Immigration NZ eMedical Information

Immigration NZ eMedical Information Form
Applicant personal details
First Name(s):*
Middle Name(s):
Surname (Family Name): *
Date of Birth: *
Age: *
Gender: *
Country of birth: *
Age under 18 years - parent or legal guardian details required
First Name:
Last Name:
Relationship to you:
Visa category
Do you have an immigration case number (beginning with NZER or NZHR) ?*

NoNZERNZHR
What is the immigration case number ? (If known)
Select one*

TemporaryResidenceWork to Residence
If Temporary

VisitorStudentWorker with job offerWorker without job offer
If Residence

Skill/BusinessFamilyPacific CategoriesHumanitarian UNHCRHumanitarian Other
If Work to Residence

WorkerFamily of Worker
Work to Residence - if worker, please state your intended work or occupation in New Zealand
From today, how long do you intend to stay in New Zealand*

Less than 6 months6 - 12 months12 - 24 monthsMore than 24 months
Required medical certificate
Please select*

General Medical Certificate (INZ 1007)Chest X-ray Certificate only (INZ 1096)
If unsure, click this link from Immigration New Zealand
Chest X-ray Certificate (INZ 1096)
Do you require a chest x-ray?*

YesNo
Contact information
Only New Zealand addresses and phone numbers are accepted
Email address: *
New Zealand contact number (mobile preferred): *
Apartment or unit number:
Street number: *
Street name: *
Suburb:
Town or City: *
Postcode
Passport
Please upload a picture of your passport (or provide your passport details below)- Your passport must be current- You must still bring your original passport to the appointment *

Cancelof
Passport Number:
Current Passport Quality Photo and NZ visa document
Passport Style Photo *

Cancelof
Please upload your current NZ visa

Cancelof
Should be Empty:

Immigration NZ eMedical Information Form

Applicant personal details

Age under 18 years - parent or legal guardian details required

Visa category

Required medical certificate

Chest X-ray Certificate (INZ 1096)

Contact information

Passport

Current Passport Quality Photo and NZ visa document