OFFICEUSEONLYClientno.:Datereceived://Applicationno.:ChestX-rayCertificateINZ1096Forfurtherinformationonimmigrationvisitwww.immigration.govt.nzJuly2013Whoshouldusethisform?ApplicantsforentrytoNewZealandarerequiredtohaveanacceptablestandardofhealth(HealthRequirements(INZ1121)hasmoredetails).ThischestX-raycertificaterecordsinformationaboutyourhealththatImmigrationNewZealandrequirestoassesswhetheryoumeetthisstandard.DecidingwhetheryouareeligibleforavisaImmigrationNewZealandcollectstheinformationaboutyouonthisformtodecidewhetheryouareeligibleforavisa.CollectingtheinformationisauthorisedbytheImmigrationAct2009andtheImmigrationRegulationsmadeunderthatAct.Youdonothavetoprovidetheinformation,butifyoudonotwearelikelytodeclineyourapplication.ImmigrationNewZealandmayalsosharetheinformationyouhaveprovidedwithothergovernmentagenciesthatareentitledtoitbylaw,orwithotheragencies(asyouhaveagreedinthedeclaration).Youareabletoaskfortheinformationweholdaboutyouandrequesttohaveanyofitcorrectedifyouthinkitisnecessary.TheaddressofImmigrationNewZealandisPOBox3705,Wellington,NewZealand.Thisisnotwhereyourapplicationshouldbesent.Applicant’snotesTheinformationinthissectionwillhelpyoucompletethischestX-raycertificate.Pleasereadtheinformationinthissectionbeforeyoustarttocompletethiscertificate.WhendoIusethischestX-raycertificate?YoumustusethischestX-raycertificateif:•youareapplyingforresidence,or•youareapplyingforatemporaryentryclassvisaandyouintendtostaylongerthan12months,unlessyouareapplyingforamilitaryvisa,diplomatic,consularorofficialvisa,oravisarelatedtotheAntarcticTreaty,or•youareapplyingforatemporaryentryclassvisaandyouintendtostaybetweensixto12monthsandyouarefrom,orhavevisited,aplacethatisnotonImmigrationNewZealand’slistofcountries,areasandterritorieswithalowincidenceoftuberculosis(TB).TheguideHealthRequirements(INZ1121)hasmoredetailsandincludesthefulllist.Childrenunder11yearsofageandwomenwhoarepregnantarenotrequiredtoundergoachestX-rayexaminationunlessrequestedbyINZ.WhatifIsubmittedachestX-raycertificatewithmylastapplication?YoumaynotneedanewchestX-raycertificateifyouhavesubmittedachestX-raycertificatecompletedanddatedbyaradiologistoraradiographerwithinthelast36monthswithapreviousapplication,andthatinformationhasbeenretainedbyImmigrationNewZealand*.YourimmigrationofficerwillletyouknowifanewchestX-raycertificateisrequired.Ifanewcertificateisrequiredyouareresponsibleforanyfees.Note:YouwillneedtoprovideanewchestX-raycertificateifyouhavespentsixconsecutivemonthsinaplacethatisnotonImmigrationNewZealand’slistofcountries,areasandterritorieswithalowincidenceofTBsinceanypreviouschestX-raycertificatewascompletedanddatedbyaradiologistorradiographer.TheguideHealthRequirements(INZ1121)hasmoredetailsandincludesthefulllist.*ImmigrationNewZealanddoesnotnecessarilyretainmedicalinformationaboutapplicants.2–ChestX-rayCertificate-July2013Whenfillinginthisform,pleasewriteclearlyusingCAPITALLETTERS.Thisformhasbeenapprovedundersection381oftheImmigrationAct2009WheredoIgetmyimmigrationchestX-ray?ThischestX-raycertificatemustbecompletedbyaradiologist.ThiscertificateisnottobecompletedbyaradiologistorradiographerwhoisrelatedtothepersonhavingthechestX-rayexamination.PleasenoteyoumayrequireareferralfromaregisteredmedicalpractitionerforachestX-ray.InmostcountriesImmigrationNewZealandhasapprovedlistsofpanelphysicia...