Template 8 –Lesson 4: Simplified version of application form

Note: This is not a genuine application for New Zealand citizenship form, and includes only some of the questions that are included on the real form.

Application for New Zealand Citizenship
Full name: / Current given/first name(s):
Current family/last name(s):
Other names you have ever used:
Place of birth:
Birth date:
Present citizenship(s):
Address:
Relationships: / Never married, married, separated, divorced, de facto, widowed, civil union etc.
Family applications: / Are any of your immediate family members also applying for new Zealand citizenship on a separate application form?
Name: Birth date: Country of birth:
Parental or guardian consent (if under 16): / Parent/guardian 1
Name:
Relationship to child: / Parent/guardian 2
Name:
Relationship to child:
Residence: / Date you first arrived in New Zealand:
Date permanent residence granted:
Travel: / List all trips outside New Zealand during the past five years:
Destination: From (month/year): To (month/year):
Intention: / Do you intend to continue to physically livein New Zealand?
Do you plan to travel overseas in the next 12 months? If so, purpose and how long?
English language: / Is English your first language?
If not, do you use English in your everyday life, or have you studied in English?
Character: / Have you ever committed, been convicted of or found guilty of any offence against the law of New Zealand or any overseas country?
If yes, list details.
Responsibilities and privileges of New Zealand citizenship: / If you are 14 years old or over, you must complete this section.
Some of the responsibilities are:
Some of the privileges are:
Oath or affirmation of allegiance: / If you are 14 years old or over you must swear allegiance to New Zealand at a public ceremony.
Do you wish to say the oath (you may bring your own holy book if you wish) or the affirmation?
If you are under 14 years old would you like to attend a public ceremony with your family?
Statutory declaration: / I ______of ______solemnly and sincerely declare that I believe the facts in this application are correct and I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957.
Declared at: Date:
Signed: Before me:
(Justice of the Peace, solicitor, Member of Parliament, New Zealand representative overseas or some staff at Department of Internal Affairs)