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Applicants Personal Details

First Name*

Middle Name*

Surname*

Preferred Name

Birth/Maiden Name

Date of Birth*

Gender*

Upload your Birth Certificate here*

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Max. file size: 250 MB.

(e.g. Birth certificate ONLY)

Applicants Contact Information

Phone

Mobile*

Email*

Preferred Contact Method

Applicants Address

Address*

Physical Address City Suburb Postcode Country

Do you have a different Postal Address?

Postal Address (if different from above)

Physical Address City Suburb Postcode Country

Shareholder Link

Blood link

Fathers full name

Mothers full name

Which parent do you whakapapa through?

Father
Mother

Whakapapa (Shareholder)*

Whanau Trust Name

Name of Whanau Trust you belong to

Whakapapa Upload Documents*

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Max. file size: 250 MB.

(e.g. Birth Certificate or Shareholders Verification)

Bank Account

Bank Account Name*

BSB

(Australian Accounts ONLY)

Bank Account Number*

Upload Documents*

Drop files here or

Max. file size: 250 MB.

(e.g. Bank Statement or Bank chit)

Declaration

I declare that all information provided in this application is true and correct to the best of my known knowledge.*

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Applicants Personal Details

Applicants Contact Information

Applicants Address

Shareholder Link

Blood link

Other ways you may link

Spouse/Partner

Whangai (As per Tikanga Maori)

Legally adopted

Stepchild/Step grandchild

Bank Account

Declaration

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