OFFICEUSEONLYClientno
:Datereceived://Applicationno
:ChestX-rayCertificateINZ1096Forfurtherinformationonimmigrationvisitwww
immigration
nzJuly2013Whoshouldusethisform
ApplicantsforentrytoNewZealandarerequiredtohaveanacceptablestandardofhealth(HealthRequirements(INZ1121)hasmoredetails)
ThischestX-raycertificaterecordsinformationaboutyourhealththatImmigrationNewZealandrequirestoassesswhetheryoumeetthisstandard
DecidingwhetheryouareeligibleforavisaImmigrationNewZealandcollectstheinformationaboutyouonthisformtodecidewhetheryouareeligibleforavisa
CollectingtheinformationisauthorisedbytheImmigrationAct2009andtheImmigrationRegulationsmadeunderthatAct
Youdonothavetoprovidetheinformation,butifyoudonotwearelikelytodeclineyourapplication
ImmigrationNewZealandmayalsosharetheinformationyouhaveprov