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
NoNZERNZHR
What is the immigration case number ? (If known)
TemporaryResidenceWork to Residence
VisitorStudentWorker with job offerWorker without job offer
Skill/BusinessFamilyPacific CategoriesHumanitarian UNHCRHumanitarian Other
WorkerFamily of Worker
Work to Residence - if worker, please state your intended work or occupation in New Zealand
Less than 6 months6 - 12 months12 - 24 monthsMore than 24 months
Required medical certificate
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)
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 *

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

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Please upload your current NZ visa

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Should be Empty:

Immigration NZ eMedical Information Form