V.01.Form.01.

01 Private Visitor Application - Adult Visitor

Private Visitor Information

Applying to visit someone in prison
Unless exceptional circumstances exist, anyone wanting to visit a prisoner has to apply for approval under
the Corrections Regulations 2005.
To apply for approval you must complete this form and return it to the prison that you want to visit.

If there is contract restriction which prohibits the prisoner from making contact with you then you
must also completeC.01.Form.01 Confirmation by protected person of willingness to maintain
contact, which confirms that you are willing to make contact.

Contact will not be permitted if a no contact conditions (NCC) is in place, unless there is an exemption
allowing visits.

Information provided by you is required to make a decision on whether a visit can be approved. Decisions
are made in accordance with the Corrections Act 2004 and the Corrections Regulations 2005.
The failure to supply an answer to a question could result in approval being declined. The principles of the
Privacy Act 1993 apply to the information supplied. You may contact Corrections at any time to access or
correct the information Corrections holds about you.

Before you return your V.01.Form.01.01 Private Visitor Application - Adult Visitor Form (and any
V.01.Form.01.02 Private Visitor Application - Child Visitor Forms) please check that you have:
provided all information that applies to you
attached a photocopy of your identification(s) or your endorsed passport photo
attached a V.01.Form.01.02 Private Visitor Application - Child Visitor for every child under the age of
18 that might visit with you.

Bringing a child to prison

If you want to bring a child (aged under 18) with you to prison, an individual application must be completed
for each child aged under 18 that might visit with you, using V.01.Form.01.02 Private Visitor Application –
Child Visitor.

Processing your application

The purpose of any visit to a prisoner by a Private Visitor is to maintain the family and social relationships of
the prisoner in order to promote the prisoner’s re-integration into the community on release.
Contact between prisoners and their families is encouraged and supported so far as is reasonable and
practical and to the extent that this contact is consistent with the maintenance of safety and security.

You may be denied approval if:

• Your visit is not likely to maintain family and social relationships of the prisoner in order to promote
the prisoner’s reintegration into the community on release.
• You fail or refuse to provide any information required by law (see information below regarding
Regulation 106A).
• You provide information which is reasonably believed to be false.
• You refuse to authorise Corrections staff to have access to official records to verify information given
by you.

You may be denied approval to visit a prisoner if the visit is likely to adversely affect:
• The security, discipline or good order of the prison; or
• The welfare, chances of successful rehabilitation, or safety of a prisoner.
• The welfare or safety of any person in the prison, including the visitor.

POM-V.01.Form.01.01 Private Visitor Application – Adult Visitor

Last updated: 01 Jul 2020 Page 1 of 4
You may be prohibited from visiting if the visit is likely to adversely affect:
• The security, discipline or good order of the prison: or
• The welfare, chances of successful rehabilitation, or safety of a prisoner; or
• The welfare or safety of any person in the prison, including the visitor; and
• Prohibiting the visitor is appropriate or necessary in the circumstances.

Regulation 106A information that you must give:

• the prisoner’s name
• the visitor’s name and date of birth
• the nature of the visitor’s relationship with the prisoner (if any)
• whether the visitor has ever served a sentence of imprisonment, and if so when
• whether the visitor is currently on bail
• whether the visitor has been convicted of an offence within the last 2 years
• whether the visitor has been refused admittance to the prison, or any other prison, as a visitor
• whether the prisoner concerned has any convictions or current charges for offences against the
visitor
• any contact restriction that the visitor is aware of that may have a bearing on the suitability of a visit
If requested, you must also give any additional information that prison staff believe to be necessary to ensure
the safe management of the visit and/or the safety and welfare of any visitor.

Prison Visit Decision

The outcome of your application will be provided to you in writing. The outcome will be one of the following:
1. Approval to visit (without conditions).
2. Approval to visit (with conditions). Conditions could include a booth visit, or a visit via Audio-Visual
Link (AVL).
3. Declined to visit.
4. Declined and issued a Prohibition Order.
You have the right to request a review of any prison visit decision (including when a Prohibition Order is
issued). The process for reviewing a decision will be outlined in the decision notification form.

Identification
If your application is approved you must bring photo identification and your approval letter with you each time
you visit. The acceptable types of photo identification are shown on the next page.
This form also tells you what you need to do if you don’t have any acceptable types of photo identification.
All approved child visitors must bring their V.01.Form.01.06 Child Visitor Approval Notification or
V.01.Form.01.07 Child Visitor Approval Notification - with conditions each time they visit.

Important rules about taking photos, videos and other recordings

Private visitors are not permitted to bring into prison any electronic device such as cell phones, cameras or
any other electronic device capable of either transmitting or recording.

POM-V.01.Form.01.01 Private Visitor Application – Adult Visitor

Last updated: 01 Jul 2020 Page 2 of 4
V.01.Form.01.01 Private Visitor Application - Adult Visitor

Adult Private Visitors are persons aged 18 years and over applying for approval to visit a prisoner. Complete
this form to apply to visit a prisoner. See Private Visitors Information for further details.

Details of the prison you want to visit

See details under Find a Location on www.corrections.govt.nz.
Prison name: Aaron James HAMIORA
Details of the prisoner you want to visit
Prisoner’s Last Name: Hamiora
Prisoner’s First Name:
Aaron james
Your relationship to the prisoner: Partner

Your personal details

Date Of Birth: 10/07/1970 Gender: Male Female
The name you provide must match the name on the identification that you produce when you visit.
Last Name: Smith

First Name: Tori shantelle jade

Are you known by any other names or aliases? If so, provide these below.
Last Name: Hamilton

First Name: Samantha Delores

Last Name: Paraha

First Name: Samantha Delores

Last Name:
First Name:

Last Name:
First Name:
Address to where you want any correspondence regarding this application sent to:
Street number & name: 69 milton road
Suburb: Papatoetoe
Town / City: Postcode:
Auckland
Phone Numbers: Home: Mobile: Work:
0225261798

Acceptable identification
You must present one form of acceptable identification each time you visit the prison. It must be current and
valid (not expired) every time you visit.
Tick the box next to the identification you intend to produce. You can tick more than one.
Driver’s Licence 18 + Card Bank Card with photo
Super Gold Card with photo Student ID Card Passport
Attach to this application a copy of each form of identification ticked.

POM-V.01.Form.01.01 Private Visitor Application – Adult Visitor

Last updated: 01 Jul 2020 Page 3 of 4
What if I do not have acceptable identification?
If you do not have acceptable identification, attach a passport photo to this form. Your full name, address
and date of birth must be endorsed on the back of the photo by:
• a Justice of the Peace, Deputy Court Registrar, barrister or solicitor, teacher, member of the Police, or
• another person with standing in the community (e.g. a Kaumatua or a bank manager) who has known
you for at least 12 months; and
o is not related to you; and
o does not live with you.
You must keep a copy of the photo and bring it with you each time you visit.

Other information about you we need to know to consider your application

Have you served a sentence of imprisonment? Yes No (Tick one)
If yes when? 2005

Are you currently on bail? Yes No (Tick one)

Have you been convicted of any offence within the last two years? Yes No (Tick one)
Are you currently charged with any offence for which a conviction has not yet Yes No (Tick one)
been entered?
If yes, please list:

Has the prisoner you are applying to visit ever been convicted of offences against Yes No (Tick one)
you? Or do they have active charges for offences against you?
If yes, please list:

Have you ever been refused entry to this or any other prison as a visitor? Yes No (Tick one)
Do you have a contact restriction (such as a Protection Order or a Restraining Yes No (Tick one)
Order) which prohibits or restricts contact from the prisoner?
If yes, please list:
I was serving a home detention and was instructed once completed I could apply

Authorisation and Signature

For this application to be considered you must complete this section:
I declare that I have disclosed in this application all the information that is relevant to me and that all of the
information given in this application is, to the best of my knowledge and belief, correct.
I authorise Corrections staff at (prison name)
Mount Eden Correction Facility
to have access to any information in official records to verify the information contained in this application and
for any subsequent checks if my application is approved and while I have approved visitor status that may be
considered necessary.
Your Last Name: Smith

Your First Name: Tori shantelle jade

Signature: Date: 1 September 2021

This information is required to make a decision on whether a visit can be approved. Decisions are made in
accordance with the Corrections Act 2004 and the Corrections Regulations 2005. The failure to supply an
answer, or consent to criminal records being used could result in the visit being denied. The principles of the
Privacy Act 1993 apply to the information supplied. You may contact Corrections at any time to access or
correct the information you have provided.
When you have completed this form, post it to the prison you named at the beginning of this application.

POM-V.01.Form.01.01 Private Visitor Application – Adult Visitor

Last updated: 01 Jul 2020 Page 4 of 4