AHPRA Application

General:

Profession

Do you currently hold a registration as a nurse/midwife in New Zealand?

Yes No

Current Annual Practicing Certificate:

Yes No

YOUR DETAILS (Same as in Passport):

Title

First Name

Middle Name

Last Name

Date of Birth (DOB):

Sex

Male Female

Country of Birth:

Place/City of Birth:

Languages Known:

Mobile Number:

Address Details:

Residential Address:

Principal Place of Practice Address:

Mailing Address:

Passport Details:

Passport Number:

Expiry Date:

Issuing Country:

Professional Qualification:

Name of the Qualification:

Start Date (as in Transcript):

Completion Date:

Country where Qualification was Received:

Name of the Institution (University/College):

NCNZ Registration Details:

Nursing Council of New Zealand Registration Number:

Upload Document
(Upload your passport copy attested by Justice of Peace or Notary and include the following statement: I certify that this is a true copy of the original and the photograph is a true likeness of the person presenting the document as sighted by me.)

AHPRA Application

General:

YOUR DETAILS (Same as in Passport):

Address Details:

Passport Details:

Professional Qualification:

NCNZ Registration Details:

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