I1 to I9 relate to section 7(1) of the Immigration Act (persons prohibited from being granted a permit).Questions I1 to I9 relate to section 7(1) of the Immigration Act (persons prohibited from being granted a permit).Questions I1 to I9 relate to section 7(1) of the Immigration Act (persons prohibited from being granted a permit).People described in section 7(1) of the Immigration Act cannot ordinarily be granted residence in New Zealand.People described in section 7(1) of the Immigration Act cannot ordinarily be granted residence in New Zealand.People described in section 7(1) of the Immigration Act cannot ordinarily be granted residence in New Zealand.People described in section 7(1) of the Immigration Act cannot ordinarily be granted residence in New Zealand.People described in section 7(1) of the Immigration Act cannot ordinarily be granted residence in New Zealand.

Has your partner ever been sentenced to imprisonment for a term of five years or more Yes No(including any expunged criminal records)?

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Expiry date

Taxation number

Taxation number

Country



Country

Please list all countries, including all countries of citizenship, your partner has lived in for a total of 12 months or12 months or12 months or12 months or12 months ormore more more more more in the last 10 years. Include all countries where their stay has been broken by any departures.

From To Country

From To Country

From To Country

From To Country

From To Country

From To Country

From To Country

From To Country

From To Country

From To Country

1I


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Has your partner been sentenced to imprisonment for a term of 12 months or more within Yes Nothe last 10 years (including any expunged criminal records)?

Does your partner have a removal order from New Zealand currently in force against them? Yes No

Has your partner ever been deported from any country, including New Zealand? Yes No

Has your partner ever been involved in any terrorist activities or supported similar Yes Noviolent activities?

Has your partner been a member of, or belonged to, any terrorist group? Yes No

Has your partner been involved in any drug trading or trafficking? Yes No

Has your partner been a member of, or belonged to, any group with criminal objectives? Yes No

Has your partner been a member of, or belonged to, any group that has engaged in or Yes Nosupported criminal activities?

If you answered ‘yes’ to any of questions I1 to I9 above, you must provide a full explanation about the surroundingcircumstances. If, having considered your explanation, the NZIS assesses that your partner is a person to whomsection 7(1) of the Immigration Act applies, your Expression of Interest cannot be accepted into the Pool.

Is your partner currently under investigation, or wanted, by any law enforcement agency Yes Noin any country?

Has your partner ever been convicted or found guilty of any offence(s) against the law Yes Noin any country?

Has your partner been convicted of an offence (including a traffic offence), committed Yes Nowithin the last five years, involving dangerous driving, driving having consumed excessivealcohol (including drunk driving and driving with a blood or breath alcohol content in excessof a specified limit) or driving having consumed drugs?

Has your partner ever been charged with any offence against the law in any country? Yes No

Has your partner ever been removed from any country, including New Zealand? Yes No

Has your partner ever been refused entry to any country, including New Zealand? Yes No

Has your partner ever been refused a visa/permit for any country, including New Zealand? Yes No

Has your partner been involved in any people trafficking? Yes No

Has your partner, been a member of, or belonged to, any group of people that had/has Yes Noobjectives or principles based on hostility against people or groups of people on the basisof colour, race, ethnic or national origins?

Has your partner been a member of, or belonged to, any group of people that had/has Yes Noobjectives or principles based on an assumption that persons of a particular race or colourare inherently inferior or superior to other races or colours?

Has your partner, in the course of applying for a New Zealand visa/permit, made any Yes Nostatement or provided any information, evidence or submission that was false, misleadingor forged, or withheld material information?

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Section J: Partner’s health

In this section we need to confirm that your partner meets a minimum standard of health which is a prerequisite for theSkilled Migrant Category . Providing accurate information about your partner’s health status is very important. Pleaseprovide the following details about your partners health. Section A4 of the Government’s Immigration Policy refers.

Questions J1 to J4 concern medical conditions for which a medical waiver cannot be granted. People withthese conditions cannot ordinarily be granted residence in New Zealand.

Does your partner, or is your partner likely to, require dialysis treatment in the immediate future? Yes No

Does your partner have active tuberculosis? Yes No

Does your partner have a mental disorder, or intellectual disability that has needed care Yes Noin a hospital or supervised residence for more than 90 days in the last 2 years?

Does your partner have a physical incapacity that requires full-time care? Yes No

If you answered ‘yes’ to any of questions J1 to J4 above, you must provide an explanation of your medicalcondition. If, having considered your explanation, the NZIS assesses that your partner’s medical condition is onefor which a medical waiver cannot be granted, your Expression of Interest cannot be accepted into the Pool.

Has your partner been exposed to, or diagnosed with, any infectious or communicable disease? Yes No

Is your partner receiving, or has received, any treatment for any psychiatric condition or Yes Nodevelopmental disorder?

Does your partner have any condition that is likely to require ongoing treatment or Yes Nomedication?

If you answered ‘yes’ to any of these questions, you must provide a full explanation of your partner’smedical condition. If your Expression of Interest is selected from the Pool you may be asked to provide amedical certificate to confirm this information.


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If you answered ‘yes’ to any of these questions, you must provide a full explanation about the surroundingcircumstances. If your Expression of Interest is selected from the Pool your partner may be asked to providea police certificate.



Section K: Partner’s English language ability

The information you provide in this section will give us an indication of your partner’s English language ability.Meeting the minimum standard of English language will assist your partner to settle successfully in New Zealand.Please provide the following details about your partner’s English language ability. Section SM5 of theSkilled Migrant Category Policy refers.

Does your partner meet the minimum standard of English, listed below? Refer to the Guide under English LanguageRequirements in the section Summary of Terms. Select only one.

An IELTS Test Report with an overall band score of 5 or more ] Go to Q K3] Go to Q K3] Go to Q K3] Go to Q K3] Go to Q K3

An IELTS Test Report with an overall band score of 6.5 or more if you are claimingpoints for your partner’s skilled employment, offer of skilled employment andrecognised qualifications. ] Go to Q K3] Go to Q K3] Go to Q K3] Go to Q K3] Go to Q K3

Study for a recognised qualification conducted entirely in English ] Go to Q L1] Go to Q L1] Go to Q L1] Go to Q L1] Go to Q L1

Completed qualifications that meet the minimum standard, as defined in the Guide ] Go to Q L1] Go to Q L1] Go to Q L1] Go to Q L1] Go to Q L1

Current skilled employment in New Zealand for 12 months or more ] Go to Q L1] Go to Q L1] Go to Q L1] Go to Q L1] Go to Q L1

Otherwise meets the minimum standard, as defined in the Guide ] Go to Q K2] Go to Q K2] Go to Q K2] Go to Q K2] Go to Q K2

None of the above

PLEASE NOTE: Unless you are claiming points for your partner’s recognised qualification, skilled employment oroffer of skilled employment, partners must pre-purchase English for Speakers of Other Languages (ESOL) tuition ifthey do not meet the minimum standard of English. They will need to attend English language classes once theyarrive in New Zealand.

Please provide details explaining why your partner meets the minimum standard. Refer to the Guide under EnglishLanguage Requirements in the section Summary of Terms.

If your partner has an IELTS certificate, what is the Test Report Form number?

What was the date that your partner sat their test and the score?

Overall IELTS band score

1K

2K

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Section L: Partner’s skilled employment

In this section you can qualify for bonus points if your partner has current ongoing skilled employment in NewZealand or an offer of ongoing skilled employment in New Zealand. Your partner will only be able to claim pointsfor an offer of skilled employment in New Zealand if they meet the English language requirements for principalapplicants. Refer to the Guide under English Language Requirements in the section Summary of Terms.

Furthermore, if your partner has an offer of employment in an occupation which requires registration, your partnerwill only be able to claim points for this offer of employment if they have the required registration. Occupationsrequiring registration can be found in the Guide under Occupational Registration in the section Summary of Terms.Please provide the following details about your partner's skilled employment. Section SM10 of the SkilledMigrant Category Policy refers.

Are you claiming points for your partner’s skilled employment? Refer to the Guide under Skilled Employment in thesection Summary of Terms. Select only one.

Offer of skilled employment in New Zealand

Current skilled employment in New Zealand for more than 12 months

Current skilled employment in New Zealand for less than 12 months

None of the above ] Go to Q M1] Go to Q M1] Go to Q M1] Go to Q M1] Go to Q M1

What is your partner’s job title?

Please indicate why you or your partner believe this job is skilled employment. Refer to the Guide under SkilledEmployment in the section Summary of Terms.

Please provide the following details for the skilled employment detailed above.

Employer contact name (manager)

Business/organisation name


Suburb City


Country

Telephone


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Section M: Partner’s recognised qualification(s)

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In this section we need to confirm whether your partner’s qualification(s) will be recognised in New Zealand.PLEASE NOTE: Your partner will only be able to claim points for their qualification(s) if they meet the Englishlanguage requirements for principal applicants. Refer to the Guide under English language requirements in thesection Summary of Terms. Please provide the following details about your partner’s recognisedqualification(s). Section SM17 of the Skilled Migrant Category Policy refers.

Are you claiming points for your partner’s recognised qualification(s)? Refer to the Guide underRecognised Qualification in the section Summary of Terms.

Yes No

Please provide the details of the recognised qualification(s) for which your partner is claiming points:

Name of qualification(s)



Institution name

Address

Phone Student ID#

Is this qualification(s) included on the List of Recognised Qualifications (refer to form NZIS 1080)?

Yes No ] Go to Q M2c] Go to Q M2c] Go to Q M2c] Go to Q M2c] Go to Q M2c

What is the level assessed by the NZQA, as defined in the Guide?

Level

Has this qualification(s) been assessed by the NZQA?

Yes No ] Go to Q N1] Go to Q N1] Go to Q N1] Go to Q N1] Go to Q N1

What is the reference number, type and level assessed by the NZQA? Refer to the Guide under QualificationsAssessment Report in the section Summary of Terms.

Reference number


Level

What New Zealand qualification(s) was this qualification(s) assessed as being comparable with?

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Section N: Other family

ChildrenHow many children do you have? This includes biological, adopted and step-children from previous marriages/relationships.

Please provide the following details for your children (including biological, adopted and step-children from previousmarriages/relationships).

Full name


Partnership status

Married De facto Separated Divorced Widowed Never Married

Country of residence

Will this child be included in your application for residence? Yes No

Full name


Partnership status




Full name


Partnership status




1N

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Full name


Partnership status




Full name


Partnership status




Full name


Partnership status




Full name


Partnership status



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Give details of ALL your family, including those adopted legally or by custom. It is not necessary to list deceased familymembers. Family includes biological and adoptive parents, siblings (including step, half and adopted brothers andsisters), cousins, nieces and nephews, etc.

Full name


Partnership status



Relationship to you

Full name


Partnership status



Relationship to you

Full name


Partnership status



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For each DEPENDENT child who will be included in your residence application, please complete a ChildSupplement Expression of Interest form. Please refer to the Guide under Dependent Children in thesection Summary of Terms.

If you are separated or divorced and bringing a child under 16 years of age with you to New Zealand, wewill need to see proof of their right to leave their home country and your right to remove them. SectionF5.20 of the Government's Residence Policy refers.


Relationship to you

Full name


Partnership status



Relationship to you

Full name


Partnership status



Relationship to you

Full name


Partnership status



Relationship to you

Full name


Partnership status


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Relationship to you

Full name


Partnership status



Relationship to you

Full name


Partnership status



Relationship to you

Full name


Partnership status



Relationship to you


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Section O: Partner’s family

How many children does your partner have? This includes biological, adopted and step-children from previousmarriages/relationships. Do not include children already listed under N1.

None

Please provide the following details for your partner’s children (including biological, adopted and step-children fromprevious marriages/relationships).

Full name


Partnership status




Full name


Partnership status




Full name


Partnership status




Children

1O

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Full name


Partnership status




Full name


Partnership status




Full name


Partnership status





For each DEPENDENT child who will be included in your residence application, please complete a ChildSupplement Expression of Interest form. Please refer to the Guide under Dependent Children in the sectionSummary of Terms.

If your partner is separated or divorced and bringing a child under 16 years of age with them to NewZealand, we will need to see proof of their right to leave their home country and your partner’s right toremove them. Section F5.20 of the Government’s Residence Policy refers.

D D M M YY

D D M M YY

D D M M YY


2 Give details of ALL your partner’s family, including those adopted legally or by custom. It is not necessary to listdeceased family members. Family includes biological and adoptive parents, and full, half, step and adoptedbrothers and sisters.

Full name


Partnership status



Relationship to you

Full name


Partnership status



Relationship to you

Full name


Partnership status



Relationship to you

Full name


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O

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Partnership status



Relationship to you

Full name


Partnership status



Relationship to you

Full name


Partnership status



Relationship to you

Full name


Partnership status



Relationship to you

Full name

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Partnership status



Relationship to you

Full name


Partnership status



Relationship to you

Full name


Partnership status



Relationship to you


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Declaration

Yes

This section must be signed by the principal applicant on behalf of all people included in this Expression of Interest.Make sure you understand the declarations below before you sign and agree to them.

Important■ I understand that if I make any false statements, or provide any false or misleading

information, or have changed or altered this form (including the Child Supplementform) in any material way, my Expression of Interest may be declined, my residence visaor permit may later be revoked, I lose any right to appeal, and I may also be committingan offence and liable to prosecution.

■ I understand the notes and questions in this form (including the Child Supplementform), and I declare the information given about myself, my partner and any children istrue and complete.

■ I declare that I have listed all my family members, including any adopted by law or bycustom and my grandparents or legal guardians (if any) if both my parents aredeceased, and understand that the non-declaration of any family members may resultin that family member not being recognised as part of my family in future applications.

■ I declare that I will inform the New Zealand Immigration Service (NZIS) of any relevantfact or any change of circumstances that may: (i) affect the decision on my Expressionof Interest form and application for a permit, or or or or or (ii) affect the decision to grant a permitthat relies on the visa for which I am expressing interest and applying.

■ I declare that there are no matters or warrants outstanding, or investigations of any kind,which could have any current or future effect on the assessment of my good character, orthe good character of any other persons included in this Expression of Interest.

■ I authorise the NZIS to make any enquiries it deems necessary regarding theinformation provided on this form (including the Child Supplement form), and to sharethis information with other Government agencies (including overseas agencies) to theextent necessary to make decisions about my immigration status. I also consent to anyorganisation providing relevant information to the NZIS about me.

■ I authorise the NZIS to provide information about my state of health and myimmigration status to any health service agency. I authorise any health service agencyto provide information about my state of health to the NZIS.

■ I accept that any advice given to me by the NZIS before expressing interest andsubmitting this form (including the Child Supplement form) was intended to assist me,and acting on that does not mean that my application for residence will be granted.

■ I understand that in order to work in certain occupations in New Zealand, registration isrequired by law. I accept that the grant of residence does not guarantee thatregistration will be granted.

D D M M YYSignature of principalapplicant

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes


Declaration for person assisting the applicant to complete this form

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To be completed and signed by any person who has assisted the applicant to complete this form by explaining,translating or filling in the form for the applicant.

Full name of person assisting

Address of person assisting

I understand that after the applicant has signed this form (including the Child Supplement form) it is an offence toalter or enter further information on it, alter any material attached to it, or attach any further material to it, unlessthe person making the alteration or addition states on the form what information or material has been altered orattached, why, and by whom. I understand that the maximum penalty for this offence is a fine of up to NZ$100,000and/or a term of imprisonment of up to seven years.

I certify that I have assisted in the completion of this form and any additional forms at the request of the applicantand and and and and that the applicant understood the content of the form(s) and agreed that the information provided is correctbefore signing the declaration. I have assisted the applicant as a:

lawyer agent, consultant or representative translator friend or family member

other please specify

Signature ofperson assisting

The information about you and your family in this form is being collected to determine whether we will invite youto apply for residence in New Zealand.

The main recipient of the information is the New Zealand Immigration Service of the Department of Labour, but itmay also be shared with other Government agencies that are entitled to this information under applicablelegislation. In particular, the Ministry of Social Development (Work and Income) may be given information aboutyour personal resources.

The collection of the information is authorised by the Immigration Act 1987 and the Immigration Regulations madeunder that Act. The supply of the information is voluntary, but if you do not supply the mandatory informationrequired by the Expression of Interest form, then your Expression of Interest cannot be accepted.

You will, if you are in New Zealand, have the right to see the information about you held by the New ZealandImmigration Service, and to ask for any of it to be corrected if you think that is necessary. The addresses of theNew Zealand Immigration Service can be found on our website at www.immigration.govt.nz

Privacy Act


If you are not completing an Expression of Interest online, send your Expression of Interest to:

Expression of Interest TeamNew Zealand Immigration ServiceDX SR57164Level 1, Unisys HouseThe TerraceP O Box 3705WellingtonNew Zealand

Submitting your Expression of Interest

Payment details

I enclose (amount) NZ$ or USD

Bank cheque Bank draft

Credit card (specify type) MasterCard Visa

Name of cardholder

Card number Expiry date

C.V.C Number

Signature

PLEASE NOTE: If we determine that your Expression of Interest does not meet the minimum criteria for submission,your fee may not be refunded. To meet the minimum submission requirements, you should ensure that you havecompleted this form correctly by answering all relevant questions, that you meet the prerequisites and qualify formore than 100 points. If you wish to check your eligibility before submitting your Expression of Interest, werecommend that you complete your Expressions of Interest online through our website atwww.immigration.govt.nz. Submitting an Expression of Interest online is cheaper and you will know immediatelywhether your Expression of Interest has been accepted into the Pool.

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Payment must be in New Zealand dollars. The only exception is a USD bank draft. No other currency will beaccepted. Do not send cash.

Details on the fee payable to submit your Expression of Interest are available on our website atwww.immigration.govt.nz and in our leaflet New Zealand Immigration Fees.

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Formular Emigrare NZ 1100

Documents

Transcript of Formular Emigrare NZ 1100