For more information visit www.justice.govt.nz/tribunals/immigration/immigration-and-protection

Immigration and Protection Tribunal

For more information visit www.justice.govt.nz/tribunals/immigration/immigration-and-protection IPT 10/18 - 1

Residence Class Visa Appeal Important information to be read in conjunction with Guide 1.

1 What is this form for? Use this Notice of Appeal form if you want to appeal to the Immigration and

Protection Tribunal (the Tribunal) against a decision by Immigration New Zealand or the Minister of Immigration: • Declining your residence class visa application; • Cancelling your resident visa; or• Refusing to grant you (a resident visa holder) entry permission into New Zealand.

Important information• Please read Guide 1 - A Guide to Lodging a Residence Class Visa Appeal before you start

completing this form. The Guide will help you assess whether you are entitled to an appeal and provides information on how to lodge an appeal.

• You must include all documents, information, or evidence you wish the Tribunal to consider in deciding your appeal.

• Therearestricttime-framesforfilinganappeal.

2 How much does it cost to lodge an appeal?• The fee for lodging this appeal with the Tribunal is NZ

$700. The Tribunal is unable to waive this fee.

3 How do you complete this form?• You must complete this form in English. • PleaseprintinCAPITALLETTERSiffillingoutbyhand.• You/your representative must complete all the parts of this

form.• Please provide a copy of the Immigration

New Zealand decision you are appealing. • Provide copies of any other documents or evidence you

wish to submit in support of your appeal. All documents mustbeprovidedinEnglishorwithacertifiedtranslationinEnglish. Two copies of all documents need to be provided.

• Pleaseprovideacertifiedcopyofyouridentificationpagefrom your passport.

• If you are a minor appellant (under 18 years of age and not married or in a civil union), a responsible adult must sign on your behalf. If you do not have a parent present to act as responsible adult, tick the relevant box in Part 7 of this form and the Tribunal will nominate a responsible adult to act for you.

Form 1

See the Guide to Lodging a Residence Class Visa Appeal

• You must sign Parts 6 and 7. If you have a representative, he/she should also sign Part 5F.

4 How long do you have to lodge this appeal?• Your appeal form must be lodged no later

than 42 days after the date you were notifiedofImmigrationNewZealand’sdecision. Please refer to Guide 1 on how to calculate the period to appeal.

5 How do you lodge this appeal?• You must lodge this Notice of Appeal

together with the NZ $700 fee and all relevant documents in person, by courier or by post to the Tribunal at the address at the end of this form.

• You may also send in advance a copy of this Notice of Appeal with your credit card details by fax or email, but note that you will still need to deliver or post the original of this Notice of Appeal and supporting documents to the Tribunal.

For more information visit www.justice.govt.nz/tribunals/immigration/immigration-and-protection IPT 10/18 - 1

Definitions

Appellant An appellant is the person who applied for, and was declined, a residence class visa.

Certifiedcopy A true copy, approved by someone legally allowed to approve it. If you are in New Zealand, certifiedcopiesmustbeapprovedbyalawyer,notarypublic,JusticeofthePeaceorcourtofficial.

Certifiedtranslation AwrittentranslationfromonelanguageintoEnglishthathasbeenofficiallycertifiedbya recognised translation agency. A translation by a friend or family member will not be accepted.

Decision The letter from Immigration New Zealand or the Minister of Immigration telling you what they decided in regards to your application.

Minorappellant A minor appellant is an appellant who is under 18 years of age and not married or in a civil union.

Representative A representative must be a lawyer, a licensed immigration adviser, or a licence-exempt person. For the full list, see Guide 1.

Responsibleadult Thisiseithertheminorappellant’sparentorapersonnominatedbytheTribunal.

6 What will happen after you lodge your appeal?• After you have lodged your appeal, the Tribunal will

write to let you know that your appeal has been received.

• A copy of your appeal will be sent to Immigration New Zealand who will provide your immigration fileandanyrelatedfiles(eg,previoustemporarypermit applications, previous unsuccessful residence applications) to the Tribunal.

• If you change your representative or your (or your representative’s)contactdetailschangeyoumustnotify the Tribunal immediately.

7 Who can help you with this form?• The following persons can help you complete this

form:› a lawyer› a licensed immigration adviser› a licence-exempt person.

• Note: Only the above persons can act as your representative. The Tribunal can only accept appeals lodged by you or any one of the persons listed above. For more details, please refer to Guide 1.

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For more information visit www.justice.govt.nz/tribunals/immigration/immigration-and-protection

Immigration and Protection Tribunal

Page 1 For more information visit www.justice.govt.nz/tribunals/immigration/immigration-and-protection IPT 10/18 - 1

ItisanoffenceundertheImmigrationAct2009tomakeanystatement,provideinformation,evidenceorsubmissionsknowingthattheyarefalseormisleadinginanymaterialaspectinanyappealormatterinthenatureofanappealtotheTribunal.

Pleasefillinallsectionsbelow:

Part1:Appellant’sinformation

1A:Whatisyourfullname?(Asshownonyourpassport)

Last name(s)

First name(s)

Title Mr Mrs Ms Miss Dr Other (specify)

1B:Whatothernamesareyouknownby?

Name(s)

1C:Whatisyourgender?(Pleasetick )

Male Female Prefer not to disclose

Other (please tell us your gender identity)

1D:Whenwereyouborn?

Date (day/month/year) / /

1E:Whatcountriesareyouacitizenof?

List all countries

1F:WhatdatedidyouarriveinNewZealand?(Ifapplicable)

Date (day/month/year) / /

1G:Whatdatedidyourvisaexpire,orwhatdateisyourvisaduetoexpire?(Ifapplicable)

Date (day/month/year) / /

1H:Whatisyourcurrentrelationshipstatus?(Youmaytickmorethanone )

Never Married Married Engaged Separated

Widowed Civil Union Partnership / Defacto Divorced

Residence Class Visa Appeal NoticeofAppealUnder the Immigration Act 2009

Form 1

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Part2:Appellant’scontactdetails

2A:Whatisyourcurrentresidentialaddress?(ThiscannotbeaPOBox).This is where you are currently living.YoumustnotifytheTribunalimmediatelyifyouchangeyouraddress.

Street number / Street name

Suburb Town / City

Country Post code

2B:Whatareyourcontactdetails?Please include country code for phone numbers outside New Zealand.

Daytime contact phone number ( )

Other contact phone number ( ) Fax number ( )

2C:Whatisyouremailaddress?

2D:Wheredoyouwantustosendalldocumentsandofficialnoticesrelatingtothisappeal?(ThiscannotbeaPOBox).

Note that under section 225(2)(i) of the Immigration Act 2009 you must provide the Tribunal with a current address to which communications relating to your appeal may be sent.

(Pleasetickone )

to your representative (details to be provided in Part 5). Move on to Part 3 and continue.

to you, at the address in 2A and 2C above.

to you, at the following address (if you are a minor appellant and have a responsible adult, this will be the responsible adult’s address for communication):

Street number / Street name

Suburb Town / City

State (if applicable) Post code

Country (if not New Zealand)

Responsibleadult’semailaddress

YOuMusTNOTIFYTHETRIBuNAlIMMEDIATElYIFYOuCHANGEYOuRADDREss. Note that under section 225(4) of the Immigration Act 2009 the Tribunal may rely on the latest address you provided for purpose of communications relating to your appeal.

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Part3:spouse/partnerandchildren

3A:WerethereotherpersonsincludedinyourresidenceclassvisaapplicationtoImmigrationNewZealand?Pleasetick

Yes. Move on to 3B. No. Move on to Part 4.

3B:PleaselistallpersonswhowereincludedinyourresidenceclassvisaapplicationtoImmigrationNewZealand.

Last name(s)

First name(s)

Date of birth (day/month/year) / /

Relationship to principal appellant

Do you wish to include this person in this appeal? (Please tick ) Yes No

Last name(s)

First name(s)

Date of birth (day/month/year) / /

Relationship to principal appellant

Do you wish to include this person in this appeal? (Please tick ) Yes No

Last name(s)

First name(s)

Date of birth (day/month/year) / /

Relationship to principal appellant

Do you wish to include this person in this appeal? (Please tick ) Yes No

Last name(s)

First name(s)

Date of birth (day/month/year) / /

Relationship to principal appellant

Do you wish to include this person in this appeal? (Please tick ) Yes No

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Part3:spouse/partnerandchildren(continued)

Last name(s)

First name(s)

Date of birth (day/month/year) / /

Relationship to principal appellant

Do you wish to include this person in this appeal? (Please tick ) Yes No

Last name(s)

First name(s)

Date of birth (day/month/year) / /

Relationship to principal appellant

Do you wish to include this person in this appeal? (Please tick ) Yes No

Last name(s)

First name(s)

Date of birth (day/month/year) / /

Relationship to principal appellant

Do you wish to include this person in this appeal? (Please tick ) Yes No

Last name(s)

First name(s)

Date of birth (day/month/year) / /

Relationship to principal appellant

Do you wish to include this person in this appeal? (Please tick ) Yes No

Last name(s)

First name(s)

Date of birth (day/month/year) / /

Relationship to principal appellant

Do you wish to include this person in this appeal? (Please tick ) Yes No

Continue on a separate sheet of paper if necessary and attach it to this form

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Page 5 For more information visit www.justice.govt.nz/tribunals/immigration/immigration-and-protection IPT 10/18 - 1

Part3:spouse/partnerandchildren(continued)

3C:Doyourdependentchildrenincludedinthisappealwishtoexpresstheirviewsinrelationtothisappeal?(Pleasetick )

Yes

No

PleasewritelegiblyandinCAPITAllETTERsifcompletingbyhand.

Name of child

Child’sviews

Continue on a separate sheet of paper if necessary and attach it to this form.

3D:Doesyourspouse/partner(ifincludedinthisappeal)wishtoexpresshis/herviewsinrelationtothisappeal?(Pleasetick )

Yes

No

PleasewritelegiblyandinCAPITAllETTERsifcompletingbyhand.

Name of spouse

Spouse’sviews

Continue on a separate sheet of paper if necessary and attach it to this form.

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Part4:Appealinformation

4A:WhatisyourImmigrationNewZealandclientnumber?

4B:WhatisyourImmigrationNewZealandapplicationnumber?

Date of decision (day/month/year) / /

Date you received the decision (day/month/year) / /

PleaseincludeacopyofthedecisionfromImmigrationNewZealandortheMinisterofImmigration.

4C:Whatresidencecategorydidyouapplyunder?

4D:Whattypeofdecisiondidyoureceive?(Pleasetick )

AnImmigrationOfficerdeclinedyourresidenceclassvisaapplication.

Immigration Act 2009, Section 187(1)(a)(i)

TheMinisterofImmigrationdeclinedyourresidenceclassvisaapplication,andclassifiedinformationwasreliedonin making the decision.

Immigration Act 2009, Section 187(1)(a)(ii)

Your resident visa was cancelled when you were outside New Zealand.

Immigration Act 2009, Section 187(1)(b)

You were granted a resident visa but were refused entry permission into New Zealand.

Immigration Act 2009, Section 187(1)(c)

4E:Whatarethegroundsforyourappeal?(Pleasetick .Youmaytickboth)

The decision was not correct in terms of the residence instructions. (Pleaseexplainin4F).

Immigration Act 2009, Section 187(4)(a)

Your special circumstances are such that consideration of an exception to those residence instructions should be recommended (Pleaseexplainin4F).

Immigration Act 2009, Section 187(4)(b)

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Part4:Appealinformation(continued)

4F:Explainwhyyouthinkthatthedecisionwasnotcorrect,orthatyourspecialcircumstancesaresuchthatanexceptiontotheresidenceinstructionsshouldberecommended.

You must write your reasons in English or provide a certified translation in English.

You must provide, together with this Notice of Appeal and within the 42-day appeal period, any documents or information you want the Tribunal to take into account when considering your appeal. There are restrictions on what the Tribunal may take into account. All supporting documents and information must be in English or with a certified English translation.

PleasewritelegiblyandinCAPITAllETTERsifcompletingbyhand.

Continue on a separate sheet of paper if necessary and attach it to this form.

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Page 8 For more information visit www.justice.govt.nz/tribunals/immigration/immigration-and-protection IPT 10/18 - 1

Part5:Representative’sinformation

If you do not have a representative, you do not need to complete this part. Go to Part 6.

Onlyalawyer,licensedimmigrationadviser,oralicence-exemptpersoncanactasarepresentative.OverseasadvisersmustalsoberegisteredwiththeImmigrationAdvisersAuthority.

5A:Whatisyourrepresentative’sname?

Last name(s)

First name(s)

Title Mr Mrs Ms Miss Dr Other (specify)

Organisation name (if applicable)

5B:Whatisyourrepresentative’sphysicaladdress?(ThiscannotbeaPOBox)Notices, documents, and information relating to this appeal may be sent to this address.

Street number / Street name

Suburb Town / City Post code

Whatisyourrepresentative’spostaladdress?

Delivery service type PO Box/Bag/DX number

Locality Town / City Post code

5C:Whatareyourrepresentative’scontactdetails?Please include country code if phone number is outside New Zealand

Daytime contact phone number ( )

Other contact phone number ( ) Fax number ( )

5D:Whatisyourrepresentative’semailaddress?

5E:Declaration

I (the representative) accept the authority to act on behalf of the appellant.

I will accept service of notices, communications, and other documents on his/her behalf.

Iama: (Pleasetickone )

Lawyer

Licensed Immigration Adviser Licence number

Licence-exempt person. Please tick your ground for exemption

person providing immigration advice in an informal or family context only

current member of Parliament or one of their staff

foreign diplomat or consular staff

public service employee providing immigration advice within the scope of their employment agreement

staff of a community law centre or citizens advice bureau

5F:Representative’ssignature

Signature Date (day/month/year) / /

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Part6:Consentandsignature(s)

ConsenttocharactercheckwithNewZealandPolice

ThisauthorisationMusTbesignedbyyouandeverypersonincludedintheappealaged17yearsorolder.

1. I authorise the Tribunal to seek information from the New Zealand Police about my criminal record and/or character. I authorise the New Zealand Police to provide this information to the Tribunal.

2. Any information provided to the Tribunal by the New Zealand Police may, for the purposes of this appeal, also be provided by the Tribunal to Immigration New Zealand and the Minister of Immigration.

Signature of appellant Date (day/month/year) / /

Signature of spouse/partner Date (day/month/year) / /

Name & signature of dependent child 1

Date (day/month/year) / /

Name & signature of dependent child 2

Date (day/month/year) / /

Name & signature of dependent child 3

Date (day/month/year) / /

Continue on a separate sheet of paper if necessary and attach it to this form.

Part7:Principalappellant’sdeclaration

DEClARATIONThisdeclarationMusTbesignedbyallappellantsaged17yearsorolder.Knowing that it is an offence under the Immigration Act 2009 to make a declaration that is false, I declare that the answers in the form are true and correct. I authorise my representative to act on my behalf in all matters with the Tribunal and receive all correspondence and documents relating to my appeal.

Signature of appellant Date (day/month/year) / /

If you are a minor appellant, under 17 years of age, a responsible adult must sign this declaration for you.

Responsibleadult’sname&signature

Name

Signature Date (day/month/year) / /

Relationship to appellant

If you are a minor appellant and require a responsible adult to be nominated for you by the Immigration and Protection Tribunal, tick the box below:

I require a responsible adult to be nominated by the Tribunal.

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Thispagehasbeenleftblankdeliberately

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Part8:FeePayment

ThefeeforlodgingthisappealisNZ$700.AllpaymentsmustbemadeinNewZealanddollars.Pleasemakechequespaybleto‘MinistryofJustice’.Thisfeepaymentisnon-refundable.

8A:Howareyoupayingyourlodgementfee?(Pleasetick )

Personal cheque (only New Zealand cheques will be accepted)

Bank cheque / bank draft

Cash (only use cash if you are paying in person)

Credit card (please complete the rest of Part 8)

THEFOllOWINGsECTIONsARETOBEFIllEDOuTBYTHECARDHOlDER.

8B:PleasechargetomycreditcardtheamountofNZ$700:(Pleasetick )

Visa

MasterCard

8C:Whatisthenameofthecardholder?

Name on the card

8D:Whatisthecreditcardnumber?

8E:Whatistheexpirydateonthecreditcard?

/ (e.g. month/year)

Please note: We will never ask for your CVC number. Do not provide this on the form or at any time.

8F:signatureofthecardholder

The cardholder must sign below.

Signature: Date signed: (day/month/year) / /

We will only hold your credit card information while we process the payment of your lodgement fee. Once the payment has been processed this information will be destroyed and will not be used for any other purpose.

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TribunalContactDetails

Immigration and Protection Tribunal Tribunals Unit

Ph: 64 9 914 4299 Fax: 64 9 914 5263 Email: IPT@justice.govt.nz

www.justice.govt.nz/tribunals/immigration/immigration-and-protection

Physical address: (Use this address to deliver items in person or to send by courier. Do not post items to this address.)

level1,ChorusHouse41FederalstreetAuckland1010NewZealand

Postal address: (Use this address for posting items only. Do not courier items to this address.)

DXEX11086AucklandNewZealand

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Checklist

Pleaseticktoconfirmthefollowing

You have answered all the relevant parts of this form in English.

You have provided an email/address where you want us to send all documents and notices relating to this appeal.

YouhaveprovidedthecertifiedcopyofthedecisionfromImmigrationNewZealandortheMinisterofImmigration.

Youhaveprovidedallinformation(certifiedcopies)youwantthetribunaltotakeintoaccountwhenconsideringyourappeal(inEnglishorwithacertifiedtranslation).Twocopiesofalldocumentsmustbeprovided.

If you have a representative, he/she has signed Part 5F.

You and every person 17 years or older, have signed at Part 6. This signature authorises the police to provide information about each person.

You (or your responsible adult if you are under 17 years of age) have signed at Part 7. This signature declares that everything you have said is true.

You have included your NZ $700 lodgement fee or completed the credit card details in Part 8. This fee is non-refundable.

Youhaveprovidedacertifiedcopyoftheidentificationpagefromyourpassport.