NZ Citizenship Application Form – Samoan

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?*
Please specify*
First and middle names*
Surname or family name*
Are you?*
- Male
- Female
What is your date of birth?*

Day
Month
Year
City, town or village where you were born*
Country where you were born*
Which country or countries are you currently a citizen of?*
Apart from the ones you listed in question above, have you ever been a citizen of any other country?*
- Yes
- No
Print them here*
Is this the first time you have applied for New Zealand citizenship?*
- 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?*
- Yes
- No
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

Day
Month
Year
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

Questions about your parents