Course Extension/Transfer Form Family name(s)* Given name(s)* Date of birth* DD slash MM slash YYYY Extension start date* DD slash MM slash YYYY Number of course weeks*Course General English (GE) Study type full-time part-time English for Business (EB) Study type full-time part-time English for University (EU) Executive course / One-to-one IELTS Study type full-time part-time IELTS Academic Writing Evening Class Cambridge Exam Preparation VisaWhat visa do you currently hold?* Visitor visa Student visa Working Holiday visa Work visa Residence visa other What is the end date of your current visa?* DD slash MM slash YYYY Insurance is compulsoryBy law you cannot start classes without proof that you have purchased Medical and Travel Insurance.International Students must have appropriate and current medical and travel insurance while studying in New Zealand. We arrange a low cost insurance with generous benefits designed especially for students coming to New Zealand. It includes cover for your international travel and loss of fees if your course is interrupted by an insurable event.Please check one* My current insurance is valid until the end of my stay in NZ I will arrange my own insurance until the end of my stay in NZ Please arrange insurance for me Do you have any pre-existing medical conditions § ? Yes No § A pre-existing medical condition is a condition that started before you applied for your insurance. If you answered 'Yes' to this question, you will have to complete a form on the Uni-Care website.Declarations* I have read and accept the Conditions of Enrolment. We process the data you give us on behalf of our company, with the purposes of providing the requested service(s) and of billing for the service(s). The data you give us will be kept for the length of time necessary to comply with legal obligations. The data will only be shared with third parties to enable us to manage your booking and deliver our services, in cases of emergency or where we have a legal obligation. Please visit https://www.languages.ac.nz/privacy/ to see exactly how your data is shared. You have the right to access your personal data, as processed by Languages International, and to correct inaccurate data or ask for its deletion when the data is no longer needed.* I have read and accept the privacy statement below. We process the data you give us on behalf of our company, with the purposes of providing the requested service(s) and of billing for the service(s). The data you give us will be kept for the length of time necessary to comply with legal obligations. The data will only be shared with third parties to enable us to manage your booking and deliver our services, in cases of emergency or where we have a legal obligation. Please visit https://www.languages.ac.nz/privacy/ to see exactly how your data is shared. You have the right to access your personal data, as processed by Languages International, and to correct inaccurate data or ask for its deletion when the data is no longer needed.* I give permission for Languages International and Immigration New Zealand to share information about my visa with each other. Digital signature (Your full name)* Date* DD slash MM slash YYYY Δ
