Travel History Request Form

Cook Islands Immigration Travel History Request Form

Use this form if you are applying for a copy of your movements in and out of the Cook Islands.
Travel History/Movement Check Request

Cook Islands Immigration securely holds travel history records for all travellers who arrive and depart the Cook Islands. The information held can be provided to an individual upon request and payment of the relevant fee.

Please note that the information can only be released to the person it specifically relates to. If you are applying for this letter on behalf of someone else, you must provide a copy of your government issued identification and a letter from the individual authorising you to request this information on their behalf.
Please select from the options below which orgnisation requires a copy of your travel history?*

Pension - New Zealand Ministry of Social DevelopmentPension - Cook Islands Ministry of Internal AffairsNew Zealand Inland Revenue DepartmentCook Islands Revenue Management DivisionNew Zealand Citizenship OfficeSuperannuationOther
The following fee is required to be paid before an Travel History/Movement Check letter is issued.*
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Travel History/Movement Check LetterLists your travel movement in and out of the Cook Islands.
$25.00NZD

Total

$0.00NZD
Full name - as per your passport*

Given namesSurname
Date of birth*

DayMonthYear
Gender*
Country of birth*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Nationality*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodePassport issuing country
Passport No.*
Expiry Date*

DayMonthYear
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Email*

Confirmation Email
Phone Number

Country CodeArea CodePhone Number
Provide a brief explanation of your request.*
Supporting Documents

The following documents must be provided;
Valid Passport*

or other valid government issued identification
Cancelof
Travel Information Request Form*

issued by the agency who is requesting this information
Cancelof
Any other additional information

upload any other documents that maybe relevant to your application for an exemption
Cancelof
PAYMENT INFORMATION

A $25.00 fee is required to be paid for the Travel History/Movement Check letter.
Please use the following details:

Bank: ANZ New Zealand
SWIFT Code: ANZBNZ22
Account No: 01 1839 0329172 00
Account Name: Cook Islands Government

Please ensure that you apply the following reference to your deposit:
IMM - (followed by your Name)

Once your application has been submitted you will be required to provide proof of this deposit on request by an Immigration official.
PAYMENT INFORMATION

A $25.00 fee is required to be paid for the Travel History/Movement Check letter.
Please use the following details:

Bank: Bank of the South Pacific
SWIFT Code: BOSPCKCR
Account No: 0159651401
Account Name: CIG-MIN OF FOREIGN

Please ensure that you apply the following reference to your deposit:
IMM - (followed by your Name)

Once your application has been submitted you will be required to provide proof of this deposit on request by an Immigration official.
Delcaration*

I hereby declare to the best of my ability that the above information is true and correct. I agree and understand that by ticking this box, this is the legal equivalent of my handwritten signature, and I consent to being legally bound by this declaration.
Date*

DayMonthYear
Please verify that you are human*
Once your request has been processed you will receive an email from our Immigration team with further details. You can expect to hear back within 7 working days.
For any queries contact Te Kauono Tutara e te Mana Tiaki, Ministry of Foreign Affairs & Immigration on (682) 29347 ext. 1 or email immigration.exemptions@cookislands.gov.ck
Should be Empty:

Cook Islands Immigration Travel History Request Form

Travel History/Movement Check Request

Supporting Documents

PAYMENT INFORMATION

PAYMENT INFORMATION