Passport Verification (DIA) Application & Subscriber Agreement
Business name
*
Physical address
*
Postal address
*
Business website
*
NZBN, ABN or equivalent
If applicable
Charities registration number
If applicable
Legal status of business
*
Sole Trader, Partnership, Limited Liability, etc.
Please explain the nature of your business including its core functions
*
Please provide information detailing all purposes for which the agency will carry out identity information checks and the reasons why the proposed identity information checks need to be carried out.
Do you have a privacy policy?
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Yes
No
Do you have an information security policy?
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Yes
No
Do you have a risk management policy?
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Yes
No
Please provide the URL to your privacy policy
*
The DIA will automatically reject all applications that do not have a valid privacy policy URL. Create a free privacy policy here - https://form.jotform.com/211632459814053
Do you have a documented plan for security incidents
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Yes
No
Do you have a documented plan for business continuity / disaster recovery
*
Yes
No
Please provide details of any other relevant information regarding your Security and Risk Management practices, for example, the results of any relevant IT security assessment or audit or demonstrated compliance with the New Zealand Information Security Manual or equivalent:
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Has your business been found in breach of the New Zealand Privacy Act 1993 or any other relevant legislation or regulation; or any serious information security breaches either in New Zealand or overseas within the past five years?
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No
Yes
Signature
Date
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Signer's Name
*
Signer's Position
*
Applicant Name (Subscriber)
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Company Number
*
Phone
*
Address
*
Town/City
*
Postal Code
*
Please select your business structure
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Sole Trader
Partnership
Limited Liability
Other
Please nominate the purpose/s for access
*
ID Verification
Primary Contact Name
*
Primary Contact Phone
*
Primary Contact Email
*
Signature
*
Signer's Name
*
Signer's Title
*
Date
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
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