Please indicate your preference:
NZ
Australia / NZ Only / Australia Only
Name
*
Email
*
Telephone number (day)
*
Telephone number (night)
*
Nationality
*
Age
below 20
20-24
25-29
30-34
35-39
40-44
45-49
50-55
above 55
*
Date of Birth
dd/mm/yyyy
Occupation
*
Spouse's Age
below 20
20-24
25-29
30-34
35-39
40-44
45-49
50-55
above 55
Spouse's Date of Birth
dd/mm/yyyy
Spouse's Occupation
Number of Children
Age of each child
Do you or any of your family have any serious medical problems?
Have your ever lived in another country for more than 12 months in the last ten years? List countries
DO YOU HAVE ANY RELATIVES LIVING IN NZ OR AUSTRALIA? Eg Brother or, Sister , Parents, Aunty or Uncle, Nephew or Nieces , Please indicate how long they have lived in those countries with residence status
Yes
No
ENGLISH: Please indicate term that best describes English ability:
YOU
fluent
good
basic
no English
SPOUSE
fluent
good
basic
no English
CHILDREN 16+
fluent
good
basic
no English
IELTS SCORES IF ANY:
EMPLOYMENT: Have you/spouse been offered employment in NZ or Australia? Yes/No: Details below:
yes
no
QUALIFICATIONS
Please provide details of your formal qualifications. If your spouse has qualifications please list these below:
Bachelor Degree
Yes
No
Field of Study
Name of University
Standard Completion Time
Date Degree Awarded
Masters Degree
Yes
No
Field of Study
Name of University
Standard Completion Time
Date Degree Awarded
Other two-year-plus Diplomas completed. Please provide Details
WORK EXPERIENCE
How many years of work experience do you have?
Have you worked in your occupation 12 months in last 24?
How many years of work experience does your spouse have?
Has your spouse worked in her occupation 12 months in last 24?
BUSINESS EXPERIENCE: OWNERSHIP
Have you ever owned your own business?
Yes
No
If so, for how many years?
What % of the business was owned by you or your spouse:
If the business has closed date of closure:
What was the approx. annual turnover of the business over the last 5 years?
How many staff employed?
BUSINESS EXPERIENCE AS AN EMPLOYEE MANAGER:
Your position (title and management tier):
What was the annual turnover of the company that employed you?
How many years were you in this position?
How many staff were employed:
APPROXIMATE NET ASSETS: Please indicate level in drop down box below.
My assets are at least US$1.5 Million
My assets are at least US$1 Million
My assets are at least US$500,000
My assets are at least US$260,000
My assets are below US$260,000
N.B. We cannot assess you under Business or Investor Categories without this information. Please note that assets can belong to you or your spouse/children and include real estate, shares, bank deposits, interest in a business, gold and silver bullion”
I confirm that the above information is correct: