PLEASE PROVIDE BELOW INFORMATION and ANSWER ALL QUESTIONS: FOR HELP, CONTACT OFFICE

USE EXTRA SHEET IF NEEDED:

NAME:

Current Address:

Phone:

Email Id:

1. Color of eyes and height for your self and spouse and kids

Your Height: Color of Eyes: Spouse Height & color of eyes. Kids Height & Color of Eyes

2. Funds Available (Not required if applying under SPOUSAL sponsorship)

3. Have you done Biometrics

4. Your Marital Status,

If Married, Marriage Date:

5. Have you or any of your (Spouse and Kids) has been refused visa to Canada or USA OR any other country? If yes, provide details

6. Have you or your family member (Spouse, KID) ever been arrested or charged OR CONVICTED of any kind of Crime inside or Outside
Canada

7. Are you or your spouse & kids are or were associated with any violent group/ terrorist activity.

8. Do you or your spouse or kids have any serious disease, Physical or mental disorder
9. Have you changed your name:
10. Do you hold passport of any other country?

11. Have you ever served in Military or Police Services?

12. Family name of your Mother before marriage:

13. Have you been previously Married or In Common Law Relationship?

If Yes, provide the NAME of your previous Spouse:

Date of Birth of spouse

Date Relationship Started

Date relationship Ended:

14. Date you entered First time in Canada & Name of Airport

15. Date you entered last time in Canada & Name of Airport

16. Have you been to any other country in last five years,
if yes Please write Name of country,

Date of Entry

Date of Exit

your status in that country for e.g. Worker/Visitor/PR etc.

17. Have you done IELTS OR CELPIP

18. What is your Native Language?

 19. List all your Secondary and Post-Secondary Education. Use separate sheet if space is less:
TOTAL YEARS OF ELEMENTARY______ SECONDARY_______COLLEGE/UNIVERSITY______TRADE/APPRENTICESHIP______

FROM TO NAME OF INSTITUTION/SCHOOL CITY/TOWN COUNTRY TYPE OF CERTIFICATE ISSUED FIELD OF STUDY
(Year/ Month) SECONDARY/DIPLOMA/DEGR
(Year/ Month) EE ETC.
/SUBJECTS

20. Do you have any Relative in Canada? If yes, provide the following information:
Name of Relative Relationship Name of City & Province Number of Years spent in STATUS IN CANADA
Canada
PR/ WORKER/ STUDENT

21. Give following details of any of your Friend/Relative (Not your Employer) who can be Contacted in Future:
Name: Phone No: Email
 22. List all the countries that you visited and that you have lived (except your country of citizenship) in over the past 10 years.

FROM TO PURPOSE OF Country, City (ADDRESS IF KNOWN )

(dd/mm/yyyy) (dd/mm/yyyy) TRAVEL

23. Provide the detail of your personal/ Work history since the age of 18. (please do not leave any gap, write Unemployed if not working),

FROM TO ACTIVITY/DESIGNATION CITY/TOWN COUNTRY NAME OF EMPLOYER COMPANY/SCHOOL

(Year/ Month) (Year/ Month) NAME OF JOB
 24. List all your addresses since the age of 18.

FROM TO ADDRESS CITY/TOWN PROVINCE/ POSTAL CODE COUNTRY

(Year/ Month) (Year/ Month) STATE ZIP CODE
 25.FAMILY INFORMATION(LIST ALL YOUR BRO/SIS & KIDS, STEP BRO/SIS, STEP KIDS( USE SEPARATE SHEET IF NECESSARY)
NAME DATE OF BIRTH PLACE OF Date of Death, Marital ADDRESS and EMAIL OCCUPATION
BIRTH(City, if Expired STATUS,
Country) WERE BOTH
PRESENT

MOTHER

FATHER

SPOUSE

Bro/ sis

Bro/sis

Bro/ sis

Bro/Sis

CHILD