Formular Emigrare NZ 1100

FOR NZIS USE
EOI reference number

Date received
Expression of Interest form
SKILLED MIGRANT CATEGORY
If you are interested in migrating to New Zealand as a skilled migrant, and if you have the skills we need, then completing this Expression
of Interest is your first step.
When you submit this Expression of Interest, you may be considered for an Invitation to Apply for residence in New Zealand only if you
meet the following requirements:
Character
Health
English language
Age
Meet the minimum threshold of 100 points for employability and capacity building factors
The criteria for each of these requirements are explained in this form as per the Governments Residence Policy (Skilled Migrant Category).
If you are unsure about whether you meet the prerequisites, use the Skilled Migrant Quick Check and the Points Indicator on the New Zealand
Immigration Service website at www.immigration.govt.nz to get an idea of whether its worth completing an Expression of Interest.
You must complete all the questions in the form, unless the form specifically directs you straight to another question or section further on.
If a question does not apply to you, mark it N/A or Not Applicable.
If you leave questions that qualify for the award of points blank, this will be interpreted as a no answer. If you fail to answer any other
questions or to clearly mark them as N/A or not applicable, we may send the incomplete form back to you and it will not be submitted
into the Expression of Interest Pool until all the necessary information is provided.
Expressions of Interest must be accompanied by the correct Expression of Interest Fee.
Do not send supporting documentation with your Expression of Interest form. Include only any additional sheets required to complete
questions in the form.
Detailed explanations to assist you to fill out this form can be found in the Expression of Interest Guide or on the New Zealand
Immigration Service website at www.immigration.govt.nz
If you are found to have provided false information or to have omitted any relevant information in the Expression of Interest, or any
subsequent application(s), your application may be declined and you will lose the right to appeal the decision to decline your application.
Principal applicant
Section A: Identity
In this section we need to confirm that you are who you say you are. Please provide the following information
about yourself.
A
Family name
Given name(s)
Please provide all other names you are/or have been known by.
Preferred title
Mr
Mrs
Ms
Miss
Dr
Other (please specify)

Expression of Interest form Principal applicant NZIS 1100
pg 1
Gender
Date of birth
You are eligible for points for your age up to the age of 56. If you are
aged 56 and over your Expression of Interest will not be accepted into the
Pool and you should not complete any further questions. Section SM18
of the Skilled Migrant Category Policy refers.
Country of birth
Male
Female
POINTS
D D MM Y Y
Country
A
Please provide your Birth Certificate number and the name of the issuing authority.
Birth Certificate number
Name of issuing authority
10 Please provide details of all passports currently held.
Please state your main country of citizenship/nationality.
Passport number
Country
Family name
Given name(s)
Date of issue
D D MM Y Y
Date of expiry
D D MM Y Y
Date of expiry
D D MM Y Y
Place of issue
Passport number
Country
Family name
Given name(s)
Date of issue
D D MM Y Y
Place of issue
Passport number
Country
Family name
pg 2
CLAIMED
Given name(s)
Date of issue
D D MM Y Y
Date of expiry
D D MM Y Y
Place of issue
A
11 Please list any other citizenships currently held.
12 Where applicable, please provide the following details.

Driver licence
Name(s) as shown on driver licence
Driver licence number
Valid for which country/state/area
Expiry date
D D MM Y Y

Expiry date
D D MM Y Y

Expiry date
D D MM Y Y
Taxation number
Taxation number
Country
Social Security number
Country
pg 3
13 Please list all countries, including all countries of citizenship, you have lived in for a total of 12 months or more in
the last 10 years. Include all countries where your stay has been broken by any departures.
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
14 Please provide your residential address and contact details. This will be considered your permanent place of
residence for tax purposes.
Number and street name
Suburb
City
County/Province/State
PIN/ZIP
Country
Telephone
(Country code/Area code/Telephone number)
(eg+12 3 456 7890)
Email
If different from your residential address, please provide your mailing address.
If you are in New Zealand and list a New Zealand address, this will be your New Zealand address for the purpose of
the New Zealand Immigration Act.
pg 4
Number and street name/PO Box
Suburb
City, PIN/ZIP code
Country
A
15 What is your current partnership status? (Select only one)

Married
De facto
Separated
Divorced
Widowed
Never married
A
16 Do you meet the minimum requirements for recognition of partnerships? Refer to the
Yes
No
Yes
No
Guide under Partner in the section Summary of Terms.

A
17 Will your partner be included in your residence application?
18 How many children do you have? This includes biological, adopted, step-children from previous marriages/
relationships.
Will any of these children be included in your residence application?
Yes
No
For each DEPENDENT child who will be included in your residence application, please complete a Child Supplement
Expression of Interest Form. Please refer to the Guide under Dependent Children in the section Summary of Terms.
If you are separated or divorced and bringing a child under 16 years of age with you to New Zealand, we will need to
see proof of their right to leave their home country and your right to remove them. Section F5.20 of the Governments
Residence Policy refers.
A
19 What is your main occupation?

PLEASE NOTE: Your main occupation is the job you spent most hours doing in the last 12 months. If you have not
worked in the last 12 months, please state your previous occupation. If you have not worked for the past five years
or more, please state "Not applicable".
20 If you have an agent acting on your behalf, or someone assisting you to complete this Expression of Interest, please
provide the following details for this person.
Please refer to the Guide to see who can assist you fill out your Expression of Interest.
Name
Number and street name/PO Box
Suburb and city

Country
Phone/night
Phone/day
pg 5
Phone/cellular
(Country code/Area code/Cellular number)
Email
A
21 Do you authorise the person listed in Question A19 to act on your behalf in relation to this
Yes
No
Expression of Interest?
A
22 Please indicate who you prefer the New Zealand Immigration Service to communicate directly with. Select only one.
You
You and a copy to the person listed in Question A15 where communication is made by way of email or a letter
The person listed in Question A15 only.
PLEASE NOTE: The NZIS reserves the right to contact the principal applicant directly on any matter relating to this
Expression of Interest.
23 What is your preferred means of communication in relation to this Expression of
Email
Letter
Interest?
Section B: Character
In this section we need to confirm that you are of good character which is a prerequisite of the Skilled Migrant Category..
Please provide the following details about your character. Section A5 of the Governments Immigration Policy refers.
Questions B1 to B9 relate to section 7(1) of the Immigration Act (persons prohibited from being granted a residence
permit). People described in section 7(1) of the Immigration Act cannot ordinarily be granted residence in New
Zealand.
B
Have you ever been sentenced to imprisonment for a term of five years or more (including
any expunged criminal records)?
Yes
No
Have you been sentenced to imprisonment for a term of 12 months or more

within the last 10 years (including any expunged criminal records)?
Yes
No
Do you have a removal order from New Zealand currently in force against you?
Yes
No
Have you ever been deported from any country, including New Zealand?
Yes
No
Have you been involved in any terrorist activities or supported similar violent activities?
Yes
No
Have you been a member of, or belonged to, any terrorist group?
Yes
No
Have you been involved in any drug trading or trafficking?
Yes
No
Have you been a member of, or belonged to, any group with criminal objectives?
Yes
No
Have you been a member of, or belonged to, any group that has engaged in or supported
criminal activities?
Yes
No
10 Are you currently under investigation, or wanted, by any law enforcement agency in any country?
Yes
No
11 Have you ever been convicted or found guilty of any offence(s) against the law in any country?
Yes
No
pg 6
12 Have you been convicted of an offence (including a traffic offence), committed within
Yes
No
the last five years, involving dangerous driving, driving having consumed excessive alcohol
(including drunk driving and driving with a blood or breath alcohol content in excess of a
specified limit) or driving having consumed drugs?
B
13 Have you ever been charged with any offence against the law in any country?
Yes
No
14 Have you ever been removed from any country, including New Zealand?
Yes
No
15 Have you ever been refused entry to any country, including New Zealand?
Yes
No
16 Have you ever been refused a visa/permit for any country, including New Zealand?
Yes
No
17 Have you been involved in any people trafficking?
Yes
No
18 Have you been a member of, or belonged to, any group of people that had/has objectives
Yes
No
Yes
No
Yes
No
or principles based on hostility against people or groups of people on the basis of colour,
race, ethnic or national origins?
B
19 Have you been a member of, or belonged to, any group of people that had/has objectives
or principles based on an assumption that persons of a particular race or colour are
inherently inferior or superior to other races or colours?
20 Have you, in the course of applying for a New Zealand visa/permit, made any statement
or provided any information, evidence or submission that was false, misleading or forged, or
withheld material information?
If you answered yes to any of questions B1 to B9, you must provide a full explanation about the
surrounding circumstances. If, having considered your explanation, the NZIS assesses that you are a person
to whom section 7(1) of the Immigration Act applies, your Expression of Interest cannot be excepted into
the Pool.
If you answered yes to any of questions B9 to B20, you must provide a full explanation about the
surrounding circumstances. If your Expression of Interest is selected from the Pool, you may be asked to
provide a police certificate or other relevant information.
Please attach additional sheets if necessary.
Section C: Health
In this section we need to confirm that you meet a minimum standard of health, which is a prerequisite of the
Skilled Migrant Category. Providing accurate information about your health status is very important. Please
provide the following details about your health. Section A4 of the Governments Immigration Policy refers.
Questions C1 to C4 concern medical conditions for which a medical waiver cannot be granted. People with
these conditions cannot ordinarily be granted residence in New Zealand.
C
Do you or are you likely to require dialysis treatment in the immediate future?
Yes
No
Do you have active tuberculosis?
Yes
No
pg 7
Do you have a mental disorder or intellectual disability that has needed care in a hospital
or supervised residence for more than 90 days in the last two years?
Yes
No
Do you have a physical incapacity that requires full-time care?
Yes
No
Have you been exposed to, or diagnosed with, any infectious or communicable disease?
Yes
No
Are you receiving, or have received, any treatment for any psychiatric condition or
developmental disorder?
Yes
No
Do you have any condition that is likely to require ongoing treatment or medication?
Yes
No
If you answered yes to any of questions C1 to C4, you must provide an explanation of your medical
condition. If, having considered your explanation, the NZIS assesses that your medical condition is one for
which a medical waiver cannot be granted, your Expression of Interest cannot be accepted into the Pool.
If you answered yes to any of questions C5 to C7, you must provide a full explanation of your medical
condition. If your Expression of Interest is selected from the Pool, you may be asked to provide a medical
certificate to confirm this information.
Section D: English language ability

In this section we ask you to confirm that you meet the minimum standard of English language, which is a
prerequisite of the Skilled Migrant Category. Please provide the following details about your English language
ability. Section SM5 of the Skilled Migrant Category policy refers.
D
Please indicate who you meet the minimum standard of English, as defined in the Guide under English Language
Requirements in the section Summary of Terms. (Select one only)
An IELTS Test Report with an overall band score of 6.5 or more
] Go to Q D3
Study for a recognised qualification conducted entirely in English
] Go to Q E1
Current skilled employment in New Zealand for 12 months or more ] Go to Q E1

Otherwise meet the minimum standard, as defined in the Guide
] Go to Q D2
PLEASE NOTE: If you selected one of the last three options, you may be asked to provide an IELTS certificate.
If you cannot demonstrate that you meet the minimum standard of English, your Expression of Interest
cannot be accepted into the Pool. You should not complete any further questions.
pg 8
Please provide details explaining why you meet the minimum standard, as defined in the Guide under
English Language Requirements in the section Summary of Terms.
If you have an IELTS certificate, what is your IELTS Test Report Form number?
What was the date you sat your test?
D D MM Y Y
Overall IELTS band score

The following sections outline the factors which qualify for points. To submit your Expression of Interest,
you must meet the minimum threshold of 100 points.
Section E: Skilled employment

In this section you qualify for points and bonus points, depending on whether you have current skilled employment in
New Zealand or an offer of skilled employment in New Zealand. Please provide the following details about your
employment. Sections SM7, SM8, SM9 and SM19 of the Skilled Migrant Category Policy refer.
E
Are you claiming points for skilled employment, and declare that you meet policy criteria for any of the following?
Refer to the Guide under Skilled Employment in the section Summary of Terms. Select only one.
POINTS
Current skilled employment in New Zealand for 12 months or more

CLAIMED
Current skilled employment in New Zealand for less than 12 months

Offer of skilled employment in New Zealand
None of the above ] Go to Q F1
E
What is your job title?
Please indicate why you believe this job is skilled employment. For example, what specialist, technical or management
expertise this job requires. Refer to the Guide under Skilled Employment in the section Summary of Terms.

E
Please provide the following details for the skilled employment listed above.
Employer contact name (manager)
pg 9
Business/organisation name
Suburb
City
PIN/ZIP
Country
Telephone
(Country code/Area code/Telephone number eg+12 3 456 7890)
E
To do your job in New Zealand, do you require full or provisional occupational registration? Refer to the Guide under
POINTS
Occupational Registration in the section Summary of Terms.
No
Yes, please provide the following:

CLAIMED
New Zealand Occupational Registration Number (if applicable)

Name of the New Zealand Occupational Registration Body
E
Is your skilled employment outside Auckland? Refer to the Guide under Employment outside Auckland in the section
Summary of Terms.
POINTS
Yes
No
CLAIMED
Is your skilled employment in one of the identified future growth areas? If yes, please provide the growth area
name. Refer to the Guide under Identified Future Growth Area in the section Summary of Terms for the future
POINTS
growth area names.
Yes
No ] Go to Q E8
CLAIMED
Growth area name

E
Is your skilled employment in one of the identified clusters? If yes, please provide the cluster name. Refer to the
POINTS
Guide under Cluster in the section Summary of Terms for cluster names.
Yes
No ] Go to Q E9
CLAIMED
Cluster name
E
Is your skilled employment in one of the areas of absolute skills shortage? If yes, please provide the absolute skills
shortage occupation name. Refer to the Priority Occupations List (POL) on our website www.immigration.govt.nz or
request a copy of the List from your nearest NZIS branch.
POINTS
Yes
No ] Go to Q F1
CLAIMED
Absolute skills shortage occupation name

PLEASE NOTE: If you are invited to apply for residence your employer will need to confirm your claims in relation to
questions E8 and E9.
pg 10
Section F: Recognised qualification(s)

In this section you qualify for points and bonus points if you have a recognised qualification(s). Please provide
the following details about your qualification(s). Sections SM14, SM15 and SM16 of the Skilled Migrant
Category Policy refer.
POINTS
Are you claiming points for a recognised qualification(s) and declaring that you meet policy criteria? Refer
to the Guide under Recognised Qualification in the section Summary of Terms
CLAIMED
Yes
F
No
Please provide the details of the recognised qualification(s) for which you are claiming points.
Name of qualification
Date obtained
D D MM Y Y
Date commenced studies
Major area of study

Date completed studies
D D MM Y Y
D D MM Y Y
Institution name
Address
Phone
Student ID#

F
2a
Is this qualification(s) included on the List of Recognised Qualifications, (refer to form NZIS 1080) or has an
Occupational Registration Body assessed your qualification(s) as comparable to a New Zealand qualification that is
on the List of Recognised Qualifications?
Yes
No ] Go to Q F2c
Please provide level
If your qualification is a level 4 acceptable trade, please provide the name of the acceptable trade.
2b Has your qualification(s) been assessed by the NZQA?

Yes
No ] Go to Q F3
PLEASE NOTE: If you have answered no to questions F2a and F2b, this qualification does not qualify for points as a
recognised qualification(s).
F
2c
What is the level assessed by the New Zealand Qualifications Authority (NZQA)? Refer to the guide under New
Zealand Qualifications in section Summary of Terms.
Level
2d What are the reference number, type and level assessed by NZQA? Refer to the Guide under Qualifications
Assessment Report in the section Summary of Terms.
Reference number
pg 11
Type
Preliminary
Interim
Full
Level
What New Zealand qualification(s) was your qualification(s) assessed as being comparable with?
3 Do you have a recognised New Zealand qualification(s) gained after two or more years of study in New Zealand?
POINTS
No ] Go to Q F4
Yes, please provide the following details:

CLAIMED
Name of qualification(s)
D D MM Y Y
Date obtained
Major area of study
D D MM Y Y
D D MM Y Y
Institution name
Suburb
City
PIN/ZIP
Country
Telephone
Student ID#
(eg+12 3 456 7890)
Qualifications and bonus points

PLEASE NOTE: A qualification(s) in an identified future growth area or cluster only qualifies for bonus points if you
are also claiming points for current skilled employment or an offer of skilled employment in an identified future
growth area or cluster.
Only complete Questions F4 to F6 if you are claiming points for current skilled employment or an offer of skilled employment.
Is your qualification(s):
F
4 Is your qualification(s) in one of the identified future growth areas? If yes, please provide the growth area name.
Refer to the Guide under Identified Future Growth Area in the section Summary of Terms for growth area names.
Yes
No ] Go to Q F5
Growth area name

F
5 Is your qualification(s) in one of the identified clusters? If yes, please provide the cluster name. Refer to the Guide
under Cluster in the section Summary of Terms for cluster names.
Yes
No
] Go to Q F6
Cluster name
pg 12
Is your qualification(s) in one of the areas of absolute skills shortage? If yes, please provide the absolute skills
shortage occupation name. Refer to the Priority Occupations List (POL) on our website at www.immigration.govt.nz
or request a copy of the List from your nearest NZIS branch.
No ] Go to Q G1
Yes

F
If this qualification(s) is not the qualification(s) for which you claimed points for in questions F2 to F4, please
provide the following details about qualification(s).
Name of qualification
Date obtained
D D MM Y Y
Major area of study

D D MM Y Y
D D MM Y Y
Institution name
Address
Phone
Student ID#

F
7a
Is this qualification(s) included on the List of Recognised Qualifications, (refer to form NZIS 1080) or has an
Occupational Registration Body assessed your qualification(s) as comparable to a New Zealand qualification that is
on the List of Recognised Qualifications?
Yes
No
Please provide level
If your qualification is a level 4 acceptable trade, please provide the name of the acceptable trade.
7b Has your qualification(s) been assessed by the NZQA?

Yes
No
PLEASE NOTE: If you have answered no to questions F7a and F7b, this qualification does not qualify for points as a
recognised qualification(s).
F
7c
What is the level assessed by the New Zealand Qualifications Authority (NZQA)? Refer to the guide under New
Zealand Qualifications in section Summary of Terms.
Level
7d What are the reference number, type and level assessed by NZQA? Refer to the Guide under Qualifications
Reference number
Type
Preliminary
Interim
Full
Level
pg 13
What New Zealand qualification(s) was your qualification(s) assessed as being comparable with?
Section G: Recognised work experience

In this section we recognise the importance of skills and experience gained through your previous employment
that:
are readily transferable; and
will enable you to get skilled employment in New Zealand; and
will help you to contribute to New Zealand socially and economically.
Please provide the following details about the recognised work experience for which you are claiming
points. Sections SM11, SM12 and SM13 of the Skilled Migrant Category Policy refer.
PLEASE NOTE: If you do not have current skilled employment in New Zealand or an offer of skilled employment in
New Zealand, you can only qualify for points for your work experience if it is recognised, and was gained legally in
a labour market that is comparable to New Zealand. Refer to the Guide under Comparable Labour Market in the
section Summary of Terms.
G
Work experience 1
From D D M M Y Y
To D D M M Y Y
Name of employer
Suburb
City
PIN/ZIP
Country
Type of business
Position held
Country employer is domiciled in

Telephone
Contact name
(eg+12 3 456 7890)
Please indicate why you believe this work experience should be recognised. Refer to the Guide under Recognised
Work Experience in the section Summary of Terms. (For example, it is relevant to your recognised qualification, or
your skilled employment.)
pg 14
Work experience 2
From D D M M Y Y
To D D M M Y Y
Name of employer
Suburb
City
PIN/ZIP
Country
Type of business
Position held

Telephone
Contact name
(eg+12 3 456 7890)
Work experience 3
From D D M M Y Y
To D D M M Y Y
Name of employer
Suburb
City
PIN/ZIP
Country
Type of business
Position held
pg 15
Telephone
Contact name
(eg+12 3 456 7890)
Please indicate the total number of years of work experience in New Zealand. Refer to the the Guide under
Recognised Work Experience in the section Summary of Terms.
POINTS
2 but less than 4 years
6 years or more
None of the above
CLAIMED
Please indicate the total number of years of recognised work experience. Refer to the Guide under Recognised Work
Experience in the section Summary of Terms. Include any New Zealand work experience indicated in QG2.
POINTS
10 years or more
None of the above
CLAIMED
Please indicate the total number of years of work experience in an identified future growth area. Refer to the Guide
under Identified Future Growth Area in the section Summary of Terms. You need to note that work experience in an
identified future growth area only qualifies for bonus points if you are also claiming points for current skilled
employment or an offer of skilled employment in an identified future growth area.
POINTS
6 years and over
None of the above
CLAIMED
Growth area name

G
Please indicate the total number of years of work experience in an identified cluster. Refer to the Guide under
Cluster in the section Summary of Terms. You need to note that work experience in an identified cluster only
qualifies for bonus points if you are also claiming points for current skilled employment or an offer of skilled
employment in an identified cluster.
POINTS
6 years and over

CLAIMED
None of the above

Cluster area name
pg 16
Please indicate the total number of years of work experience in an area of absolute skills shortage. Refer to the
Guide under Area of Absolute Skills Shortage in the section Summary of Terms.
POINTS
6 years and over

CLAIMED
None of the above

Section H: Partners identity

In this section we need to gather and confirm your partners personal details. Please provide the following
information about your partner. You need to provide this information even if your partner is not intending
to apply for residence with you.
H
Family name
Given name(s)
Please provide all other names your partner is/or has been known by.
Preferred title
Mr
Mrs
Ms
Miss
Dr
Other (please specify)

H
Gender
Country of birth
Please provide your partners Birth Certificate number and the name of the issuing authority.
Male
Female
6 Date of birth
D D MM Y Y
Birth Certificate number

Name of issuing authority
H
Please provide your partners main country of citizenship/nationality.
10 Please provide details of all passports currently held by your partner.

Passport number
Country
Family name
Given name(s)
Date of issue
D D MM Y Y
Date of expiry
D D MM Y Y
pg 17
Place of issue
Passport number
Country
Family name
Given name(s)
Date of issue
D D MM Y Y
Date of expiry
D D MM Y Y
Date of expiry
D D MM Y Y
Place of issue
Passport number
Country
Family name
Given name(s)
Date of issue
D D MM Y Y
Place of issue
H
11 Please list any other citizenships currently held.
12 Where applicable, please provide the following details:

Driver Licence
Expiry date
D D MM Y Y

Expiry date
D D MM Y Y

pg 18

Expiry date
D D MM Y Y
Taxation number
Taxation number
Country
Country
H
13 Please list all countries, including all countries of citizenship, your partner has lived in for a total of 12 months or
more in the last 10 years. Include all countries where their stay has been broken by any departures.
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
From
MM Y Y
To M M Y Y
Country
Section I: Partners character

In this section we need to confirm that your partner is of good character which is a prerequisite of the Skilled
Migrant Category.. Please provide the following details about your partners character. Section A5 of the
Governments Residence Policy refers.
Questions I1 to I9 relate to section 7(1) of the Immigration Act (persons prohibited from being granted a permit).
People described in section 7(1) of the Immigration Act cannot ordinarily be granted residence in New Zealand.
I
Has your partner ever been sentenced to imprisonment for a term of five years or more
(including any expunged criminal records)?
Yes
No
pg 19
Has your partner been sentenced to imprisonment for a term of 12 months or more within
the last 10 years (including any expunged criminal records)?
Yes
No
Does your partner have a removal order from New Zealand currently in force against them?
Yes
No
Has your partner ever been deported from any country, including New Zealand?
Yes
No
Has your partner ever been involved in any terrorist activities or supported similar
violent activities?
Yes
No
Has your partner been a member of, or belonged to, any terrorist group?
Yes
No
Has your partner been involved in any drug trading or trafficking?
Yes
No
Has your partner been a member of, or belonged to, any group with criminal objectives?
Yes
No
Has your partner been a member of, or belonged to, any group that has engaged in or
supported criminal activities?
Yes
No
If you answered yes to any of questions I1 to I9 above, you must provide a full explanation about the surrounding
circumstances. If, having considered your explanation, the NZIS assesses that your partner is a person to whom
section 7(1) of the Immigration Act applies, your Expression of Interest cannot be accepted into the Pool.
I
10 Is your partner currently under investigation, or wanted, by any law enforcement agency
Yes
No
Yes
No
Yes
No
in any country?
I
11 Has your partner ever been convicted or found guilty of any offence(s) against the law
in any country?
12 Has your partner been convicted of an offence (including a traffic offence), committed
within the last five years, involving dangerous driving, driving having consumed excessive
alcohol (including drunk driving and driving with a blood or breath alcohol content in excess
of a specified limit) or driving having consumed drugs?
13 Has your partner ever been charged with any offence against the law in any country?
Yes
No
14 Has your partner ever been removed from any country, including New Zealand?
Yes
No
15 Has your partner ever been refused entry to any country, including New Zealand?
Yes
No
16 Has your partner ever been refused a visa/permit for any country, including New Zealand?
Yes
No
17 Has your partner been involved in any people trafficking?
Yes
No
18 Has your partner, been a member of, or belonged to, any group of people that had/has
Yes
No
Yes
No
Yes
No
objectives or principles based on hostility against people or groups of people on the basis
of colour, race, ethnic or national origins?
I
19 Has your partner been a member of, or belonged to, any group of people that had/has
objectives or principles based on an assumption that persons of a particular race or colour
are inherently inferior or superior to other races or colours?
20 Has your partner, in the course of applying for a New Zealand visa/permit, made any
statement or provided any information, evidence or submission that was false, misleading
or forged, or withheld material information?
pg 20
If you answered yes to any of these questions, you must provide a full explanation about the surrounding
circumstances. If your Expression of Interest is selected from the Pool your partner may be asked to provide
a police certificate.
Section J: Partners health

In this section we need to confirm that your partner meets a minimum standard of health which is a prerequisite for the
Skilled Migrant Category . Providing accurate information about your partners health status is very important. Please
provide the following details about your partners health. Section A4 of the Governments Immigration Policy refers.
Questions J1 to J4 concern medical conditions for which a medical waiver cannot be granted. People with
these conditions cannot ordinarily be granted residence in New Zealand.
J
Does your partner, or is your partner likely to, require dialysis treatment in the immediate future?
Yes
No
Does your partner have active tuberculosis?
Yes
No
Does your partner have a mental disorder, or intellectual disability that has needed care
in a hospital or supervised residence for more than 90 days in the last 2 years?
Yes
No
Does your partner have a physical incapacity that requires full-time care?
Yes
No
If you answered yes to any of questions J1 to J4 above, you must provide an explanation of your medical
condition. If, having considered your explanation, the NZIS assesses that your partners medical condition is one
for which a medical waiver cannot be granted, your Expression of Interest cannot be accepted into the Pool.
J
Has your partner been exposed to, or diagnosed with, any infectious or communicable disease?
Yes
No
Is your partner receiving, or has received, any treatment for any psychiatric condition or
developmental disorder?
Yes
No
Does your partner have any condition that is likely to require ongoing treatment or
medication?
Yes
No
If you answered yes to any of these questions, you must provide a full explanation of your partners
medical condition. If your Expression of Interest is selected from the Pool you may be asked to provide a
medical certificate to confirm this information.

pg 21
Section K: Partners English language ability

The information you provide in this section will give us an indication of your partners English language ability.
Meeting the minimum standard of English language will assist your partner to settle successfully in New Zealand.
Please provide the following details about your partners English language ability. Section SM5 of the
Skilled Migrant Category Policy refers.
K
Does your partner meet the minimum standard of English, listed below? Refer to the Guide under English Language
Requirements in the section Summary of Terms. Select only one.
An IELTS Test Report with an overall band score of 5 or more
] Go to Q K3
An IELTS Test Report with an overall band score of 6.5 or more if you are claiming
points for your partners skilled employment, offer of skilled employment and
recognised qualifications.
] Go to Q K3
Study for a recognised qualification conducted entirely in English
] Go to Q L1
Completed qualifications that meet the minimum standard, as defined in the Guide ] Go to Q L1
Current skilled employment in New Zealand for 12 months or more
] Go to Q L1
Otherwise meets the minimum standard, as defined in the Guide
] Go to Q K2
None of the above

PLEASE NOTE: Unless you are claiming points for your partners recognised qualification, skilled employment or
offer of skilled employment, partners must pre-purchase English for Speakers of Other Languages (ESOL) tuition if
they do not meet the minimum standard of English. They will need to attend English language classes once they
arrive in New Zealand.
K
Please provide details explaining why your partner meets the minimum standard. Refer to the Guide under English
Language Requirements in the section Summary of Terms.
If your partner has an IELTS certificate, what is the Test Report Form number?
What was the date that your partner sat their test and the score? D D M M Y Y
Overall IELTS band score
pg 22
Section L: Partners skilled employment

In this section you can qualify for bonus points if your partner has current ongoing skilled employment in New
Zealand or an offer of ongoing skilled employment in New Zealand. Your partner will only be able to claim points
for an offer of skilled employment in New Zealand if they meet the English language requirements for principal
applicants. Refer to the Guide under English Language Requirements in the section Summary of Terms.
Furthermore, if your partner has an offer of employment in an occupation which requires registration, your partner
will only be able to claim points for this offer of employment if they have the required registration. Occupations
requiring registration can be found in the Guide under Occupational Registration in the section Summary of Terms.
Please provide the following details about your partner's skilled employment. Section SM10 of the Skilled
Migrant Category Policy refers.
L
Are you claiming points for your partners skilled employment? Refer to the Guide under Skilled Employment in the
section Summary of Terms. Select only one.
POINTS
Offer of skilled employment in New Zealand

Current skilled employment in New Zealand for more than 12 months
CLAIMED
Current skilled employment in New Zealand for less than 12 months

None of the above ] Go to Q M1
L
What is your partners job title?
Please indicate why you or your partner believe this job is skilled employment. Refer to the Guide under Skilled
Employment in the section Summary of Terms.
Please provide the following details for the skilled employment detailed above.
Employer contact name (manager)
Business/organisation name
Suburb
City
PIN/ZIP
Country
Telephone
(eg+12 3 456 7890)
pg 23
Section M: Partners recognised qualification(s)

In this section we need to confirm whether your partners qualification(s) will be recognised in New Zealand.
PLEASE NOTE: Your partner will only be able to claim points for their qualification(s) if they meet the English
language requirements for principal applicants. Refer to the Guide under English language requirements in the
section Summary of Terms. Please provide the following details about your partners recognised
qualification(s). Section SM17 of the Skilled Migrant Category Policy refers.
M
Are you claiming points for your partners recognised qualification(s)? Refer to the Guide under
Recognised Qualification in the section Summary of Terms.
POINTS
CLAIMED
Yes
M
No
Please provide the details of the recognised qualification(s) for which your partner is claiming points:
Name of qualification(s)
Date obtained
D D MM Y Y
Major area of study
D D MM Y Y
Date completed studies D D M M Y Y
Institution name
Address
Phone
M
2a
Student ID#
Is this qualification(s) included on the List of Recognised Qualifications (refer to form NZIS 1080)?
No ] Go to Q M2c
Yes
M
2b
What is the level assessed by the NZQA, as defined in the Guide?

Level
2c
Has this qualification(s) been assessed by the NZQA?

No ] Go to Q N1
Yes
M
2d
What is the reference number, type and level assessed by the NZQA? Refer to the Guide under Qualifications
Reference number
Type
Preliminary
Interim
Full
Level
What New Zealand qualification(s) was this qualification(s) assessed as being comparable with?
pg 24
Section N: Other family

Children
N
How many children do you have? This includes biological, adopted and step-children from previous marriages/
relationships.
Please provide the following details for your children (including biological, adopted and step-children from previous
marriages/relationships).
Full name
Gender
Male
Female
Date of birth D D M M Y Y
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Country of residence
Will this child be included in your application for residence?
Yes
No
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Yes
No
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Yes
No
pg 25
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Yes
No
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Yes
No
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Yes
No
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
pg 26
Yes
No

For each DEPENDENT child who will be included in your residence application, please complete a Child
Supplement Expression of Interest form. Please refer to the Guide under Dependent Children in the
section Summary of Terms.
If you are separated or divorced and bringing a child under 16 years of age with you to New Zealand, we
will need to see proof of their right to leave their home country and your right to remove them. Section
F5.20 of the Government's Residence Policy refers.
N
Give details of ALL your family, including those adopted legally or by custom. It is not necessary to list deceased family
members. Family includes biological and adoptive parents, siblings (including step, half and adopted brothers and
sisters), cousins, nieces and nephews, etc.
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Widowed
Never Married
Widowed
Never Married
Relationship to you
Full name
Gender
Male
Female
Date of birth
D D MM Y Y
Partnership status
Married
De facto
Separated
Divorced
Relationship to you
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
pg 27
Relationship to you
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Widowed
Never Married
Widowed
Never Married
Widowed
Never Married
Relationship to you
Full name
Gender
Male
Female
Date of birth
D D MM Y Y
Partnership status
Married
De facto
Separated
Divorced
Relationship to you
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Relationship to you
Full name
Gender
Male
Female
Partnership status
Married
pg 28
De facto
Separated
Divorced
Relationship to you
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Widowed
Never Married
Widowed
Never Married
Relationship to you
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Relationship to you
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Relationship to you
pg 29
Section O: Partners family

Children
O
How many children does your partner have? This includes biological, adopted and step-children from previous
marriages/relationships. Do not include children already listed under N1.
None
Please provide the following details for your partners children (including biological, adopted and step-children from
previous marriages/relationships).
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Yes
No
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Yes
No
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
pg 30
Yes
No
Full name
Gender
Male
Female
Date of birth
D D MM Y Y
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Yes
No
Full name
Gender
Male
Female
Date of birth
D D MM Y Y
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Yes
No
Full name
Gender
Male
Female
Date of birth
D D MM Y Y
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Yes
No

For each DEPENDENT child who will be included in your residence application, please complete a Child
Supplement Expression of Interest form. Please refer to the Guide under Dependent Children in the section
Summary of Terms.
If your partner is separated or divorced and bringing a child under 16 years of age with them to New
Zealand, we will need to see proof of their right to leave their home country and your partners right to
remove them. Section F5.20 of the Governments Residence Policy refers.
pg 31
Give details of ALL your partners family, including those adopted legally or by custom. It is not necessary to list
deceased family members. Family includes biological and adoptive parents, and full, half, step and adopted
brothers and sisters.
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Widowed
Never Married
Widowed
Never Married
Relationship to you
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Relationship to you
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Relationship to you
Full name
Gender
pg 32
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Widowed
Never Married
Widowed
Never Married
Widowed
Never Married
Relationship to you
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Relationship to you
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Relationship to you
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Relationship to you
Full name
pg 33
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Widowed
Never Married
Widowed
Never Married
Widowed
Never Married
Relationship to you
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Relationship to you
Full name
Gender
Male
Female
Partnership status
Married
De facto
Separated
Divorced
Relationship to you
pg 34
Declaration
This section must be signed by the principal applicant on behalf of all people included in this Expression of Interest.
Make sure you understand the declarations below before you sign and agree to them.
Important
I understand that if I make any false statements, or provide any false or misleading
information, or have changed or altered this form (including the Child Supplement
form) in any material way, my Expression of Interest may be declined, my residence visa
or permit may later be revoked, I lose any right to appeal, and I may also be committing
an offence and liable to prosecution.
Yes
I understand the notes and questions in this form (including the Child Supplement
form), and I declare the information given about myself, my partner and any children is
true and complete.
Yes
I declare that I have listed all my family members, including any adopted by law or by
custom and my grandparents or legal guardians (if any) if both my parents are
deceased, and understand that the non-declaration of any family members may result
in that family member not being recognised as part of my family in future applications.
Yes
I declare that I will inform the New Zealand Immigration Service (NZIS) of any relevant
fact or any change of circumstances that may: (i) affect the decision on my Expression
of Interest form and application for a permit, or (ii) affect the decision to grant a permit
that relies on the visa for which I am expressing interest and applying.
Yes
I declare that there are no matters or warrants outstanding, or investigations of any kind,
which could have any current or future effect on the assessment of my good character, or
the good character of any other persons included in this Expression of Interest.
Yes
I authorise the NZIS to make any enquiries it deems necessary regarding the
information provided on this form (including the Child Supplement form), and to share
this information with other Government agencies (including overseas agencies) to the
extent necessary to make decisions about my immigration status. I also consent to any
organisation providing relevant information to the NZIS about me.
Yes
I authorise the NZIS to provide information about my state of health and my

immigration status to any health service agency. I authorise any health service agency
to provide information about my state of health to the NZIS.
Yes
I accept that any advice given to me by the NZIS before expressing interest and
submitting this form (including the Child Supplement form) was intended to assist me,
and acting on that does not mean that my application for residence will be granted.
Yes
I understand that in order to work in certain occupations in New Zealand, registration is

required by law. I accept that the grant of residence does not guarantee that
registration will be granted.
Yes
Signature of principal
applicant
D D MM Y Y
pg 35
Declaration for person assisting the applicant to complete this form

To be completed and signed by any person who has assisted the applicant to complete this form by explaining,
translating or filling in the form for the applicant.
Full name of person assisting
Address of person assisting
I understand that after the applicant has signed this form (including the Child Supplement form) it is an offence to
alter or enter further information on it, alter any material attached to it, or attach any further material to it, unless
the person making the alteration or addition states on the form what information or material has been altered or
attached, why, and by whom. I understand that the maximum penalty for this offence is a fine of up to NZ$100,000
and/or a term of imprisonment of up to seven years.
I certify that I have assisted in the completion of this form and any additional forms at the request of the applicant
and that the applicant understood the content of the form(s) and agreed that the information provided is correct
before signing the declaration. I have assisted the applicant as a:
lawyer
other
agent, consultant or representative
translator
friend or family member
please specify
Signature of
person assisting
D D MM Y Y
Privacy Act
The information about you and your family in this form is being collected to determine whether we will invite you
to apply for residence in New Zealand.
The main recipient of the information is the New Zealand Immigration Service of the Department of Labour, but it
may also be shared with other Government agencies that are entitled to this information under applicable
legislation. In particular, the Ministry of Social Development (Work and Income) may be given information about
your personal resources.
The collection of the information is authorised by the Immigration Act 1987 and the Immigration Regulations made
under that Act. The supply of the information is voluntary, but if you do not supply the mandatory information
required by the Expression of Interest form, then your Expression of Interest cannot be accepted.
You will, if you are in New Zealand, have the right to see the information about you held by the New Zealand
Immigration Service, and to ask for any of it to be corrected if you think that is necessary. The addresses of the
New Zealand Immigration Service can be found on our website at www.immigration.govt.nz
pg 36
Payment details
Details on the fee payable to submit your Expression of Interest are available on our website at
www.immigration.govt.nz and in our leaflet New Zealand Immigration Fees.
Payment must be in New Zealand dollars. The only exception is a USD bank draft. No other currency will be
accepted. Do not send cash.
I enclose (amount) NZ$
Bank cheque
or USD
Bank draft
Credit card (specify type)
MasterCard
Visa
Name of cardholder
Card number
Expiry date D D M M Y Y
C.V.C Number
Signature
D D MM Y Y
PLEASE NOTE: If we determine that your Expression of Interest does not meet the minimum criteria for submission,
your fee may not be refunded. To meet the minimum submission requirements, you should ensure that you have
completed this form correctly by answering all relevant questions, that you meet the prerequisites and qualify for
more than 100 points. If you wish to check your eligibility before submitting your Expression of Interest, we
recommend that you complete your Expressions of Interest online through our website at
www.immigration.govt.nz. Submitting an Expression of Interest online is cheaper and you will know immediately
whether your Expression of Interest has been accepted into the Pool.
Submitting your Expression of Interest
If you are not completing an Expression of Interest online, send your Expression of Interest to:
Expression of Interest Team
New Zealand Immigration Service
DX SR57164
Level 1, Unisys House
The Terrace
P O Box 3705
Wellington
New Zealand
pg 37

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EOI reference number

Expression of Interest form

SKILLED MIGRANT CATEGORY

Other (please specify)

10 Please provide details of all passports currently held.

Please state your main country of citizenship/nationality.

Expression of Interest form Principal applicant NZIS 1100

11 Please list any other citizenships currently held.

12 Where applicable, please provide the following details.

Name(s) as shown on driver licence

Name(s) as shown on driver licence

Expression of Interest form Principal applicant NZIS 1100

Expression of Interest form Principal applicant NZIS 1100

Number and street name/PO Box

15 What is your current partnership status? (Select only one)

Guide under Partner in the section Summary of Terms.

17 Will your partner be included in your residence application?

Will any of these children be included in your residence application?

19 What is your main occupation?

Suburb and city

Expression of Interest form Principal applicant NZIS 1100

(Country code/Area code/Telephone number)

23 What is your preferred means of communication in relation to this Expression of

Have you been sentenced to imprisonment for a term of 12 months or more

Have you been involved in any drug trading or trafficking?

Expression of Interest form Principal applicant NZIS 1100

17 Have you been involved in any people trafficking?

Please attach additional sheets if necessary.

Do you have active tuberculosis?

Expression of Interest form Principal applicant NZIS 1100

Do you have a physical incapacity that requires full-time care?

Please attach additional sheets if necessary.

Section D: English language ability

Study for a recognised qualification conducted entirely in English

Current skilled employment in New Zealand for 12 months or more ] Go to Q E1

Expression of Interest form Principal applicant NZIS 1100

What was the date you sat your test?

Overall IELTS band score

Section E: Skilled employment

Current skilled employment in New Zealand for 12 months or more

Current skilled employment in New Zealand for less than 12 months

What is your job title?

Please attach additional sheets if necessary.

Yes, please provide the following:

New Zealand Occupational Registration Number (if applicable)

Growth area name

Absolute skills shortage occupation name

Expression of Interest form Principal applicant NZIS 1100

Section F: Recognised qualification(s)

Date commenced studies

Major area of study

Please attach additional sheets if necessary.

Please provide level

2b Has your qualification(s) been assessed by the NZQA?

Expression of Interest form Principal applicant NZIS 1100

Yes, please provide the following details:

Date commenced studies

Major area of study

Date completed studies

Qualifications and bonus points

Growth area name

Expression of Interest form Principal applicant NZIS 1100

Absolute skills shortage occupation name