Consent to Disclosure of Information (NZ) Form

Consent to Disclosure of Information (NZ) Form

Protected Once Completed - C CONSENT TO DISCLOSURE OF INFORMATION (NZ) Form To be completed by all applicants age 17 and older: please complete this ...

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Protected Once Completed - C

CONSENT TO DISCLOSURE OF INFORMATION (NZ) Form To be completed by all applicants age 17 and older: please complete this form and attach it with your application kit to be submitted to the designated Visa Office or Processing Centre. Category of Application:

Permanent Residence


Temporary Resident: Worker, Student, Visitor, eTA

Canadian Visa Office Abroad/Overseas Processing Office: _______________________________________________


Please complete the following information and attach a copy of the Photo/ID Page and Signature page of your passport to this form.

Family name

Given Names

Other Names Used Gender



Date of Birth:_______ /_______ /_______ DD



Country of Birth Last address in New Zealand

Street Address:




CONSENT: I hereby consent to the disclosure by the New Zealand Police of any information they may have pursuant to my application for a visa for Canada. I confirm that I am aware that my full criminal record will be released even if I meet the eligibility criteria stipulated in section 7 of the New Zealand Criminal Records (Clean Slate) Act 2004 due to the application of section 14(3)(ii) of that Act, namely that this authorisation relates to a matter dealt with by the law of a country other than New Zealand, being a question asked on an application form by the immigration or customs agency of that country.

Signature: ________________________________________________________


____ / ____ / _____ DD


For Office Use Only: SYD Rec'd Date:



Result Rec'd Result :

CIC SYD (AUS) - 2016-04

No Conviction History Recorded under details Conviction History


How to obtain a police certificate: New Zealand Do I need to provide a police certificate when applying for permanent residence? Yes, a criminal history report is required for all applicants aged 17 or older.

How do I obtain one? The applicant must complete and sign Consent to Disclosure of Information (NZ) form, and attach a clear photocopy of their current photo/ID page and signature page of their passport to the form. When completing the Consent to Disclosure of Information (NZ) form it is important to: Ensure you provide your current or last know New Zealand address – this address is required for the processing of your NZ criminal history check Ensure you sign and date the Disclosure of Information (NZ) form Ensure a clear photocopy of the photo/ID page and signature page of your passport is attached to the Consent to Disclosure of Information (NZ) form – note that the photocopy of your passport does not need to be certified or notarized

How should I submit the Consent to Disclosure of Information (NZ) form? The completed Disclosure of Information (NZ) form and copy of your photo/ID and signature pages of your passport must be included in your visa application kit at time of submission to CIC. The CIC Office processing your application will work with the appropriate authorities to obtain the required Criminal History Report on your behalf. IMPORTANT: Applicants should not send their Disclosure of Information (NZ) form directly to the New Zealand Police Authorities.

Are other New Zealand Police Certificates acceptable? No, a New Zealand Ministry of Justice certificate or similar is not acceptable substitute.