Please Note - Marshall Bird & Curtis charges US$50 to process this questionnaire. this will need to be paid before your assessment can be processed. please feel free to contact us at for additional information.

1. Contact Information
a. Your Full Name

(First name, middle name, last name)


Email Address

Telephone Number
Day Night

Fax Number

b. Information About You

Male Female

Date of Birth


Your Citizenship (List all Countries for which you hold Citizenship)

Married Single

c. Family Information

Your Partner's Full Name

(First name, middle name, last name)

Your Partner's Citizenship

First Names and Age of Children

2. Residency

a. Are any of the following people New Zealand Residents (R) or NZ Citizens (C)?
Complete this section for relatives who are 17 years of age or older.

Mother Father Brother Sister Child Other Relative

Your Spouse's:
Mother Father Brother Sister Child Other Relative

How long have they lived there?

3. Your Qualifications

a. List any Technical/Trade or University qualification/s YOU have; the month and year you started studies, the month and year completed, and the name and address of the institution where the qualifications were obtained.

List only qualifications which have been fully completed.

Include all trade experience that you obtained while studying that was a component of the degree.


Trade Certificate


b. Your Partner's Qualifications

Give details of any Diploma/Degree YOUR PARTNER has:

c. Work History

List YOUR work history (your position/s by job title) since you finished your education, and the dates you were employed in each position:

Present Occupation

Job Title

4. Employment in New Zealand

a. If you have had a job offer from a New Zealand company, give job title and employer's name:


What city is the job offer in?

The offer of employment must be for permanent, full-time (more than 30 hours a week) work. Jobs paid by commission and/or retainer are not acceptable.

If you have ever worked in New Zealand give details of job description, employer and dates:

5. Settlement Funds

a. How much money do you have available to bring with you to New Zealand?
Currency: Amount:

Settlement funds include not only cash, but also shares and stocks, vehicles, property, or any other assets, and can be yours or your spouses, or belong to both of you. You must be able to transfer the funds to New Zealand. Subtract any money owed before entering the final figure. Funds can be in any currency.

6. English Ability

a. You: Fluent Conversational Limited
b. Partner: Fluent Conversational Limited
c. Children: Fluent Conversational Limited

You and your partner and any child over 16 accompanying you to New Zealand must speak a modest standard of English.

7. Health / Character

a. Have you ever been convicted of a crime?
Yes No

b. Have you ever been deported from or asked to leave a country?
Yes No

c. Do you suffer from/ get treatment for health or mental problems?
Yes No

d. Have you been refused permission to visit/work/study/live in New Zealand?
Yes No

If you answered "Yes", or if your partner and/or children who are going to accompany you to New Zealand answer "Yes" to any of these questions, give full details:

e. If there are any answers that you want to expand upon, or if there is anything else you want to tell us about yourself, or your family, enter details here: