*** Transcriber's Note Please set your voice synthesiser to read most punctuation. When you encounter the caret sign (^) at the end of a line, please enter the applicable information, if necessary. *** Department of Internal Affairs – Te Tari Taiwhenua CIT005 / DCS: DENIAL Application for denial of New Zealand citizenship Use this application to request a letter that proves you are not a New Zealand citizen. Things you need to know: • The fee for this application is $112.40. • The processing time is 15 working days. Allow extra time for postage. • There is no urgent service. • We may ask for further identification before we give you any information. • Applications must be completed by the applicant, unless they are aged 15 or under. For applicants aged 15 or under, their parent or legal guardian must complete the application. You must provide: • a photocopy of the biodata page (the page that shows your personal details and photo) of your current passport • the completed form • the application fee. Contact us Website: govt.nz/contact-citizenship-office Email: Issuance.2@dia.govt.nz Only use email for queries about the form. To return the form, follow the postage instructions at the end of the form. Do not email the form to us. Checklist Make sure you have everything you need. If you do not provide all the documents that you need, your application will be delayed. All original documents will be returned to you. Everyone needs to supply the following with their application: 1. a photocopy of the biodata page (personal details section which shows a photograph) of the applicant’s current passport 2. the filled out payment section at the end of this form. You may also need to send us the statutory declaration in Section 5, if you are missing any details in ‘Section 3: Your parents’ details’. Section 1: Applicant details 1. Your name and title Please enter your title, for example Mr, Ms, Miss, Master or Other ^ Current first name(s) ^ Current surname. ^ Other names. Include all names you are, or have been, known as. For example, official name changes, names used at school or work, English name, adoptive namesfamily names, and any other names used. ^ 2. Your place and date of birth Village, town or city of birth ^ Country of birth ^ Date of birth (dd/mm/yyyy) ^ 3. Your gender (male, female or non-binary) ^ Section 2: Your marriage or civil union partner’s details This section is for the details of your partner or spouse. Do not fill this section in if you are not married or in a civil union. 5. Partner’s name First and middle names ^ Surname or family name ^ 6. Partner’s date of birth (dd/mm/yyyy) ^ 7. Date of marriage or civil union (dd/mm/yyyy) ^ Section 3: Your parents’ details You must fill out all the fields in this section. If you do not know all the details, tell us why in section 5. 8. Parent 1’s details First and middle names ^ Surname or family name ^ Village, town or city of birth ^ Country of birth ^ Date of birth (dd/mm/yyyy) ^ Are they a New Zealand citizen? (Yes or no) ^ 9. Parent 2’s details First and middle names ^ Surname or family name ^ Village, town or city of birth ^ Country of birth ^ Date of birth (dd/mm/yyyy) ^ Are they a New Zealand citizen? (Yes or no) ^ Section 4: Consent giver details If the applicant is aged 15 or under, provide details of the parent or legal guardian giving consent. 10. Is the consent giver the applicant's Parent 1 named in question 8, Parent 2 named in question 9, or legal guardian? ^ 11. Consent giver’s name If the consent giver is one of the parents listed in Section 3, you can leave the name fields blank. First and middle names ^ Surname or family name ^ Section 5: Statutory declaration Use this declaration if you do not know or you have missed out information about your parents in ‘Section 3: Your parents’ details’. If the applicant is aged 15 or under, the consent giver must fill out and sign this statutory declaration. You will need to sign this section in front of a person authorised to take a statutory declaration. An authorised person must be: • a Justice of the Peace (JP) • a solicitor or notary public (you may have to pay for their services) • a Registrar or Deputy Registrar of the District Court or the High Court, or • authorised staff in some government agencies. 12. I, Enter your full name ^ 13. of Enter address where you live. This cannot be a PO Box. Street number and name ^ Suburb ^ Town or city ^ Country ^ 14. a Enter your occupation. For example, bricklayer, teacher, unemployed ^ 15. solemnly and sincerely declare that Write why you could not complete all the details in ‘Section 3: Parent details’. Number each point to make it clearer. What you write must be true. You can be prosecuted if you make a false declaration. ^ 16. And I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957 Fill out and sign this section before a person authorised to take a statutory declaration. Your signature ^ Date signed (dd/mm/yyyy)^ Declared at (place, for example town or city and country) ^ Before me (name of official witness) ^ Signature of official witness ^ Qualification of authorised person ^ Section 6: Applicant declaration The Department of Internal Affairs (DIA) processes applications using information matching programmes to share data with other agencies. These authorised information matching programmes share citizenship data we hold with: • the Electoral Commission • Inland Revenue • Waka Kotahi, New Zealand Transport Agency • the Ministry of Education • the Ministry of Social Development • Immigration New Zealand. Details are available on the DIA website at www.dia.govt.nz Collection and use of information given to support your application We need you to give certain information to support your application. The decision to give us your information is your choice. If you do not give us all the information we need, we may decline your application. We need your information: • to process your application • to check if the application meets the requirements of the Citizenship Act 1977. We collect and hold information from this form at the Department of Internal Affairs, PO Box 10680, Wellington. Under the Privacy Act 2020 you can access, check and correct the personal information you choose to give us. 17. Applicant declaration • I understand that the information, to the best of my knowledge is true, complete and correct. • I understand that if I give false information, any document issued on the basis of that information may be cancelled and the matter referred to the New Zealand Police. • I confirm that I have read and understood all the statements in this applicant declaration. • I allow an authorised matching programme, under Section 112 of the Births, Deaths, Marriages, and Relationships Registration Act 2021 to use my information to determine my eligibility for this application. • I allow DIA to contact me or other agencies, if needed, to process this application. Signature of applicant ^ Date of signature (dd/mm/yyyy) ^ If the applicant is aged 15 or under, the consent giver must sign this declaration on the applicant’s behalf. Section 7: Fees and delivery denialconfirmation 18. Fees The application fee for a denial of New Zealand citizenship letter is $112.40. Delivery fee Select a delivery method: I want the letter couriered to a New Zealand address for $0. Yes or no ^ I want the letter couriered to an overseas address for $15-30. Yes or no ^ Delivery to Australia, Asia, or Pacific will cost $15. Delivery to the USA will cost $20. Delivery to Europe will cost $25. Delivery to the rest of the world (includes Azerbaijan, Armenia, Bulgaria, Bosnia and Herzegovina, Cyprus, Croatia, Greece, Georgia, Macedonia, Malta, Moldova) costs $30. Contact us if you are unsure whether we can deliver to your country. 19. Delivery address: We may need you or your consent giver’s email address to get in contact if a postal address changes. Delivery name ^ Street number and name ^ Suburb ^ Town or city ^ Country ^ Postcode ^ Contact phone number ^ Email address ^ 20. Payment Do not post cash or card. Do not email credit card details. Charge my credit or debit card (Visa, MasterCard, American Express, Prezzy Card): Card number ^ Card expiry date (mm/yy)^ Name on card ^ Cardholder signature ^ Next steps Print and sign the form. Post the form, appropriate fee(s), and documents to us. When you post your application, it is best to use a ‘track and trace’ courier bag to keep track of your original documents. We will return your documents by courier. Postal address Citizenship Office Identity Services Department of Internal Affairs PO Box 10680 Wellington 6140 Courier address Citizenship Office Level 2, 7 Waterloo Quay Pipitea Wellington 6011 New Zealand Last updated 18 July 2024.