OFFICE USE ONLY Client no.: Date received: / / Application no.
August 2022 INZ 1142
Application to Work for a
Recognised Seasonal Employer
Application for a limited visa
Important information
This form is only to be used to apply for a limited visa to work for a recognised seasonal employer that has offered you
temporary seasonal work in the horticulture or viticulture industries. If two or more recognised seasonal employers
have recruited you to work for them one after the other during your visa, you only need to fill out one visa application
and pay one visa fee and immigration levy.
It is an offence to employ a person who is not entitled to work in New Zealand. One way for employers to avoid
committing this offence is to check a person’s entitlement to work with Immigration New Zealand’s online VisaView
system. VisaView is authorised by legislation. If you believe that an employer has been given the wrong entitlement
information via VisaView you may contact the Immigration Contact Centre (0508 558 855) to request correction of
that information.
Limited visas
All applications under Recognised Seasonal Employer (RSE) Instructions to work for a recognised seasonal employer
must be made as a limited visa application for an ‘express purpose’ (in this case to work for an RSE).
There are several restrictions on people who hold limited visas.
• You must leave New Zealand no later than the date that your visa expires.
• You may not apply for a different kind of visa while you are in New Zealand. You can apply for a further limited visa,
but it must be for the same express purpose.
• You may not request a special direction or a visa under section 61 of the Immigration Act 2009 while you are in
New Zealand.
• You do not have any of the appeal rights that holders of other kinds of visas have, such as the right to appeal to the
Immigration and Protection Tribunal.
If you are in New Zealand unlawfully after your limited visa expires, you will be liable for immediate deportation from
New Zealand.
For your application to be accepted you must submit all of the documents that are requested. If you do not submit
all required documents, your application will not be accepted and it will be returned to you.
All supporting documents must be in English or translated by a recognised private or official translation service.
Application requirements
This form must be completed, signed and accompanied by the application fee and immigration levy (see our Fees Guide
(INZ 1028), or refer to our website www.immigration.govt.nz/fees. Alternatively, the application fee and immigration
levy may be provided separately by the prospective recognised seasonal employer if they have agreed to this in advance.
You must include with this form all the following documents.
immigration.govt.nz
When filling in this form, please write clearly using CAPITAL LETTERS.
• Your passport or travel document* (which must be All applicants applying for a limited visa under the
valid for at least three months past the date you plan RSE Limited Visa Instructions who are citizens of, or
to leave New Zealand). are normally resident in a country listed as having high
• A recent passport-size photograph attached to this risk factors for HIV/AIDS must complete an RSE Scheme
form at ‘Section A: Applicant’s personal details’. Supplementary Medical Certificate (HIV Test Form).
• A completed Chest X-ray Certificate (INZ 1096) Medical certificates must be less than three months
(if required, see ‘Health requirements’ below). old when you lodge your application unless you have
• A completed RSE Instructions Supplementary provided one with an earlier application and that
Medical Certificate (HIV Test Form) (INZ 1143) certificate is less than 36 months old.
(if required, see ‘Health requirements’ below) See the Guide to Working for a Recognised Seasonal
• Provide evidence of either holding or being approved Employer for a list of countries with:
to hold acceptable medical insurance such as an • a low incidence of TB, and
insurance certificate or letter of approval from an
insurance company. • high-risk factors for HIV/AIDS.
You must provide a copy of an employment agreement Medical insurance requirements
between yourself and a New Zealand RSE employer
All applicants applying for a limited visa under the
that has an agreement to recruit overseas workers.
RSE Limited Visa Instructions must provide evidence
The employment agreement must be signed by both
of holding or being approved to hold acceptable
the RSE and you. If you have been employed to work for
medical insurance.
different employers for consecutive periods (e.g. three
months for the first employer and four months for the See the Guide to Working for a Recognised Seasonal
second employer) you must have an employment Employer for information on the RSE medical insurance
agreement from each employer. requirements.
For further information, including where to send your
Character requirements
application and supporting documents, see the Guide to
Working for a Recognised Seasonal Employer (INZ 1144). You are required to declare in this application if you have
ever been convicted of, charged with, or investigated
*While you can provide a certified copy of your passport for anything against the law of any country. You are
with your application, we highly recommend you provide
also required to declare if you have ever been deported,
your original passport. This will enable us to process
your application faster and it may be needed to complete refused entry, or removed from any country excluding
your application. Please note during the processing of an New Zealand. If you have been removed, deported or
application an immigration officer may request any document, excluded from any country, you may not meet character
including your original passport. requirements and may not be eligible to be granted a visa.
Health requirements Although a police certificate is not required for
temporary applicants that intend staying in New Zealand
Applicants applying for a limited visa (regardless of for less than 24 months, you may be required to provide
intended length of stay) under the RSE Limited Visa a police certificate with your application if you have
Instructions must complete a Chest X-ray Certificate spent 24 months or longer in New Zealand (including any
(INZ 1096) if you: time you have already spent in New Zealand). If you have
• are from a country, area or territory not listed as provided a police certificate with a previous application,
having a low-incidence of tuberculosis (TB)*, or it is valid for 24 months.
• have spent more than a total of three months in
When filling in this form, please write clearly in English
the past five years in a country, area or territory
using CAPITAL LETTERS. Tear off and retain pages 1 to 2
not listed as having a low incidence of TB, or
if you wish.
• have spent six consecutive months since your last
Chest X-ray Certificate was issued (if you have
previously applied for a visa) in a country, area or
territory not listed as having a low incidence of TB.
Pregnant women are not required to have an X-ray.
If you are pregnant a medical certificate confirming this
will be required from an Immigration New Zealand (INZ)
Panel Doctor.
2 – Application to Work for a Recognised Seasonal Employer – August 2022
OFFICE USE ONLY Client no.: Date received: / / Application no.:
August 2022 INZ 1142
Application to Work for a
Recognised Seasonal Employer
Application for a limited visa
Application type
This form may be used to apply for an RSE limited visa.
Tick one of the following as appropriate.
✔ I am applying for a limited visa from outside New Zealand.
Tick this box if you want to travel to New Zealand to work for an RSE.
I am applying for a further limited visa from New Zealand.
Tick this box if you are in New Zealand, currently hold an RSE limited visa, and are applying for a further RSE limited visa. Note: if you are in
New Zealand and applying for a further RSE limited visa, you need to allow sufficient time for a decision to be made on your application before
your current visa expires. If your visa does expire, your application for a further visa does not make your stay in New Zealand lawful or give you
the right to remain in New Zealand while your application is being considered.
If you are in New Zealand on an RSE limited visa, any application you submit for any other temporary or residence class visa (except for another
RSE visa) will be declined.
Section A Applicant’s personal details
All applicants must complete this section.
Attach one passport-size photograph of yourself here. The photograph must be
less than six months old. Write your full name on the back of the photograph.
A1 Client number (if known)
A2 Name as shown in passport
4.5cm
Family/last name
KHADKA
Given/first name(s) 3.5cm
BHARAT
A3 Preferred title Mr Mrs Ms Miss Dr Other (specify)
A4 Other names you are known by or have ever been known by
A5 Your name in ethnic script
BHARAT KHADKA
immigration.govt.nz
When filling in this form, please write clearly using CAPITAL LETTERS.
A6 Gender Male Female A7 Date of birth 2 5 07 1986
A8 Town/city of birth NAW ALPARASI
Country of birth NEPAL
A9 Current country of residence NEPAL
A10 Passport details
Number PA2632642
Country NEPAL Expiry date 04 04 2 0 34
A11 Country of citizenship NEPAL
A12 Other citizenships/passports you hold NONE
A13 Partnership status Married/in civil union Never married/never in civil union Partner/De facto
Separated Engaged Widowed
Divorced/dissolved civil union
Section B Contact details
All applicants must complete this section.
B1 Your residential address and telephone number in your home country
Address PRAGATINAGAR , DEVCHULI-15 , NAWALPARASI
NEPAL
Telephone (daytime) +9779867043021 Telephone (evening) +9779867043021
Email [email protected]
B2 Name and address for communication about this application
Same as address at B1 , or as below
Family/last name Given/first name(s)
DARSHAN SUBEDI
Company name (if applicable) and address
AENEID SEVENTEEN LTD.
9429038991127
New Zealand Business Number (if applicable) For help search: www.nzbn.govt.nz
Telephone (daytime) + 64 9 9 7 79990 Telephone (evening) + 64 9 9 7 79990
Email [email protected]
B3 Do you authorise the person stated at B2 to act on your behalf? Yes No
4 – Application to Work for a Recognised Seasonal Employer – August 2022
B4 Have you received immigration advice on this application?
You can find a definition of immigration advice at www.immigration.govt.nz/advice.
Yes Make sure that your immigration adviser completes Section I: Immigration adviser’s details.
No
B5 Once in New Zealand, what will your contact details be? Provide your New Zealand residential (or New Zealand employer’s)
address and telephone numbers.
Address Garden Terrace, Devonport,
Auckland 0624, New Zealand
Telephone (daytime) + 64 4 8303327 Telephone (evening) + 64 9 97736920
Email [email protected]
Section C RSE employment details
C1 What is your main occupation? FARMER
Your main occupation is the job you spent the most hours doing in the last 12 months. If you have not worked in the last 12 months,
state your previous occupation. If you have not worked in the last five years or more, please state “Not Applicable”.
C2 Provide the contact details of the recognised seasonal employer (RSE) who has offered you employment in
New Zealand and your Employment Period number.
RSE’s name and address
AENEID SEVENTEEN LIMITED
69 Takatu Road, Matakana, Auckland, New Zealand
RSE’s telephone (daytime) + 64 4 8303327 RSE’s telephone (evening) + 64 9 9779990
Employment Period number 01 MAY 2024 - 30 DEC 2024
C3 Provide the following details about your offer of employment.
Position offered (planting/maintaining/ Date of entry to Date of start of work Date of finish of work Date of departure
harvesting/packing) New Zealand from New Zealand
GENERAL ORCHARD WORKER 01 05 2024 30 12 2024 30 12 2024 15 01 2025
/ / / / / / / /
C4 If you have an offer of employment from two or more RSEs, for two or more consecutive periods of employment,
provide details of these job offers in the table below.
RSE’s name Employment Period Position offered Date of start of work Date of finish of work
Number (planting/maintaining/
harvesting/packing)
/ / / /
/ / / /
/ / / /
/ / / /
/ / / /
Application to Work for a Recognised Seasonal Employer – August 2022 – 5
When filling in this form, please write clearly using CAPITAL LETTERS.
C5 How did the RSE recruit you? (Tick the most appropriate box(es))
Recruited directly by employer
Recruited through a government agency
Recruited through a private agency.
C6 Did you pay any fees to the employer or agency?
Yes Indicate below how much you paid and what the fees covered
No
C7 Tick the box that applies to you:
I have attached my insurance certificate as evidence that I hold acceptable medical insurance.
I have attached a letter of approval from an insurance company as evidence of being approved to hold
acceptable medical insurance.
For information about acceptable medical insurance see the Guide to Working for a Recognised Seasonal
Employer (INZ 1144).
Section D Tax obligations
You must pay tax while earning wages in New Zealand. To pay the right amount of tax you need to be issued an
IRD number by Inland Revenue.
If you tick ‘yes’ in question D1 below, you give permission for information you provided in Section A and your
employer’s address to be sent to Inland Revenue for the purpose of issuing an IRD number. This will only occur
if your application for a limited visa is approved.
If you already have an IRD number from previous work in New Zealand, you do not need a new number and should not
answer this question. To confirm the IRD number you were issued, you can call Inland Revenue on 0800 227 774 while
you are in New Zealand.
D1 Do you want your information sent to Inland Revenue to apply for an IRD number? Yes No
Note: The answer to this question will not affect the outcome of your RSE limited visa application.
Inland Revenue privacy statement
If you have requested an IRD number in this application at ‘Section D: Tax obligations’, Inland Revenue will hold
the information supplied. They may also exchange information about you with the Ministry of Social Development,
the Ministry of Justice, the Department of Labour, the Ministry of Education, the New Zealand Customs Service,
the Accident Compensation Corporation or their contracted agencies, as well as to overseas countries with which
Inland Revenue has an information supply agreement. Inland Revenue also has an agreement to supply information
to Statistics New Zealand for statistical purposes only.
You may ask to see the personal information Inland Revenue holds about you by calling 0800 227 774 while you are in
New Zealand. Unless Inland Revenue has a lawful reason for withholding the information, they will show it to you and
correct any errors.
6 – Application to Work for a Recognised Seasonal Employer – August 2022
Section E Additional details
E1 Do you have a national identity (ID) number, or other unique identification number that was issued to you by any
government?
Yes List here 39912
No
E2 Have you undertaken military service in any country?
Yes Provide a brief chronological account of your military service in the table below. Include dates of your military service, your
position/rank, unit(s) that you served in, and your role within the unit(s). Also list any military ID number(s) assigned to you.
No
Date from Date to Rank Unit Role
/ / / /
/ / / /
/ / / /
/ / / /
/ / / /
/ / / /
Military ID number(s)
E3 Are you presently subject to military service obligations in any country?
Yes
No If you are a citizen of a country in which compulsory military service exists, state below why you are exempt from military service
E4 Have you been associated with any intelligence agency or group, or law enforcement agency?
Yes Specify below.
No
E5 Have you been associated with any group or organisation that has engaged in or promoted the use of violence
to further their aims?
Yes Specify below.
No
Application to Work for a Recognised Seasonal Employer – August 2022 – 7
When filling in this form, please write clearly using CAPITAL LETTERS.
E6 Have you ever committed or been involved in committing war crimes, crimes against humanity, and/or human
rights abuses?
Yes Specify below.
No
Section F Character details
F1 Have you been:
• convicted Yes No
• charged Yes No
• under investigation Yes No
for any offence(s) against the law in any country?; or
• deported from Yes No
• excluded (refused entry) from Yes No
• refused a visa by Yes No
• removed from Yes No
any country, excluding New Zealand?
If you have answered Yes to any of the questions in F1 , provide details below. Continue on a separate piece of
paper if necessary.
Section G Health details
All applicants must complete this section.
G1 Do you have tuberculosis (TB)? Yes No
G2 Are you HIV positive? Yes No
G3 Do you have any medical condition(s) that requires, or may require, one of the following during your stay
in New Zealand?
• Renal dialysis Yes No
• Hospital care Yes No
• Residential care* Yes No
* Residential care is long-term care provided in live-in facilities for the aged or for people with physical, sensory, intellectual,
or psychiatric disabilities.
8 – Application to Work for a Recognised Seasonal Employer – August 2022
If you have answered Yes to any of the above questions, provide further details such as what your medical
condition is and how long you have had the medical condition.
G4 Do you hold a passport issued by a country that is on the list of low incidence tuberculosis (TB) countries?
Yes Go to G5
No Go to G6
For a list of low incidence TB countries, refer to Guide to Working for a Recognised Seasonal Employer.
G5 Have you spent three months or more in the past five years in a country that is not on the list of low
incidence TB countries?
Yes Go to G6
No You are not required to provide a Chest X-ray Certificate (INZ 1096). Go to G8
G6 Have you submitted a chest X-ray certificate with another Immigration New Zealand application in the last
36 months?
Yes Go to G7
No You are required to provide a new Chest X-ray Certificate (INZ 1096) regardless of your intended length of stay in New Zealand.
Go to G8
G7 Have you spent six consecutive months in a country that is not on the list of low incidence TB countries since
your previous application?
Yes You are required to provide a new Chest X-ray Certificate (INZ 1096) regardless of your intended length of stay in N
Go to G8
No You are not required to provide a new Chest X-ray Certificate (INZ 1096). Go to G8
G8 Have you provided a completed Chest X-ray Certificate (INZ 1096)? Yes No
G9 Are you a citizen of a country that is on the list of countries with high risk factors for HIV/AIDS?
Yes Y ou are required to provide an RSE Instructions Supplementary Medical Certificate (HIV Test Form) unless you have provided one
to Immigration New Zealand in the last 36 months.
No
For a list of countries with high risk factors for HIV/AIDS refer to Guide to Working for a Recognised Seasonal
Employer.
G10 Are you normally resident in a country that is on the list of countries with high risk factors for HIV/AIDS?
Yes Y ou are required to provide an RSE Instructions Supplementary Medical Certificate (HIV Test Form) unless you have provided one
to Immigration New Zealand in the last 36 months.
No
G11 Have you provided a completed RSE Scheme Supplementary Medical Certificate (HIV Test Form)?
Yes No
G12 Are you pregnant?
Yes No
We will advise you if we need you to submit any further information, such as tests, reports or a new certificate
at a later date.
Application to Work for a Recognised Seasonal Employer – August 2022 – 9
When filling in this form, please write clearly using CAPITAL LETTERS.
Section H Declaration by applicant
I understand the questions and contents of this form, and the information I have provided is true and correct.
I will inform Immigration New Zealand of any relevant fact or change of circumstances that may (i) affect the
decision on my application for a visa, or (ii) affect the decision to grant entry permission based on the visa for
which I am applying.
I understand I am responsible for making sure I leave New Zealand before my visa expires and that if I do not I will
be liable for deportation.
I understand that while in New Zealand, any application I submit for a temporary or residence class visa (other than
under RSE Limited Entry Instructions) will be declined.
I understand that Immigration New Zealand may provide information about my entitlement to work to potential
employers via the online VisaView system. VisaView is authorised by legislation.
Residents and people holding work visas for a stay of two years or more (and their dependent children) are eligible
for publicly-funded health and disability services. Other work or limited visa holders, students, and visitor visa holders
generally are not eligible. People covered by New Zealand’s Reciprocal Health Agreements with Australia and the
United Kingdom are entitled to publicly-funded health care for immediately necessary medical treatment only.
I understand that if not entitled to free treatment, I will pay for any health care or medical assistance I may require
in New Zealand.
I authorise INZ to provide information about my state of health and my immigration status to any health service
agency. I authorise any health service agency to provide information about my state of health to INZ. I authorise
any insurance provider to provide information about my insurance cover to INZ.
I authorise INZ to make any enquiries it considers necessary in respect of information provided on this form in order
to make a decision on this application and enquiries about my subsequent immigration status. I authorise any
agency which holds information (including personal information) relevant to those matters to disclose that
information to INZ.
I understand that if I have received immigration advice from an immigration adviser and if that immigration adviser is
not licensed under the Immigration Advisers Licensing Act 2007 when they should be, INZ will return my application.
I understand that if granted a limited visa to work in New Zealand for a recognised seasonal employer, I am only able
to work for the employer and in the position that is noted on my limited visa label.
I understand that any breach of my limited visa conditions will result in me becoming liable for deportation and I will
be deported from New Zealand.
Signature of applicant Date
Important – please note:
1. The application fee and immigration levy (set by the New Zealand Government) is all that Immigration
New Zealand requires you to pay to submit this application form. The current fee and immigration levy is available
in the Fees Guide (INZ 1028), available from any Immigration New Zealand office or at www.immigration.govt.nz.
Where INZ has engaged a third party provider to receive applications on their behalf (via a Visa Application
Centre), you will be charged a visa facilitation fee.
2. This application will not be prioritised if you use an agent to complete or submit it on your behalf. Please seek
further information from an Immigration New Zealand immigration officer if you have any questions.
10 – Application to Work for a Recognised Seasonal Employer – August 2022
