Newfoundland and Labrador Provincial Nominee Program

International Graduate Entrepreneur Category

Application Form

Please refer to the appropriate Newfoundland and Labrador Provincial Nominee Program Application Guide for the
category to which you are applying. Please ensure that all documents requested in the Application Guide Document
Checklist are included with your application. The Office of Immigration and Multiculturalism (OIM) is unable to process
incomplete applications.

Note: Both the principal applicant, and if applicable, associated partners seeking permanent residency through the proposed
business must each complete this form.

Please indicate whether you are the principal applicant or an associated partner.

Principal Applicant Associated Partner

Section A – Personal Information

Please give your family name and given names exactly as they appear on your passport or travel document.

Family name:

Given name:

Have you ever used any other name such as a maiden name, alias or nickname. Yes No
If yes, please provide the names.

Other family name(s):

Other given name(s):

Sex: Male Female X (Unspecified)

Date of birth (dd/mm/year):

Country of birth:

Current citizenship(s):

In which country do you currently live?

If you currently live in Canada, what is your status?

Worker Student Visitor

International Graduate Entrepreneur Application Form (Jan. 2019) 1

Expiry date of your work permit, study permit or visitor record: (dd/mm/year): _____________________

If your permit or visa has expired or is about to expire, when did you apply for a new one?

(dd/mm/year): Not applicable

PASSPORT or TRAVEL DOCUMENT

Please give information exactly as it appears on your travel document.

Do you have a valid passport or travel document? Yes No

Passport or travel document number:

Issuing country: Expiry date (dd/mm/year):

CONTACT INFORMATION (Please do not give contact information for a consultant or lawyer who is representing you.):
Email address
(By giving an email address, you are agreeing to allow the Office of Immigration and Multiculturalism to send
information about you and your dependents to this email address)

Telephone number(s)
Please give the country code, area code if you have one, and telephone number where it is easiest to reach you.

Mobile Number

Home Number

Work Number

Mailing Address

street address city, town or village

province, state or district country postal code

Residential Address
Is your home address the same as your mailing address?

Yes No If no, please provide details.

street address city, town or village

province, state or district country postal code

International Graduate Entrepreneur Application Form (Jan. 2019) 2

RESIDENCES
Where do you currently live in Newfoundland and Labrador?

In the past five (5) years, have you lived for more than six (6) months in any country other than the one in which
you are living now or the countries of which you are a citizen?

Yes No

Please list all places where you lived in the past five (5) years. Use additional pages, if necessary.
NOTE: Please do not leave any gaps in time. Even a gap of one (1) month will delay processing your application.

From mm/year
City or Town Province, State or District Country
To mm/year

MARITAL STATUS

What is your current marital status?

Single Married Common-law

Legally separated Divorced Widowed Other

If you are married or in a common-law relationship, provide the date (dd/mm/year) on which you were married or
entered into the common-law relationship:

International Graduate Entrepreneur Application Form (Jan. 2019) 3

DETAILS OF FAMILY MEMBERS
We require you to provide information about each member of your family if they are not already permanent residents or
citizens of Canada. You must give this information even if your family members are not coming with you to Newfoundland
and Labrador. Please provide all names exactly as they appear on passports or travel documents. Members of your family
that must be included are:

• your spouse or common-law partner

• all of your dependent1 children
• all of the dependent children of your spouse or common-law partner

Spouse or Common-law Family Member Family Member

Partner

Family name (as on passport

or travel document)

Given name (as on passport

or travel document)

Date of birth (dd/mm/year)

Country of birth

Country of citizenship

Country of residence

Sex
What is this person’s
relationship to you?
Will this person come with
Yes No Yes No Yes No
you to Canada?
Passport/Travel Document
Document number
Issuing country

Expiry date (dd/mm/year)

Native language/Mother tongue

Highest level of education

1
According to Immigration and Refugee Protection Regulations (IRPR), a dependent is a child who depends on their parent for
financial and other support. A son or daughter is considered a dependent of their parent when the child is:
• under 22 years old, and does not have a spouse or partner, or
• 22 years old and over, and has depended largely on the parent's financial support since before the age of 22 due to a physical or
mental condition

International Graduate Entrepreneur Application Form (Jan. 2019) 4

 DETAILS OF FAMILY MEMBERS (Continued)

Family Member Family Member Family Member

Family name (as on passport

or travel document)

Given name (as on passport

or travel document)

Date of birth (dd/mm/year)

Country of birth

Country of citizenship

Country of residence

Sex
What is this person’s
relationship to you?

Will this person come with you

to Canada? Yes No Yes No Yes No
Passport/Travel Document
Document number
Issuing country

Expiry date (dd/mm/year)

Native language/Mother tongue

Highest level of education

International Graduate Entrepreneur Application Form (Jan. 2019) 5

 Section B – Personal History and Work Experience
Please provide details of your personal history for the past five (5) years. If you are under 23 years old, please include
these details since the age of 18. Please begin with the most recent information. Under “Activity”, write your occupation
or job title if you were working. If you were not working, tell us what you were doing, for example: unemployed,
studying, travelling, retired, in detention.

NOTE: Please do not leave any gaps in time. Even a gap of one (1) month will delay processing your application.

Duration (MM/YYYY) Activity Information Location

From Activity City

To Name of company, employer, school, facility, as applicable Country

International Graduate Entrepreneur Application Form (Jan. 2019) 6

 Section C – Application History
Federal Application
Have you or a family member coming with you, ever applied to Immigration, Refugees and Citizenship Canada for
admission as a permanent resident or refugee claimant?
Yes No

If yes, please complete the following.

Applicant’s full name:

Family name, Given name

Immigration, Refugees and Citizenship Canada file number:

Date of application (dd/mm/year):
Result (in-process, approved, refused, rescinded, withdrawn):
Where in Canada had you planned to live?

Has the applicant or a family member accompanying the applicant ever been refused a work permit, visitor visa,
or been refused entry to Canada? Yes No

If yes, please include a copy of the Refusal Letter with this application.

Provincial Application
Have you or a family member accompanying you ever applied for provincial nomination or permanent residence
under any other provincial or territorial program?

Yes No
If yes, please complete the following.

Applicant’s full name:

Family name, Given name

Province or territory of application:

File number: Date of application (dd/mm/year):

Result (in-process, approved, refused, withdrawn):

International Graduate Entrepreneur Application Form (Jan. 2019) 7

 Section D – Language
Your Language Ability
Native Language or Mother Tongue:

Which do you use most often, English or French?

English French

Have you taken a Canadian English Language Proficiency Index Program (CELPIP) general test or International English
Language Testing System (IELTS) general training test to assess your ability in English within the last two (2) years?

Yes No

If yes, please indicate which test?

Canadian English Language Proficiency Index Program (CELPIP) general test
International English Language Testing System (IELTS) general training test

Date of Test (dd/mm/yyyy):

Listening Speaking Reading Writing

Enter your scores

Enter equivalent Canadian Language Benchmark scores2

Have you taken a Test d'évaluation du français (TEF) to assess your ability in French within the last two (2) years?
Yes No

Date of Test (dd/mm/yyyy):

Listening Speaking Reading Writing

Enter your scores

Enter equivalent Canadian Language Benchmark scores

Proof of your language test must be attached (Results of your official English language proficiency test (CELPIP –
General or IELTS – General Training) OR your official French language proficiency test (TEF))

2
For help converting your language test scores to a Canadian Language Benchmark equivalent, refer to the IRCC language test
equivalency charts online at https://www.canada.ca/en/immigration-refugees-citizenship/corporate/publications-manuals/operational-
bulletins-manuals/standard-requirements/language-requirements/test-equivalency-charts.html

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 Section E – Newfoundland and Labrador or Other Canadian Connections
Have you, your spouse or common-law partner, or any of your dependent children lived in or visited Canada in the last
10 years?

Yes No
If yes, please describe each time you, your spouse or common-law partner, or any of your dependent children lived in or
visited Canada.

From: mm/year Who lived in or visited Canada? In which Province or Territory did Reason: work, visit, or
To: mm/year they stay? study

International Graduate Entrepreneur Application Form (Jan. 2019) 9

 Do you have family members living in Canada? Family members include your mother, father, dependent children, brothers,
sisters, aunts, uncles, cousins, grandparents, grandchildren, nieces, and nephews.
Yes No

Please include the following information for ALL family members living in Canada.

NOTE: You must provide proof of relationship, proof of relative’s status and proof of relative’s residency.
(Adaptability points provided only for relatives 19 years or older on date of application who are Canadian citizens or
permanent residents living in Newfoundland and Labrador for at least one (1) continuous year.)

Applicant
Name of relative (family name, given name) Relationship (e.g., sister) Province or Territory

Are they a Canadian citizen or permanent resident? Telephone Number Years in Canada

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

International Graduate Entrepreneur Application Form (Jan. 2019) 10

 Does your spouse or common-law partner have family members living in Canada? Family members include their mother,
father, dependent children, brothers, sisters, aunts, uncles, cousins, grandparents, grandchildren, nieces, and nephews.
Yes No

Please include the following information for ALL family members living in Canada.

NOTE: You must provide proof of relationship, proof of relative’s status and proof of relative’s residency. (Adaptability
points provided only for relatives 19 years or older on date of application who are Canadian citizens or permanent
residents living in Newfoundland and Labrador for at least one (1) continuous year.)

Spouse or common-law partner

Name of relative (family name, given name) Relationship (e.g., sister) Province or Territory

Are they a Canadian citizen or permanent resident? Telephone Number Years in Canada

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

International Graduate Entrepreneur Application Form (Jan. 2019) 11

 Section F – Education
What is the highest level of education you have successfully completed?

Provide the number of years of school you successfully completed for each of the following levels of education.
Elementary/primary
Secondary/high school
Memorial University of Newfoundland _____________
College of the North Atlantic
Give full details of all the secondary and post-secondary education (including university, college and
apprenticeship training) you have had.

Duration (MM/YYYY) Education Information Location

From Name of Institution City

To Course, degree, certificate or apprenticeship activity Country

Have you received a scholarship or award that requires you to return to your home country following the completion of your
degree?

Yes No

If yes, have you satisfied the terms of this scholarship or award?

Yes No

International Graduate Entrepreneur Application Form (Jan. 2019) 12

 Section G – Current Business Information
Only the principal applicant must complete this section. If you are an associated partner seeking permanent residency through
the proposed business, please indicate the name of the principal applicant associated with your business.

__________________________________________________

Type of business

Start-up Business Succession

Business Information

Name of Company (enter full legal name if a corporation):

Operating Name:

Canada Revenue Agency Business Number (BN) for tax/payroll purposes:

Start-up investment Amount (if applicable):

Business Purchase Price (if applicable):

Business Website:

Current Business Address

street address city, town

province, state or district country postal code

Current Business Mailing Address

Same as current address?

Yes No

If no, please provide the following information

street address city, town

province, state or district country postal code

International Graduate Entrepreneur Application Form (Jan. 2019) 13

What is your current position or title in your current business? (Example: owner, partner, manager, etc.)

How many hours per week do you spend managing the business?
hours per week

How many years have you owned the business?

What type of business do you own? (Example: manufacturing, exporting, processing)

How many employees does the company currently have?

How many employees do you manage?

What are the total company assets?

What is your level of decision-making ability in the business?

Industry/Sector: Aerospace
Agri-food/seafood
Biotechnology
Culture
Energy
Forestry
Information and communications technologies
Manufacturing
Mining/materials
Oceans technology
Retail/services
Tourism
Other (please specifiy):

International Graduate Entrepreneur Application Form (Jan. 2019) 14

Type of ownership

Sole Proprietorship
Partnership
Corporation

Please provide the ownership breakdown.

Name of Owner Percentage of Ownership (%)

Please describe any capital asset purchases (e.g., machinery and equipment).

Please provide a detailed description of the products/services your company offers its customers.

International Graduate Entrepreneur Application Form (Jan. 2019) 15

Please describe your inventory by type (e.g., finalized products, raw materials, etc).

Please provide a list of your business’ major suppliers.

Name of Supplier Supplier Contact Person Phone Number for Contact at Supplier

Please provide a list of your business’ major customers (e.g., wholesale or corporate, repeat customers).
Name of Customer Customer Phone Number

International Graduate Entrepreneur Application Form (Jan. 2019) 16

Please provide an itemized list of your expenditures to date, including a short description of the expenditure.
Expenditure Item Actual Investment ($CAD)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

International Graduate Entrepreneur Application Form (Jan. 2019) 17

Please provide a description of any leasehold improvements or renovations to date.
Improvement/Renovation Investment Amount ($)

Human Resource Information

Please provide the following information for each of your employees (attach additional tables/pages(s) if necessary).
Family Name

Given Name

Job Title

Employee Duties

Date Began (dd/mm/year)

Hourly Wage

Hours Worked Per Week

Immigration Status

International Graduate Entrepreneur Application Form (Jan. 2019) 18

 Section H – Settlement
In your own words, please tell us briefly about your plans to settle in Newfoundland and Labrador and your future here.
Statements copied from someone or somewhere else are not acceptable.

International Graduate Entrepreneur Application Form (Jan. 2019) 19

Out-of-Province Travel
Please provide details of all out-of-province travel conducted since submitting your Expression of Interest (EOI).
Date Arrived Date
Destination in Departed
Destination City Province/Country Destination Destination Purpose
(dd/mm/year) (dd/mm/year)

International Graduate Entrepreneur Application Form (Jan. 2019) 20

 Section I – General information

Note: Anyone you pay to help you with your application to immigrate into Canada must be a member of one of the
following groups:
• the Immigration Consultants of Canada Regulatory Council (ICCRC)
• a Canadian provincial or territorial law society
• the Chambre des notaires du Québec
For more information on who may represent you, visit www.canada.ca/en/immigration-refugees-citizenship/
services/immigration-citizenship-representative/learn-about-representatives.html

Assistance in completing the application

Did someone help you complete this form?

Yes No

If yes, who helped you? (Please name the person.)

Lawyer: Employer:

Immigration consultant: Other:

Did you, or will you, pay this person for their help in preparing this application?
Yes No

How did you learn about the Newfoundland and Labrador Provincial Nominee Program?

Newfoundland and Labrador promotion material Immigration Agent

Newfoundland and Labrador Office of Immigration Friend
and Multiculturalism Website
Employer
Canadian Visa Office

Immigration job fair or event overseas (specify place and date):

Other (specify):

International Graduate Entrepreneur Application Form (Jan. 2019) 21

 Section J – AUTHORIZATION TO COLLECT AND DISCLOSE INFORMATION AND
APPLICANT DECLARATION

I, ______________________________________________ _________________________
Principal Applicant – Surname, First Name (Please print) Date of Birth (dd/mm/yyyy)

And my Dependents:

______________________________________ ___________________________
Spouse/Common Law Partner – Surname, Given Name Date of Birth (dd/mm/yyyy)

Dependent(s) – Surname, Given Name Date of Birth (dd/mm/yyyy)

______________________________________ ___________________________

______________________________________ ___________________________

______________________________________ ___________________________

DO HEREBY AUTHORIZE the designated representatives of:

1. Office of Immigration and Multiculturalism, Government of Newfoundland and Labrador;

2. Immigration, Refugees and Citizenship Canada and Canada Border Services Agency;
3. and/or other person(s) or organizations referenced in my application;

to exchange all personal information contained in my application to the Newfoundland and Labrador Provincial
Nominee Program, regarding myself or any dependent member of my family, and to use it in conjunction with any
other agency or branch of either government in evaluating my application.

I also authorize this personal information to be shared as required with third parties either within or outside
Newfoundland and Labrador for the purpose of assessing my application under the Provincial Nominee Program
and promoting my integration into the provincial labour market. I understand that the Government of Newfoundland
and Labrador and its agencies may contact such parties to verify information provided by me in this application.

I understand that I have the right to examine and request corrections or amendments to my personal records,
whether held by a provincial or federal government office. Any information provided to Newfoundland and Labrador
will be disclosed only in the manner provided in this Authorization to Disclose Personal Information or as required by
the Laws of Canada and of Newfoundland and Labrador.

International Graduate Entrepreneur Application Form (Jan. 2019) 22

I DECLARE that:

1. I intend to live and reside in Newfoundland and Labrador on a permanent basis;

2. The information I have given in this application is truthful, complete and correct;
3. I understand that any false statements or concealment of a material fact may result in my exclusion from
Canada and may be grounds for my prosecution or removal;
4. I understand all the foregoing statements, having had the opportunity to ask for and obtain an explanation
of every point that was not clear to me;
5. I understand that the information I have provided is protected under federal and provincial privacy
legislations;
6. I have read and understand this declaration.

Dated this _____ day of ________________________, 20_____

___________________________________________
Signature of Principal Applicant

International Graduate Entrepreneur Application Form (Jan. 2019) 23

Section K – Declaration

Declaration of Information
Applicant and spouse or common-law partner and all accompanying dependent family members 19 years or older must initial
beside each statement and authorization to acknowledge agreement and then sign at the bottom of the page. Failure to
initial each line and sign at the bottom will result in your application being deemed incomplete and it will not be processed.

Initials

I intend to live in the Province of Newfoundland and Labrador upon arrival in Canada.

I understand that the Office of Immigration and Multiculturalism (OIM) or Immigration, Refugees
and Citizenship Canada (IRCC) may refuse my application, rescind my nomination or withdraw
my Canadian permanent resident visa if I give false information or fail to give information as
requested. Any misrepresentation or intentional omission of material information that is relevant to
the application will result in me being ineligible to re-apply for nomination for a period of five (5) years.

I understand that my application will NOT be processed if I fail to provide a complete application or fail to
include required forms and credible supporting documentation.

Program criteria are eligibility minimums. Meeting program criteria does NOT guarantee that my
application will be approved.

I will give OIM my address, phone numbers, and email address no later than 30 days after I have arrived
in Canada. I will inform OIM every time I change my address, phone numbers, or email address for 5
years after arriving in Canada. I agree to supply OIM officers with my business’ contact information in
order to monitor my business for period of up to five (5) years after the date of my business being
established. The monitoring of my business will be to ensure program integrity, my continued eligibility
for nomination, and to determine the economic significance of my business to Newfoundland and
Labrador.

The business I will establish or purchase in Newfoundland and Labrador, as per this application, complies
with all applicable provincial laws and regulations, including, but not limited to the following statutes,
as amended from time to time (refer to official versions):

Labour Standards Act

http://assembly.nl.ca/Legislation/sr/statutes/l02.htm

Workplace Health, Safety and Compensation Act

http://assembly.nl.ca/legislation/sr/statutes/w11.htm

Human Rights Act

https://www.assembly.nl.ca/Legislation/sr/statutes/h13-1.htm

Food Premises Act and Regulations (Food Services Industry Only)

http://www.assembly.nl.ca/Legislation/sr/statutes/f21-1.htm
http://www.assembly.nl.ca/Legislation/sr/regulations/rc961022.htm

I declare that the information I have given in this application is truthful, complete and correct.

International Graduate Entrepreneur Application Form (Jan. 2019) 24

 I acknowledge that I have read, understand and agree to this declaration, and that my representative has provided me with
a completed application form for review.

Signature of principal applicant Date (dd/mm/year)

Signature of spouse or common-law partner Date (dd/mm/year)

Signature of dependent family member 19 years or older Date (dd/mm/year)

Please submit completed application to the address below.

Office of Immigration and Multiculturalism

Department of Advanced Education, Skills and Labour
Government of Newfoundland & Labrador
P.O. Box 8700, St. John’s, NL A1B 4J6
Canada
Tel: (709) 729-6607
Fax: (709) 729-7381
Email: [email protected]
www.nlimmigration.ca

International Graduate Entrepreneur Application Form (Jan. 2019) 25