Aupair The Kiwi Connection
PO Box 20564 Glen
Eden, Auckland New Zealand
Ph:
0064-9-826-0083 Fax:
0064-9-8134426
Consent to disclosure of information – position
outside New Zealand
Criminal Records (Clean Slate) Act 2004
To: Licensing
& Vetting Service Centre
Office of the
Commissioner
PO Box 3017
WELLINGTON
To be completed by third
party that is to receive the personal information.
I
declare that section 14(3)(B)(ii) of the Criminal Records (Clean Slate) Act
2004 applies to this vetting
Request
– the question about this individual’s criminal records is asked in
New Zealand but relates to a
Matter
dealt with by the law of a foreign country. As such the individual is not
authorized by the
Criminal
Records (Clean Slates) Act 2004 to answer a question asked of him or her about
his or her
criminal
record by stating that he or she has no criminal record as provided by section
14(1)&(2) of the
Criminal
Records ( Clean Slate) Act 2004.
Signed:
Print
full name:
To be completed by
individual authorizing of personal information
I
confirm that I am aware that my full criminal record will be released even if I
meet the eligibility
Criteria
stipulates in section 7 of the Criminal Records (Clean Slate) Act 2004 due to
the application of
Section
14(3)(ii) of Act, as set out above.
Signed:
Print
full name:
Name:
(Surname)
(First names)
Sex: (M/F)
Maiden or any other names used
Date and place of birth:
Nationality:
Drivers
licence No:
Full residential address:
Street name and number
Suburb, City/Town
Comments of the New Zealand Police