LTBV Assessment Form

Congratulations! If you have got this far, then you will have read the minimum criteria and consider that you meet the standards required. To proceed with a request for a formal, personalised assessment, please complete the this form. Our assessment will be based on the latest information available from our authorities and will identify whether or not you qualify for residence in New Zealand.

The information requested in this questionnaire is necessary for us to evaluate your eligibility under the LTBV category. Please answer all the questions fully. It may take you some time to obtain the information and complete the questionnaire and you may prefer to print or save a copy of this file and work off-line. If you already have all the required information in a different format, you may prefer to attach that document instead of completing this form. When completed please forward to us by email, fax or mail.

Please note that the spouse of the holder of a Long-term Business Visa may apply for an open work visa and children of primary and secondary age may attend New Zealand schools on the same basis as local children. Children attending tertiary institutions must pay international fees.

Note: Your information is confidential to us and will not be provided to any other organisation without your written permission.

NOTE - PLEASE TAB TO NEXT FIELD
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Principal Applicant Details

Title	- Please select - Mr Mrs Ms Miss Dr Sir
(the following details to be shown as per passport)
Family Name:
Given Names:
Date of Birth:	Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month 01 02 03 04 05 06 07 08 09 10 11 12 Year Age[years]:
Email address: [please type carefully]
Postal address for mail delivery:
Street address for courier delivery:
Telephone:
Fax:

Spouse/DeFacto of Principal Applicant Details

(defacto partnership to be at least 18 months)

Title	- Please select - Mr Mrs Ms Miss Dr Sir
(the following details to be shown as per passport)
Family Name:
Given Names:
Date of Birth:	Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month 01 02 03 04 05 06 07 08 09 10 11 12 Year Age [years]:

Principal Applicant Past Business Experience

Organisation Name	Type of Business	Start Year	End Year

Spouse Business Experience or Work Details

Organisation Name	Type of sbusiness	Start Year	End Year

Your Proposed Business in NZ

Brief description of your proposed business in New Zealand. (Please explain briefly the products or services to be provided):

Do you plan to form a registered company?: Yes No

Ownership structure - Shareholding

Have you conducted any research into the New Zealand business market? Yes No Adequate research is a requirement of this category.

Please outline briefly the results of your research:

Please list the names of Shareholders and their respective shares held:

Funds Available

Describe the assets and value of your funds available. Please show current valuations for all transferable assets and funds, converted to US$.

Total Asset Value $US (or $NZ)

Do you wish to receive information on our exclusive 'Full Business Package' which includes immigration and the opportunity to purchase a qualifying business? Yes No

Please advise any additional information that you consider will assist us with our initial assessment.

Children

Please advise if you have any children and if so, what are their ages? List children's full names and ages

English Skills

Although proof of English language skills is not required for LTBV category applicants, evidence will be required later if an application for Residence is made under the Entrepreneur category.

Verification

In order for us to verify that you are a real person, please re-type the numbers and letters into this field.