Self Assessment - Initial Evaluation

Please fully complete the following details to enable us to best assess the most appropriate Visa/Permit that is most appropriate to your circumstances. Do not just attach your CV as this will be insufficient information. We will reply as soon as possible only if you complete all the details.

This assessment is given free of charge.

---

Principal Applicant's Family Name:		First Name:
Date OF Birth : (DD/MM/YYYY)		Place Of Birth:
Citizenship :		Male Female	Married Single
Postal Address:
City :		Country:
Phone :		Fax :
Email :

---

Spouse's Family Name		First Name:
Date OF Birth : (DD/MM/YYYY)		Place Of Birth:
Citizenship :		Male Female	Married Single

---

List the countries you and your partner have lived in for one year or more over the last 10 years:

Qualifications (exact dates studied) (grades/division/pass mark/months/year)

Full Name Of Qualification	Name Of Institution	Start: DD/MM/YY	Finish: DD/MM/YY	Full/Part Time	Grade	Yrs

Spouse's Qualification

Full Name Of Qualification	Name Of Institution	Start: DD/MM/YY	Finish: DD/MM/YY	Full/Part Time	Grade	Yrs

Your Usual Occupation

Finance Agriculture and Related Industries Administration Computing and IT Education Engineering Health Hospitality and Entertainment Legal Sales and Marketing Specialised Management Trade and Technical Unemployed Student

List all your work experience

Name Of Employer	Position Held	Full/Part Time	From: DD/MM/YY	To: DD/MM/YY

Spouse's work experience

Name Of Employer	Position Held	Full/Part Time	From: MM/YY	To: MM/YY

English ability of yourself:	Fluent Very Good Conversational Limited None
English ability of spouse:	Fluent Very Good Conversational Limited None
		Yes	No
Was the medium of instruction of school/university English?
Did you work and study at the same time?
Do you have close family members who are NZ residents?
Do you have a NZ job offer?
Have you worked in NZ?
Do you wish to set up business in NZ?
How many years of business experience?
Are you interested in a visa to investigate setting up a business in NZ?
Indicate the approximate amount of funds available to set up a NZ business. (in $US)