VAC Authorization Form July 2019 Con Ñ PDF

Paying INZ Visa Fee, VAC Service Fee and Return Courier Fees
To pay your Visa Application Center (VAC) fee and return courier charge by credit card, you must complete and
sign this form. Please fill out this form electronically and sign manually. Do not leave any blank space
Please note: TTS (TT Visa Services, Inc.) is a commercial company in partnership with Immigration New Zealand (INZ). All fees
including the visa application fee, the service fee and the courier fees are non-refundable. By signing this document, you
expressly agree to the Terms and Conditions listed on p.2 of this form and as described on our website, including Limitations
of Liability.
Applicant Details
Please note: Physical address for return of passports MUST have city, state, zip code and country.
Applicant Mr.  Ms.  Dr.
Title  Mrs.  Miss.  Other…………………………………………………………
Applicant Surname: VEGA DUEÑAS
Applicant Given Name(s): KHALIL NASSIB
Applicant Date of Birth 15/02/1988
(DD/MM/YYYY):
Physical address for Addressee Name: KHALIL NASSIB VEGA DUEÑAS
return of passports
and other original
documents Street: URBANIZACIÓN LARAPA GRANDE MANZANA F-5 LOTE 15
submitted with your
visa application form
(no P.O. box City: CUSCO State: CUSCO
addresses are
allowed): Country: PERU Zip code: 08006
Contact Telephone number 51 953753060 CELL PHONE

Please include country code + 51 84 650596 LANDLINE PHONE
area code + local number:
Email address: [email protected]
Payment Details- see Important Note below (All amounts in US Dollars)

INZ Visa Application Visitor Visa  Student Visa  Work Visa
Category:
 Other:
………………………………………………………………………………………………………………………………………………
INZ Visa fee (If you paid online. Please put PAID)
PAID
International Visitor Conservation and Tourism Levy (IVL):
This fee is per applicant (does not matter if they are in the same
application) $24 x 1
 VAC Service fee (For Paper Applications) $38
VAC Service fee (Online Applications)
Write down here the application number (only A-XXXXXX format):
$29
Return Courier fee(s) – one  $30  $55 $60

passport per envelope/per (Continental US) (Canada) (All other Locations)
applicant
 Mail-in Courier fee(s) – (Optional) Service available in the US Only.  $30
(A label can be provided by email for drop off at Courier) (Continental US)
Total charges
(to be charged to your credit card) $ 113
MBIE-MAKO-18597561
Card details
Please note: the charges will show on your credit card statement as processed by TTS or TT Visa Services.
Name of cardholder YOLANDA DUEÑAS ALVAREZ
Card number 4141 6500 0037 3542

Expiry date (MM/YYYY) 03/22 CVC/CVV number* 581
Signature of
cardholder
Credit card URBANIZACIÓN LARAPA GRANDE MANZANA F-5 LOTE 15

billing address
*Note: Your CVC/CVV number is the three or four-digit number found on the signature strip on the back of your
credit card.
TERMS AND CONDITIONS

1. All applications will be assessed and decided by INZ. TTS does not have the authority to assess visa
applications or make visa decisions and therefore, will not in any manner be liable or responsible for any delay
in the processing or refusal of any visa applications.
2. INZ fees are not able to be refunded by TTS under any circumstances. The decision to refund a visa application
fee lies solely with INZ.
3. Please ensure you provide correct contact details (including an email address if you have one) for follow up if
required.
4. Please note that the maximum extent of any and all liability of TT Visa Services, Inc. will never exceed shipping
insurance coverage you select and under no circumstances shall our liability exceed Three Hundred U.S.
dollars ($300.00) for any transaction.
5. Please note that any and all claims and/or disputes including any claim for damages of any nature or kind
against TT Visa Services, Inc. shall be subject to binding arbitration in the District of Columbia – in the City of
Washington, U.S.A. and initiated within Thirty Days (30) of the claim or damage being known or claimed to
occur.
6. I declare that I have read, I understand and expressly accept each of these Terms and Conditions and I
represent that I shall abide by these Terms and Conditions.
……………………………………………………………………… 03 / 10 /2019
(Handwritten Cardholder Signature) (Date)
……………………………………………………………………… 03 / 10 / 2019
(Handwritten Applicant Signature) (Date)
Important information
All Applicants
Your documents will be returned to you by our contracted courier service, and under normal circumstances will be
shipped the same business day they are returned to us by INZ. Shipping speed is typically overnight by 10:30 am
within the continental U.S., and 2nd day international. However, shipping delays occasionally occur due to
unforeseen circumstances such as weather.
Please note that Courier requires a residential or business address for delivery – The Courier cannot deliver to P.O.
box addresses.
Our office does not accept pre-paid envelopes/labels or hand-written labels from any courier service.
MBIE-MAKO-18597561

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Paying INZ Visa Fee, VAC Service Fee and Return Courier Fees

Contact Telephone number 51 953753060 CELL PHONE

Payment Details- see Important Note below (All amounts in US Dollars)

Return Courier fee(s) – one  $30  $55 $60

Card number 4141 6500 0037 3542

Credit card URBANIZACIÓN LARAPA GRANDE MANZANA F-5 LOTE 15

TERMS AND CONDITIONS

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