Assessment Form New Zealand

ClientInformation/Assessment Form – New Zealand

Type of Visa you are interested in: Student, Visitor, Work, Skilled Migration

First Name:
Last Name:
Current Address:
Phone Number:
Email:
Country of Citizenship:
Country of Current Residence:
Date of Birth:
Marital Status(please circle):
Single / Married

If Married, Date of Marriage:
Name of Dependent Date of Birth Relationship Occupation (if applicable) Wants to accompany (Yes/No)

Educational Details:

Visa Grant Date Visa Subclass / Type Date of Arrival in Australia Date of Departure from Australia

Have you ever been refused a visa from any country (please circle): Yes/No
If Yes, Provide details below

Country Visa Type Reason for Refusal and date

Has your Australian visa been cancelled previously (please circle): Yes/No
If Yes, Provide details below

Date of Cancellation Visa Subclass / Type Reason for Cancellation

Educational Details:

Educational Details: University/Board Commencement Year Completion Year Grade/Percentage

Work Experience:

Joining date Relieving date Organization Designation Main job duties

IELTS/PTE/TOEFL/OET/CAE Score, if available Name of Test:____________ Date of Test:____/____/________

Reading Writing Listening Speaking Overall

Do you have any relative in New Zealand, if yes, please provide following details of the relative

Name Relation Visa status Occupation State/Territory of residence

Partner (Spouse) Skills & Qualification: Please complete if applicable
Partner work experience details:

Joining date Relieving date Organization Designation Main job duties

Partner educational details:

Name of Qualification University/Board Commencement Year Completion Year Grade/Percentage

Partner IELTS/PTE/TOEFL/OET/CAE Score, if availableName of Test:___________ Date of Test:____/____/______

Reading Writing Listening Speaking Overall

Medical & Character Requirements:

Have you previously appeared for Medical Examination for New Zealand Visa? Yes/No

If Yes, Date of Medical Examination

Have you previously provided a Police Clearance Certificate for New Zealand Visa? Yes/No

If Yes, Issue date of Certificate Country

Any other information you wish to provide:



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