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Dependent Child 2: Personal DetailsA 39My surname or family name as shown in my passport is:Please attach arecent passport sizedphotograph hereA 40My first or given names as shown in my passport are:A 41I am also known by these names:A 42My name in my own ethnic script is:A 43 My sex is: Male Female A 44 My date of birth is:day month yearA 45 My country of birth was:A 46My citizenship is:A 47Passport details: Number:Country:Expiry date:day month yearDependent Child 3: Personal DetailsA 48My surname or family name as shown in my passport is:Please attach arecent passport sizedphotograph hereA 49My first or given names as shown in my passport are:A 50I am also known by these names:A 51My name in my own ethnic script is:A 52 My sex is: Male Female A 53 My date of birth is:A 54 My country of birth was:A 55 My citizenship is:day month yearA 56Passport details: Number:Country:Expiry date:day month year46
Section B Character and Declaration DetailsB 1I, or one of my family included in the application:have been; orhave not been:• convicted• charged• under investigation for any offence(s) against the law in any country;or• deported• excluded (refused entry) or• removed from any country.I, or my family have marked the above statement ‘I have been’. The reason is:B 2I understand the questions and contents of this form, and the information given is true andcorrect.Signature of principal applicant day month yearSignature of partner day month yearSignature of dependent child day month yearSignature of dependent child day month yearSignature of dependent child day month yearNote: a parent or guardian may sign on behalf of any children aged under 17 years.B 3Another person has either completed this form for me, or has helped me to complete it.Their details are:Full name of interpreter, agent or authorised representativeAddress of interpreter, agent or authorised representativeSignature of interpreter, agent or authorised representative day month yearI, the above signed, certify I have completed this form, or helped the applicant to complete it,at the request of the applicant. The applicant understood the questions on the form, and theanswers that have been written down. The applicant approved the answers before signing theform.57
Page 1 and 2: Application toTransit through New Z
Page 3 and 4: Application No.For NZIS Use OnlyApp
Page 5: Partner: Personal DetailsA 21My sur

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