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Manatū Taonga
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Personal details
Declaration by applicant
1 of 2
Personal details
Your full name
This name will appear on the certificate
Your full name
Physical address
Are you ordinarily resident in New Zealand?
Yes
No
Please provide details on the amount of time spent in New Zealand and frequency, and your usual place of residence
Have you ever been convicted of an offence against any provision of the Protected Objects (previously known as the Antiquities Act) or of the Historic Places Act?
Yes
No
Conviction details
Please provide relevant details of the conviction
Where will taonga tūturu acquired under this certificate usually be held?
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Phone number (work/home)
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Address
Address 2
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