1、OFFICE USE ONLY Client no.: Date received: / / Application no.:INZ 1017For further information on immigrationvisit www.immigration.govt.nzfor a temporary stay in New Zealand 在新西兰短期停留Visitors Visa/Permit Application访问签证/许可证申请表Use the guide to help you complete the application form请参考填写申请表Please read
2、the Visitors Visa/Permit Guide (INZ 1018) before you complete this application form. The guide will help you decide which visa or permit you should apply for and contains helpful information about how to complete the application form. The guide also gives detailed information about the evidence and
3、documents you need to send.请在填写申请表前阅读(INZ1018)。该指南可以指导你选择正确的签证或许可证类别, 向你提供所需递交证明材料的详细信息, 并且指导你如何填写申请表。When you have completed the form, please use the checklist at the end to make sure you have sent all the documents and information we need.申请表填写完整后, 请核对最后的材料清单, 以确保你提供了审理所需的全部信息和材料。We will process y
4、our application only when we receive all the information and documents we need. If you do not send all the required information, we will return your application.只有申请材料齐全时，我们才能够审理你的申请。如果申请材料不齐全, 我们将不予受理，并退还申请。You can use this form to apply for a visa/permit for a single applicant or for a family. A f
5、amily may include a principal applicant, partner, and dependent children under 20.此申请表适用于个人申请或一个家庭的共同申请, 一个家庭包括一个主申请人, 主申请人的配偶和二十岁以下的未成年子女。Immigration Advisers Licensing Act 20072007年移民顾问许可证法Under the Immigration Advisers Licensing Act 2007, anyone giving immigration advice will have have to be lice
6、nsed (unless they are exempt). From 4 May 2009, all immigration advisers working in New Zealand must be licensed. From 4 May 2010, all immigration advisers, whether working onshore or offshore, must be licensed. It is an offence to pro-vide immigration advice without holding a licence from these dat
7、es. If your immigration adviser is not licensed when they should be, Immigration New Zealand will return your application.根据2007年移民顾问许可证法的规定, 任何提供移民信息咨询的个人必须持有许可证(豁免的除外)。自2009年5月4日起, 所有在新西兰境内工作的移民顾问必须持有许可证。自2010年5月4日起, 所有移民顾问, 无论在新西兰境内工作还是境外工作,都必须持有许可证。自上述相关日期起, 在无许可证的情况下提供移民信息咨询是违法行为。如果你的移民顾问未持有许可证
8、, 新西兰移民局将退还你的申请材料。For more information and to view the Register of licensed advisers, go to the Immigration Advisers Authority website www.iaa.govt.nz, email infoiaa.govt.nz, or write to them at PO Box 6222, Wellesley Street, Auckland 1141, New Zealand.如需了解更多信息或查询持有许可证的移民顾问注册信息, 请登陆移民顾问管理局网站:www.iaa
9、.govt.nz, 电子邮件:infoiaa.govt.nz, 或写信给他们, 地址: PO Box 6222, Wellesley Street, Auckland 1141, New Zealand。When filling in this form, please print clearly in English using CAPITAL LETTERS.请用清晰的英文（大写）填写此表。When filling in this form, please print clearly in English using CAPITAL LETTERS. 请用清晰的英文（大写）填写此表。2 V
10、isitors Visa/Permit Application 访问签证/许可证申请表Section A Principal applicants personal details 主申请人个人信息All principal applicants must complete this section.所有主申请人必须完成此项内容。Attach one passport-size photograph of yourself here. The photograph must be less than six months old. Write your full name on the bac
11、k of the photograph.请在此附上你最近六个月内拍摄的护照照片一张, 并在照片背面注明姓名。Name as shown in passport 护照上的姓名Family/last name 姓Given/first name(s) 名Preferred title Mr Mrs Ms Miss Dr other (please specify)选用的称谓 先生 夫人 女士 小姐 博士 其他(请注明)Other names you are known by or have ever been known by 曾用名For more information about this
12、question, see Completing Sections A, C, and D: Personal details in the Visitors Visa/Permit Guide. 关于此问题,请参考中的“填写A,C,D部分”。Your name in ethnic script 请用你的本国文字书写你的姓名For more information about this question, see Completing Sections A, C, and D: Personal details in the Visitors Visa/Permit Guide.关于此问题,请
13、参考中的“填写A,C,D部分”。Gender 性别 Male 男 Female 女 Date of birth 出生日期 (日月年)Town/city of birth 出生城/镇Country of birth 出生国家Passport details 护照内容Number 号码Country 国家 Expiry date 有效期（日月年）For more information about this question, see Completing Sections A, C, and D: Personal details in the Visitors Visa/Permit Guid
14、e.关于此问题,请参考中的“填写A,C,D部分”。Country of citizenship 国籍Other citizenships you hold 目前持有的其他国籍Partnership status Married/in civil union Never married/never in civil union Partner婚姻状况 已婚/民事结合 未婚/从未民事结合 同居关系Separated Engaged Widowed Divorced分居 订婚 鳏寡 离婚For more information about this question, see Completing
15、Sections A, C, and D: Personal details in the Visitors Visa/Permit Guide.关于此问题,请参考中的“填写A,C,D部分”。Are you applying for a visa/permit on the basis of a partnership? Yes No你是否基于配偶关系申请签证/许可证? 是 否4.5cm3.5cmA1A2A3A4A5A7A8A9A10A11A6Visitors Visa/Permit Application 访问签证/许可证申请表 3 Section B Contact details 联系方
16、式All principal applicants must complete this section.所有主申请人必须完成此项内容。Your residential address and telephone number in your home country你在本国(中国)的住址和电话号码Address 住址Telephone (daytime) 电话(白天) Telephone (evening) 电话(夜晚)Fax 传真 Email 电子邮件Your New Zealand residential address and telephone number (if you are
17、already in New Zealand)你在新西兰的住址和电话号码(如你已在新西兰境内)Address 住址Telephone (daytime) 电话(白天) Telephone (evening) 电话(夜晚)Fax 传真 Email 电子邮件Name and address for communication about this application关于此申请你希望使用的联系人姓名及地址(请用中文填写)Same as address at B1 , or Same as address at B2 , or Other 地址同 B1, 或 地址同 B2, 或 其它Family/
18、last name 姓 Given/first name(s) 名Company name (if applicable) and address 公司名称(如适用)及地址Telephone (daytime) 电话(白天) Telephone (evening) 电话(夜晚)Fax 传真 Email 电子邮件Do you authorise the person stated at B3 to act on your behalf? Yes 是 No 否如果你在B3中提供的是代理人的信息,你是否已向其授权代表你行事? Have you received immigration advice
19、on this application? 你是否得到指定联系人提供的移民信息指导?Yes Please make sure that your immigration adviser completes Section N: Immigration advisers details. Go to B6是 请确保你的移民顾问填写第N项: 移民顾问详细信息. 请转到 B6No Go to B7 .否 请转到 B7 Immigration adviser reference code for online enquiries (if known). This is not the advis-ers
20、 licence number. 用于网上咨询的移民顾问代码(如适用) 。这不是移民顾问的许可证号。Would you like us to email you instructions for registering to check online how your application is progressing?你是否希望我们通过电子邮件指导你如何注册并在网上查询自己的申请进展?Yes 是 No 否Names and addresses of any friends, relatives, or contacts you have in New Zealand (if applica
21、ble)你在新西兰的所有朋友、亲属或联系人的姓名及地址(如适用)Name 姓名B1B2B3B4B5B6B7B8When filling in this form, please print clearly in English using CAPITAL LETTERS. 请用清晰的英文（大写）填写此表。4 Visitors Visa/Permit Application 访问签证/许可证申请表Address 地址Relationship 关系Name 姓名Address 地址Relationship 关系List all periods of employment, including se
22、lf-employment请提供所有职业信息, 包括自谋职业。Date from (dd/mm/yy )起(日/月/年)Date to (dd/mm/yy )止(日/月/年)Name of employer雇主名称Location地址Type of work/occupation/job title工作性质/职务/ / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /B9C1C2C3Section C Partners personal details 配偶的个人信息All principal applicants
23、who have ticked Married/in civil union, Partner or Engaged at A11 must complete this section with their partners personal details, whether or not the partner is included in this application. Attach a photograph of your partner only if they are included in this application. 所有在A11项选择“已婚”、“同居关系”或“订婚”的
24、主申请人,无论其配偶是否一同申请,必须完成此项内容。若此申请包含你的配偶，请提供配偶的护照照片一张。If applicable, attach one passport-size photograph of your partner here. The photograph must be less than six months old. Write your partners full name on the back of the photograph.如适用，请在此附上你配偶的最近六个月内拍摄的护照照片一张, 并在照片背面注明你配偶的姓名。Partners name as shown
25、in passport 配偶护照上的姓名Family/last name 姓Given/first name(s) 名Partners preferred title Mr Mrs Ms Miss Dr other (please specify)配偶选用的称谓 先生 夫人 女士 小姐 博士 其他(请注明)Other names your partner is known by or has ever been known by 配偶的曾用名4.5cm3.5cmVisitors Visa/Permit Application 访问签证/许可证申请表 5 For more information
26、 about this question, see Completing Sections A, C, and D: Personal details in the Visitors Visa/Permit Guide.关于此问题,请参考中的“填写A,C,D部分”。Partners name in ethnic script 请用你的本国文字书写你配偶的姓名For more information about this question, see Completing Sections A, C, and D: Personal details in the Visitors Visa/Per
27、mit Guide.关于此问题,请参考中的“填写A,C,D部分”。Partners gender Male 男 Female 女 Partners date of birth 配偶的性别 配偶的出生日期 (日月年)Partners town/city of birth 配偶的出生城/镇Partners country of birth 配偶出生国家Partners passport details 配偶的护照内容Number 号码Country 国家 Expiry date 有效期 （日月年）For more information about this question, see Compl
28、eting Sections A, C, and D: Personal details in the Visitors Visa/Permit Guide.关于此问题,请参考中的“填写A,C,D部分”。Partners country of citizenship 配偶的国籍Other citizenships your partner holds 配偶目前持有的其他国籍Is your partner included in this application? 你的配偶是否被包含在此申请中？ Yes 是 No 否You must complete this section with the
29、details of each dependent child included in this application.主申请人必须填写包含在本次申请中的所有未成年子女个人信息。Dependent child one 未成年子女1Attach one recent passport-size photograph of the child here. The photograph must be less than six months old. Write the childs full name on the back of the photograph.请在此附上该子女的最近六个月内拍
30、摄的护照照片一张, 并在照片背面注明其姓名。Childs name as shown in passport 子女护照上的姓名Family/last name 姓Given/first name(s) 名Childs gender Male 男 Female 女 Childs date of birth 子女的性别 子女的出生日期 (日月年)Childs country of birth 子女的出生国家Childs passport details 子女的护照内容Number 号码C4C5C7C8C9C10C11C6Section D Dependent childrens personal
31、details 未成年子女个人信息4.5cm3.5cmD1D2D4D5D3When filling in this form, please print clearly in English using CAPITAL LETTERS. 请用清晰的英文（大写）填写此表。6 Visitors Visa/Permit Application 访问签证/许可证申请表Country 国家 Expiry date 有效期 （日月年）For more information about this question, see Completing Sections A, C, and D: Personal
32、 details in the Visitors Visa/Permit Guide.关于此问题,请参考中的“填写A,C,D部分”。Childs country of citizenship 子女的国籍Other citizenships child holds 子女持有的其他国籍Dependent child two 未成年子女2Attach one recent passport-size photograph of the child here. The photograph must be less than six months old. Write the childs full
33、name on the back of the photograph.请在此附上该子女的最近六个月内拍摄的护照照片一张, 并在照片背面注明其姓名。Childs name as shown in passport 子女护照上的姓名Family/last name 姓Given/first name(s) 名Childs gender Male 男 Female 女 Childs date of birth 子女的性别 子女的出生日期 (日月年)Childs country of birth 子女的出生国家Childs passport details 子女的护照内容Number 号码Countr
34、y 国家 Expiry date 有效期 （日月年）Childs country of citizenship 子女的国籍Other citizenships child holds 子女持有的其他国籍Dependent child three 未成年子女3Attach one recent passport-size photograph of the child here. The photograph must be less than six months old. Write the childs full name on the back of the photograph.请在此
35、附该子女的最近六个月内拍摄的护照照片一张, 并在照片背面注明其姓名。Childs name as shown in passport 子女护照上的姓名Family/last name 姓Given/first name(s) 名Childs gender Male 男 Female 女 Childs date of birth 子女的性别 子女的出生日期 (日月年)Childs country of birth 子女的出生国家D6D7D8D9 D104.5cm3.5cm4.5cm3.5cmD11D12D13D14D15D16D18D17Visitors Visa/Permit Applicat
36、ion 访问签证/许可证申请表 7 Childs passport details 子女的护照内容Number 号码Country 国家 Expiry date 有效期 （日月年）Childs country of citizenship 子女的国籍Other citizenships child holds 子女持有的其他国籍Dependent child four 未成年子女4Attach one recent passport-size photograph of the child here. The photograph must be less than six months ol
37、d. Write the childs full name on the back of the photograph.请在此附上该子女的最近六个月内拍摄的护照照片一张, 并在照片背面注明其姓名。Childs name as shown in passport 子女护照上的姓名Family/last name 姓Given/first name(s) 名Childs gender Male 男 Female 女 Childs date of birth 子女的性别 子女的出生日期 (日月年)Childs country of birth 子女的出生国家Childs passport detai
38、ls 子女的护照内容Number 号码Country 国家 Expiry date 有效期 （日月年）Childs country of citizenship 子女的国籍Other citizenships child holds 子女持有的其他国籍Continue on a separate sheet of paper if necessary.如果包含在此申请中的未成年子女超过4个， 请写在附加纸页上。D19D20D21D224.5cm3.5cmD23 D24D25D26D27D28Section E Health 健康状况All principal applicants must c
39、omplete this section. 所有主申请人必须完成此项内容。For more information about this question, see Completing Section E: Health in the Visitors Visa/Permit Guide. 关于此问题,请参考中的“如何填写E部分”。Do you or any person included in this application have pulmonary tuberculosis (TB)? Yes 是 No 否你或本次申请所包含的其他任何人是否患有肺结核？If you have ans
40、wered Yes, please provide details.如果回答为“是”，请作出详细说明E1When filling in this form, please print clearly in English using CAPITAL LETTERS. 请用清晰的英文（大写）填写此表。8 Visitors Visa/Permit Application 访问签证/许可证申请表Do you or any person included in this application have any medical condition that requires, or may requi
41、re, one of the following during your stay in New Zealand?你或本次申请所包含的其他任何人在新西兰停留期间是否需要或可能需要接受以下治疗： Renal dialysis 肾透析 Yes 是 No 否 Hospital care 住院治疗 Yes 是 No 否 Residential care 家居看护 Yes 是 No 否Residential care is long-term care provided in live-in facilities for the aged or for people with physical, sen
42、sory, in-tellectual, or psychiatric disabilities. 家居看护是指为老年人，或为身体上、感官上、智力上或精神上有疾病的人提供的长期陪同看护。If you have answered Yes to any of the questions in E2 , please provide details如果你对上述 E2 项任何问题回答为“是”， 请在下面作出详细说明。Are you or any person included in this application pregnant? Yes 是 No 否你或本次申请所包含的其他任何人是否已怀孕If
43、you have answered Yes, please provide details (who is pregnant and when are they due to give birth).如果回答为“是”，请作出详细说明（孕妇姓名，预产期）。Medical certificates you must provide 你必须提交的体检表Do you intend to visit New Zealand for less than six months? If you are in New Zealand, this includes time you have already sp
44、ent here. 你是否打算在新西兰停留六个月以下？如果你现在居住在新西兰， 这六个月应包含你在新西兰境内已经停留的时间。Yes. You do not need to provide any medical certificates. Go to E10 No. Go to E6是。你无须提交体检表。转到 E10 否。转到 E6Have you or any person included in this application submitted medical certificates that were completed and dated by a medical practit
45、ioner within the last 24 months with another Immigration New Zealand application?在过去24个月内,你或本次申请所包含的其他申请人是否在其他新西兰签证的申请中提交过体检表？Yes. Provide details 是，请详细说明 No. Go to E7 否，转到 E7Full name姓名Type of application申请类别Date application was lodged (DD/MM/YY)申请递交日期 （日/月/年）1. / /2. / /3. / /4. / /5. / /6. / /If
46、everyone included in the application has submitted medical certificates in the last 24 months you do not need to provide further medical certificates now. We will tell you if we need any further medical information. Go to E10如果在过去24个月内，本次申请所包含的每个申请人都已提交过体检表，那么他们无须提供新的体检表。如果需要任何进一步的体检信息， 我们会通知你。转到 E1
47、0If not everyone included in the application has submitted medical certificates that were completed and dated by a medical practitioner within the last 24 months, they may have to provide certificates now. Go to E7如果在过去24个月内,本次申请所包含的每个申请人都未提交过体检表，他们现在有可能需要提交体检表。转到 E7。E2E3E4E5E6Visitors Visa/Permit A
48、pplication 访问签证/许可证申请表 9 How long do you intend to stay in New Zealand? If you are in New Zealand, this includes time you have al-ready spent here. 你打算在新西兰停留多长时间？如果你在新西兰境内， 应包含你在新西兰境内已经停留的时间。More than six months but not more than 12 months. Go to E86个月以上12个月以下。转到 E8More than 12 months. You must provide a Medical and Chest X-ray Certificate (NZIS 1007). Go to E1012个月以上。 你必须提交体格检查与胸部X光表（NZIS1007）。转到 E10See the list Countries, areas, and territories with a low incidence of tuberculosis in Completing Section E: Health of
