[Photograph of person(s) to whom this permit is granted.]
Dated at , New Zealand, this day of
19 .
Collector of Customs.

[Form 3.
New Zealand Customs.
DEED OF COVENANT—TEMPORARY PERMIT.
(Immigration Restriction Acts.)
THIS DEED, made the day of , 19 , between
His Majesty the King (hereinafter called "the Crown," which expression shall include His Majesty's Government in and for the Dominion of New Zealand and any Department thereof, and any person or body acting for or on behalf of the Crown or Government, where the context so requires or admits), of the one part, and [Full name(s), occupation(s), and address(es) of person(s) executing this deed], of the other part :
Whereas [Full name, occupation, and address outside New Zealand of person desiring a temporary permit] (hereinafter called "the visitor"), who arrived in New Zealand from [Name of port from which arrived] by the ship [Name of vessel by which arrived in New Zealand] on the day of 19 , is a person to whom Part I of the Immigration Restriction Amendment Act, 1920, applies, and who has proved to the satisfaction of the Minister of Customs (or of his duly appointed delegate, the Collector of Customs at the Port of ) that he desires to enter New Zealand as a visitor only for purposes set out in section 8 of the said Act : And whereas the said Minister by his said delegate is prepared to grant the visitor a permit under the said section 8, subject to, inter alia, the condition that these presents shall be entered into :
Now, this deed witnesseth that in pursuance of the premises and of an agreement so to do the said [doth hereby for himself, his] [do hereby jointly and severally for themselves and each of them, their, and their respective] executors and administrators, covenant with the Crown upon and at all times after the granting of any such permit as aforesaid to pay to the Collector of Customs all costs, charges, and expenses that may at any time be incurred by the Crown or any public body in or about the maintenance, relief, arrest, or detention in New Zealand of the visitor and his wife and/or children (if accompanying him), or his or their deportation from New Zealand, whether arising from sickness or poverty or from default of the visitor (and/or his wife and/or his children) in compliance with any requirements of law or from any other cause, and whether or not such costs, charges, and expenses may, apart from these presents, be a debt recoverable by the Crown or such public body from the visitor or any other person : Provided always that in the case of any such costs, charges, or expenses as are not actually disbursed by the Crown or a public body, or the amount of which is not fixed by law or otherwise so as to amount to a liquidated sum, the amount thereof shall be such sum as is certified as being reasonable in the circumstances by the Minister of Justice, the Minister in Charge of Prisons, the Minister of Health, the Minister in Charge of Mental Hospitals Department, the Minister of Customs, a Hospital Board, or other person (including the Permanent Head of a Government Department) or body administering the Department or institution by, through, or in connection with which such costs, charges, and expenses were incurred :
Provided also that the liability created by these presents shall be deemed a principal liability several with the liability of the visitor under such permit and not joint, and not by way of guarantee or surety, and that the liability created by these presents shall not be prejudiced by any release of the visitor or extension of the said permit or extension of time for payment by the visitor or any other matter that might discharge a surety.
In witness whereof these presents have been executed the day and year first above written.
Signature[s] :
Signed by the said in the presence of—
Witness—
Name : Occupation : Address :

New Zealand Customs.
DEED OF COVENANT RESPECTING DEPOSIT—TEMPORARY PERMIT.
(Immigration Restriction Acts.)
THIS DEED, made the day of , 19 , between
His Majesty the King (hereinafter called "the Crown," which expression shall include His Majesty's Government in and for the Dominion of New Zealand and any Department thereof, and any person or body acting for or on behalf of the Crown or Government, where the context so requires or admits), of the one part, and [Full name of person executing this deed], of [Address], [Occupation], of the other part :
Whereas [Full name, address, and occupation outside New Zealand of person desiring temporary permit] (hereinafter called "the visitor"), who arrived in New Zealand from [Name of port from which arrived] by the ship [Name of vessel by which arrived in New Zealand] on the day of 19 , is a person to whom Part I of the Immigration Restriction Amendment Act, 1920, applies, and who has proved to the satisfaction of the Minister of Customs (or of his duly appointed delegate, the Collector of Customs at the Port of ) that he desires to enter New Zealand as a visitor only, for the purposes set out in section 8 of the said Act : And whereas the said Minister by his said delegate is prepared to grant the visitor a permit under the said section 8 subject to, inter alia, the condition that the sum of
pounds (£ ) shall be paid to the Collector of Customs to be held and applied as set out by these presents : And
whereas the said sum of has concurrently with the execution hereof been paid by to the Collector of Customs accordingly :
Now, this deed witnesseth that in pursuance of the premises it is hereby agreed between the parties hereto that the said sum of may at any time after the granting of any such permit be applied in payment to the Crown of all moneys which the visitor may at any time be called upon or liable to pay pursuant to the conditions of such permit, and which the visitor may not theretofore have paid :
And it is hereby further agreed that the said sum, or such part thereof (if any) as has not theretofore been applied or become applicable in any manner aforesaid, shall, after the final departure of the visitor from New Zealand, be repaid to the said .
In witness whereof these presents have been executed the day and year first above written.
[Signature]:
Signed by the said in the presence of—
Witness—
Name : Occupation : Address :

New Zealand Customs.
APPLICATION FOR A PERMIT TO ENTER NEW ZEALAND.
(Immigration Restriction Amendment Act, 1920.)
[To be filled up in the English Language.]
To the Honourable the Minister of Customs,
Wellington, New Zealand.
I, [Full name], of [Present address], do hereby make this application to enter New Zealand [accompanied by my wife and/or my minor unmarried child(ren)], and submit the following particulars concerning myself [and my wife and/or such child(ren)] [Strike out any words in brackets not required]—
(1) Full name :
(2) Sex :
(3) Nationality :
(4) Race or people to which applicant belongs :
(5) Place and date of birth :
(6) Places of birth and nationality of parents—
(a) Father :
(b) Mother :
(7) Last place of permanent residence :
(8) (a) Whether previously in New Zealand :
(b) If so, when :
(9) Marital state :
(10) If married—
(a) Full name and age of wife :
(b) Full name[s], age[s], and sex[es] of child[ren] :
(c) Names of members of my family mentioned above who are to accompany me :
(11) Occupation :