ImmiGov Services » New Zealand » Citizenship » Samoan Form

NZ Citizenship Samoan Form – Application Form

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Use this application form if you are a Western Samoan citizen and are applying for a grant of New Zealand citizenship.
If applying for a child who is under 16 years of age, both parents must give their consent before New Zealand citizenship can be granted.

What is your full name?(Required)

Please specify(Required)

First and middle names(Required)

Surname or family name(Required)

Are you?(Required)

Male

Female

What is your date of birth?(Required)

City, town or village where you were born(Required)

Country where you were born(Required)

Which country or countries are you currently a citizen of?(Required)

Apart from the ones you listed in question above, have you ever been a citizen of any other country?(Required)

Yes

Print them here(Required)

Is this the first time you have applied for New Zealand citizenship?(Required)

Yes

No, I have applied before

Witness section

Who can be your witness?

You have the option of having either a valid New Zealand passport holder or an Internal Affairs representative (i.e. a citizenship officer or customer service officer) as your witness. The New Zealand passport holder must:

> have a valid New Zealand passport
> have known you for 1 year or more
> be 16 years of age or older
> not be related to you or part of your extended family group
> not be your spouse or partner
> not live at the same address as you

Do you know the witness's details such as passport number, name, date of birth, address and day-time phone number?(Required)

Yes

Tick one of the boxes below to make sure that can be a witness

Citizenship Case Officer / DIA Customer Services Officer

The witness hold a valid New Zealand Passport AND the applicant is not related to me AND we do not live at the same address

Witness's New Zealand Passport number

How many years you have known the witness?

Witness's surname or family name

Witness's first and middle names

Witness's date of birth

Witness's address and contact details

Unit and/or house number and Street name Suburb City or town State / region Post code Country

Witness's home phone

Witness's day-time phone

NZ Citizenship Samoan Form – Application Form

What passports or travel documents do you have?

Questions about your parents

Your contact details

Where do you live?

Questions about the citizenship ceremony

Witness section

Order Summary