Financial Undertaking
for a Student
New Zealand
Immigration Service
T e Ratonga Manene
For NZIS Use Only
Application No.
To be completed by the guarantor (this is the person giving the financial undertaking).
Student’s Details
1
Student’s full name:
Please underline the family or surname.
2
Details of partner and children accompanying the student:
Relationship to student
Name
3
The student is applying for:
1.
a student permit/visa for a 12 month stay in New Zealand
2.
a student permit/visa for the length of their course, which is
years
months.
Please note that students can only apply for a visa or permit for the length of their course if they are studying
through certain education providers. These education providers, with which the NZIS has a special agreement,
can also process the completion of applications for further student permits on the student’s behalf. For further information
and a full list of participating education providers, please visit www.immigration.govt.nz
Guarantor’s Details
4
Length of Financial Undertaking:
5
My full name is:
years
months.
This is the person accepting the financial undertaking.
6
My residential address and telephone number is:
Telephone: Home
Mobile
Work
Declaration for Financial Undertaking
I agree and undertake to accept responsibility for the student named on this form whilst they are in New Zealand,
for:
1.
maintenance at the rate of NZ$10,000 per year or part thereof for the student named on this form and/or
2.
any costs of repatriation for the student named on this form
I confirm that:
3.
I have held sufficient funds in my bank account to act as a guarantor for
years
months.
I am currently in New Zealand
Yes
If Yes:
I am a New Zealand Citizen/Resident
If yes please provide evidence
No
Yes
No
I understand the questions and contents of this form, and the information I have provided is true and correct.
I confirm that the funds held in my bank account are my own and have not been borrowed or loaned from a third party
for the purposes of this financial undertaking.
I authorise the bank to disclose my personal details and information, including my transaction history to the New
Zealand Immigration Service, Department of Labour, if requested.
I understand that if I make any false statements, or provide any false or misleading information or have changed or
altered this form in any way, that I may be committing an offence and be liable to prosecution and imprisonment.
Signature of guarantor
day
month
year
Bank Confirmation
To be completed by bank.
Name of bank
Branch
Confirms the person providing this financial undertaking:
1.
has an account with this bank and has sufficient funds as at the date of the signature
below to make available NZ$10,000 per year or part thereof in New Zealand for
the student named on this form and/or
2.
has an account with this bank and has sufficient funds as at the date of the signature
below to make available any costs of repatriation for the student named on this form.
3.
has held sufficient funds, to act as a guarantor, of NZ$10,000 or part thereof in this
bank account for a period of:
days
months
years
Official stamp of bank
The bank accepts no obligation or liability in respect of these funds.
Signature of bank officer
day
month
year
Full name of bank officer
Matters required by Privacy Act
The information about you on this form is collected to determine your eligibility to be a guarantor for a student.
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, which are entitled to this information under applicable legislation.
The address of the New Zealand Immigration Service is PO Box 3705, Wellington, New Zealand. This is not where the application
should be sent.
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 it then the application may be declined.
Any person who is in New Zealand, has a right to access the information about them held by the New Zealand Immigration Service and
to ask for any of it to be corrected if they think that is necessary.
July 2005
This form has been approved under s132(1) Immigration Act 1987
NZIS 1014