Check List Check List * Contact information for the applicant and if necessary, the exporter Serial numbers, makers marks, registration numbers of the object(s) History and provenance of the object(s) A photograph or illustration for taonga tūturu or artworks (if a the object is deemed to be a protected New Zealand object, a photograph will be required) Sign and date the application form Details of Applicant Full name of individual and/or company, organisation, society etc who owns the object(s) being exported * Name, physical and postal address of applicant (person signing this form) * Applicant Phone (work/home) * Applicant Email * Who will be responsible for the export of the object(s) from New Zealand? * Customs Broker Freight Forwarder Courier Company Applicant Other (specify below) Other * Details of Exporter If the response to question above is not "Applicant", please provide details of the person and/or organisation who will be responsible for exporting the object(s) from New Zealand * Exporters Phone Exporters Email * Ministry Information Notice The information (including photographs, illustrations etc.) provided to the Ministry for Culture and Heritage in this application will be held by the Chief Executive for the purpose of permitting the Chief Executive and his experts to assess and evaluate the application, and for the enforcement of the Protected Objects Act. The Ministry is subject to the Official Information Act and may be required to release information in the terms of that Act. After 10 years, files from the Ministry are destroyed, sealed or housed at Archives New Zealand. Certificates regarding export may be revoked at any time prior to the shipment of the objects. Should an extension be required, the Ministry may issue a new certificate. The objects must exit New Zealand within the time specified on the certificate and the certificate is only valid for one consignment. Please note that the certificate does not authenticate the object(s) as the object(s) is assessed on the information supplied by the exporter. Under section 7(1) of the Act, the Chief Executive may impose terms and conditions on the export of a protected New Zealand object from New Zealand. This could include, but is not limited to, requiring the owner to submit detailed drawings of the object to the Ministry prior to its export, and allow an object to be only temporary exported from New Zealand. If the object is deemed to be a protected New Zealand object, you will be required to submit photographs of the object prior to a decision being made by the Chief Executive. The photographs submitted are then the property of the Ministry. Description of Objects Title or name of object; include its common name ie. painting, traction engine etc * Age of Object (please state if known or estimated) * Value of Object (in $NZ - please state if value known or estimated) NZ$ Where was the object made, and/or where and when was it found? * Who made or created the object? (individual or company) * Put "Unknown" if not known Dimensions, model and make of object, and the significant materials used * Marks, distinguishing characteristics, serial numbers and/or registration numbers on the object * Known history of the object * Any other information Please attach a Photo or Illustration of the Object Files must be less than 10 MB.Allowed file types: gif jpg jpeg png bmp eps tif pdf doc docx odt ppt pptx odp. Attach another Photo or Illustration Files must be less than 2 MB.Allowed file types: gif jpg jpeg png. Attach another Photo or Illustration Files must be less than 2 MB.Allowed file types: gif jpg jpeg png. Details of any publication in which this object has been listed or photographed Export from New Zealand I wish to export the Objects from New Zealand: (please select one) * Permanently Temporarily Proposed date of export from New Zealand * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20232024202520262027202820292030203120322033 Name of country object(s) to be exported to * Port of exit from New Zealand * Method of exit from New Zealand * Post Ship freight Airline freight Personal luggage Other Method of Exit - Other Name of ship/airline Reason for temporary export (choose one) * Exhibition and Fairs Restoration Institutional Exchange Professional Equipment Other Reason for Temporary Exit - Other Date object(s) to return to New Zealand * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year2023202420252026202720282029203020312032203320342035 Port of re-entry to New Zealand Method of re-entry to New Zealand (choose one) Post Ship freight Airline freight Personal luggage Other Method of Re-Entry - Other Name of ship/airline on Re-Entry Name and address of the person and/or institution who will be in possession of the objects for the majority of time they are outside of New Zealand * Name and address of where the objects be housed once they have returned to New Zealand Are you applying for a CARNET? How long is your CARNET valid for? Declaration by Applicant I hereby apply under section 5 of the Protected Objects Act 1975 for permission to export from New Zealand one or more protected New Zealand object(s) as described in this application. I understand that under section 7 of the Act, I may be required to make the protected New Zealand object(s) available for examination by one or more persons nominated by the Chief Executive of the Ministry for Culture and Heritage. I agree that, if so requested, the protected New Zealand object(s) will be made available for examination either at the above address or at such other place as may be requested. By entering my name below, I declare that: I or the person(s) I am the duly authorised agent for, have undisputed title of the object or the full support of all the Trustees to register the object; and the contents of this application are to the best of my knowledge true and correct. Name (in lieu of Signature) * By entering your name here you are legally Signing your name Date of Birth * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 Date of Signature * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20212022202320242025 Updated on 1st August 2016
