STUDENT VISA APPLICATION FORM
For full-time enrolled Waikato Pathways College & University of Waikato students
Complete before your appointment
□ Application Form - read and answer every page and question, then sign and date the last page.
□ Check and update your contact details at www.waikato.ac.nz/student, iWaikato link, then click on
the “Me” tab.

Payment of your tuition fees and you must print your Enrolment Agreement(s) to bring to your
appointment.

Contact Immigration NZ on 0508 558 855 -to find out if you need to submit a new Police or Medical
Certificates with this application.
Bring to your appointment
□ Your student ID card and passport – must be valid for at least three months after the new visa ends.
□Evidence of financial support for living expenses
After paying your tuition fees, show evidence of NZ $7,500 per semester or NZ $15,000 per year plus
an extra NZ $1,500 to purchase an airline ticket.
Short courses of three months or less or non-semester courses, provide evidence of NZ $1,250 per
month plus an extra NZ $1,500 to purchase an airline ticket, after paying your tuition fees.

Bank Statements – in your name and no more than five days old with at least the last three
months transactions obtained and dated one day after paying your tuition fees and stamped
by the bank.
We must be satisfied that the funds are from a genuine source, you have access to them and
they are for the purpose of your living requirements.

Term deposits - funds held in a New Zealand bank account only. The statement must show
your name, account number, start and maturity date of the term deposit or

Scholarship letter - Your letter or Financial Guarantee (in English) from your scholarship
provider stating the amount and duration of the scholarship or

Sponsorship Form for Temporary Entry - INZ form 1025 completed by a New Zealand citizen
or a permanent resident.
□ Academic results and Attendance record - if you are transferring from another New Zealand
Institution, provide a copy of your academic results and attendance record from your previous New
Zealand institution.
□ Proof of address - only if you are under 18 years at the time of this application.
When your application has been accepted


We will give you an invoice to take to the Payments Office at the Student Centre.
Pay the visa application fee of $195 (Immigration fee of $117 and University of Waikato service fee of
$78). Sign your Enrolment Agreement so your enrolment can be completed at the Payments counter.
1
When filling in this form, please print clearly using CAPITAL LETTERS.
SECTION A: Personal details
Last/Family name:
First/Given name:
_______________
Date of birth: _____________________________ University ID number: ____________________________
Gender (circle one) Male or Female
Passport number: _________________________ Passport expiry date: _____________________________
Visa expiry date: ___________________________Country of citizenship: ____________________________
Partnership status: (please circle)
Never married
Married
Partner
Engaged
Separated
Divorced
Contact details
Your Hamilton address:
___
Your e-mail address: _______________________________________________________________________
Mobile Phone Number:
Telephone number: ____________________________
Emergency Contact (please circle)
Mother
Father
Wife
Husband
Partner
Name: ______________________________________ Phone number:________________________
Course of study
Name of your Degree or Study Programme: ____________________________________________________
Are you enrolled in
One Semester or Two Semesters (please circle)
or until date of _______Day _______Month ______ Year
Do you receive a scholarship?
□ Yes □ No
If yes, name of your scholarship provider or sponsor ______________________________________________
Visa information – what visa do you currently hold? (Circle one)
STUDENT (University of Waikato)
STUDENT (Other Institution)
VISITOR
Are you a new University of Waikato student or a returning student?
2
WORK
NEW or RETURNING
SECTION B: Health Check
□ Yes
Do you have pulmonary tuberculosis (TB)?
□ No
Do you have any medical condition(s) that currently requires or may require medical treatment during your
stay in New Zealand such as –



Renal Dialysis,
Hospitalisation
Residential care*
□ Yes
□ Yes
□ Yes
□ No
□ No
□ No
*Residential care is long term care provided in a live-in facility such as a facility for people with a physical,
sensory, intellectual or psychiatric disability or an aged-person’s facility.
Are you pregnant?
□ Yes* □ No
*If you intend to give birth in New Zealand, you will need to supply evidence of an additional NZ $9,000 to
cover your maternity care or evidence that your sponsor will cover these costs.
If you have answered yes to any of the above questions, please provide details: ________________________
_________________________________________________________________________________________
Will you be in New Zealand for less than six months?
□ Yes □ No
If Yes you do not need to provide a medical certificate or chest X-ray
To be completed by all International students
Have you ever used intravenous drugs?
□ Yes
□ No
Have you ever had a blood or blood product transfusion?
□ Yes
□ No
Have you ever participated in or been exposed to any activity which may have exposed you to a
serious infectious disease (such as HIV, or hepatitis B or C)
□ Yes
□ No
If you have answered Yes to any of the above questions then you must complete a full medical check.
List of countries, areas and territories with a low incidence of Tuberculosis (TB)
Andorra
Antigua and Barbuda
Austria
Barbados
Belgium
Bermuda
British Virgin Islands
Canada
Cayman Islands
Chile
Costa Rica
Cuba
Cyprus
Czech Republic
Denmark
Dominica
Finland
France
Germany
Greece
Grenada
Iceland
Ireland
Israel (including the Occupied
Palestinian Territory, and including
East Jerusalem)
Italy
Jamaica
Jordan
Lebanon
Libya
Liechtenstein
Luxembourg
Malta
Monaco
Montserrat
3
Netherlands Antilles
Netherland
New Zealand s
Norway
Oman
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
San Marino
Slovenia
Sweden
Switzerland
Trinidad and Tobago
Turks and Caicaos Islands
United Arab Emirates
United Kingdom
United States of America
United States Virgin Islands
Vatican City
To be completed by international students (excluding PhD & Exchange students)
Are you from a country that is NOT on the list of countries, areas or territories with a low incidence of TB?
(Refer to the list on previous page). Or have you visited a country NOT on that list, for more than three months?
□ Yes Please answer the next question
□ No You do not need to provide a chest X-ray certificate. Please proceed to the next section
Have you previously provided a chest X-ray which was issued less than 36 months (3 years) ago?
□ Yes Please answer the next question
□ No You must provide a chest X-ray certificate
Since your last visa was granted, have you spent six consecutive months or more in a place that is NOT
on the list of countries, areas or territories with a low incidence of TB? (Refer to list on page 3)
□ Yes You must provide a new chest X-ray certificate
□ No You do not need to provide a new chest X-ray certificate
To be completed by PhD and Exchange students only
Have you submitted a medical certificate which was issued less than 36 months ago?
□ Yes □ No
If NO, you must provide a general medical certificate and chest X-ray.
If YES, since your last visa was granted, have you spent six consecutive months or more in a place that is NOT
on the list of countries, areas or territories with a low incidence of TB? □ Yes □ No
If YES to the above question, then you must submit a chest X-ray.
NOTE: If you are required to submit a Medical Certificate or Chest X-ray send this directly to INZ within 15 days.
Insurance requirements (Please tick)
I agree to arrange and hold insurance which my education provider considers acceptable, from the period of
my enrolment until the expiry of my student visa, unless I depart New Zealand earlier.
□ Yes
I understand that holding insurance will be a condition of my visa and that I may become liable for deportation
if I do not hold insurance, from the period of my enrolment until my visa expires, unless I depart New Zealand earlier.
□ Yes
I understand that if I apply for a further visa, I may be required to provide evidence that I held acceptable
insurance while in New Zealand, holding the visa that I am currently applying for.
□ Yes
4
SECTION C: Police Check
Have you submitted a national police certificate previously within the last 36 months?
If yes, the year of submission: _______________________
□ Yes
□ No
Immigration NZ will advise you by email if they require a new Medical or Police Certificates or further medical tests
before your visa can be processed. You must reply to all emails sent by INZ immediately or your application may be
rejected.
Have you been convicted, charged or are under investigation for offences against the law of New Zealand or
any other country?
□ Yes □ No
Have you been deported, excluded (refused entry) or removed from any country?
□ Yes □ No
If you have answered yes to any of the above, please provide details_________________________________
_________________________________________________________________________________________
Have you undertaken military service in any country?
□ Yes
□ No
If yes, please provide a brief chronological account of your military service. Include dates of your military
service, your position/rank, unit(s) that you served in, and your role within the unit(s).
List any military ID number(s) assigned to you: _______________________________________________
Date from
Date to
Rank
Unit
Are you presently subject to military service obligations in any country?
Role
□ Yes
□ No
If yes please specify: ____________________________________________________________________
If no and you are a citizen of a country in which compulsory military service exists, state why you are
exempt from military service: ____________________________________________________________
Have you been associated with any intelligence agency or group, or law enforcement agency? □ Yes □ No
If yes please specify: ____________________________________________________________
Have you been associated with any group or organisation that has engaged in or promoted the use of
violence to further their aims.
□ Yes □ No
If yes please specify: _____________________________________________________________
Have you ever committed or been involved in the commission of war crimes, crimes against humanity,
and/or human rights abuses?
□ Yes □ No
If yes please specify: _____________________________________________________________
5
SECTION D: Immigration New Zealand Declaration - All applicants read and sign this declaration
I have provided true and correct answers to the questions in this form.
I agree to tell Immigration New Zealand about any changes to my circumstances that occur after making this
application.
I agree to leave New Zealand before my visa expires. If I remain in New Zealand after my visa has expired, I
may be liable for deportation.
I agree that if I am not entitled to free health care in New Zealand, I will pay for any health care or medical
assistance I may require in New Zealand.
I understand that Immigration New Zealand may provide information about my entitlement to work to
potential employers via the online VisaView system. VisaView is authorised by legislation.
I authorise Immigration New Zealand to provide information about my health and my immigration status to
any health service agency. I authorise any health service agency to provide information about my health to
Immigration New Zealand.
I authorise Immigration New Zealand to make any necessary enquiries about information on this form so that
they can:
• make a decision on this application
• answer enquiries about my immigration status once my application has been decided.
I authorise any agency that holds information (including personal information) related to those matters to
disclose that information to Immigration New Zealand.
I authorise Immigration New Zealand to provide information about my immigration status to my past, present
or future education provider and to the International Education Appeal Authority.
If I am granted a student visa with the condition that I am accompanied by a legal guardian, I agree to live with
my legal guardian. I understand that my visa and the visa of my legal guardian may be withdrawn if I do not
meet this condition.
If I am granted a limited visa, I agree that I will leave New Zealand on or before the expiry date of that visa. If I
do not leave New Zealand, I may be immediately deported from New Zealand without the right of appeal.
I authorise The University of Waikato to contact Immigration New Zealand regarding information on my visa
status during the duration of my study at The University of Waikato. I authorise Immigration New Zealand to
release relevant immigration status information to The University of Waikato.
If I am granted a student visa with the condition that I hold acceptable insurance, I understand the
requirements regarding insurance that I have agreed to on page 4.
Signature of applicant ___________________________________Date_______________________
Note: We cannot process your application until you have paid the visa fee and you are fully enrolled. The
University of Waikato is not responsible for student visas expiring due to delays in paying the $195
application fee or the student not completing enrolment procedures. You cannot travel outside New Zealand
before your visa label is issued by Immigration New Zealand.
Academic Progress When you apply to renew your student visa, your academic progress is reviewed. It is a
condition of your student visa that you must have 100% attendance, and pass at least 75% of your attempted
papers. If you have not met these conditions the University may not be able to process you visa application
and you would need to apply directly to Immigration New Zealand.
Provisional Enrolment: Please note that once your visa application is accepted for processing you are only
provisionally enrolled while we await the decision from INZ. If your application is declined, your enrolment
will be cancelled.
6