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VISA FORM

I would like to have Assessment for immigration to Canana
I am interested in Work permit of Canada

Last First Middle

Name: Male: Female:
Address:
Home Telephone: Work Telephone: Fax:

Day Month Year

Date of Birth: Email:

City Province Country

Place of Brth:
Country of citizenship: Marital status:

City Country

If married, Where were you married?:

Day Month Year Last First Middle

Date of marriage: Spouse's name:

Day Month Year

Spouse's date of birth:
Destination in Canada, Australia, New Zealand:

Yes / No

Have you ever been to your intended country of immigration?:
If yes, when?:
If yes, where?: If yes, How long did you stay?:
Purpose of visit: Your Passport No.:

Day Month Year

Expiry date of Passport:
Have you ever been convicted of a crime?:
If yes, give date, place and explanation:

Have you ever been a member of any association in favour of relations, either cultural or economical,
between your country and intended immigration country?:

Date From-To Name of Assoc. Address of Assoc. Type of Assoc. Position or Title.

Have you ever been refused a visa or an application to immigrate to any country
(if yes, state date and province of desination)?

Date Province / state of destination.

LANGUAGE SKILLS

Written Spoken Read

Knowledge of english:

Written Spoken Read

Knowledge of french:
Mother tougue:
Have you ever taken TOEFL or IELTS test? If yes, provide date and score:

CHILDREN

Last Name 1st Name 2nd Name Birth Date (D/M/Y) Birth Place (City/Country) Level of education

Will your children accompany you ?: yes: no:

RESIDENCE (for the past 10 years)

EDUCATION (PLEASE WRITE ALL YOUR EDUCATION)

Number of years attended:
Primary: High School: Vocational: University:
Other (specify):
Have you ever taken education in French Language
HIGH SCHOOL ATTENDED

COLLEGE OR VOCATIONAL SCHOOL

UNIVERSITY ATTENDED

EMPLOYMENT (for the past 10 years)

IN THE FOLLOWING SECTION COMPLETE SPOUSE INFORMATION, IF YOU ARE MARRIED
SPOUSE LANGUAGE SKILLS

Written Spoken Read

Knowledge of english:

Written Spoken Read

Knowledge of french:
Mother tougue:
Have you ever taken TOEFL or IELTS test? If yes, provide date and score:

SPOUSE RESIDENCE (for the past 10 years)

SPOUSE EDUCATION (PLEASE WRITE ALL YOUR EDUCATION)

Number of years attended:
Primary: High School: Vocational: University:
Other (specify):
Have you ever taken education in French Language
HIGH SCHOOL ATTENDED

COLLEGE OR VOCATIONAL SCHOOL

UNIVERSITY ATTENDED

SPOUSE EMPLOYMENT (for the past 10 years)

RELATIVES OR FRIENDS IN THE COUNTRY WHERE YOU WISH TO IMMIGRATE?

Are your parents, children, brothers, sisters, aunts, uncles, neices, nephews, grandparents, or grandchildren citizens and/or permanent residents?

Do any of these relatives have a business ? If yes describe type of business:

PERSON WHO SHALL ASSIST YOU IF ANY:
The following person, employer or organization has offered to assist me after arrival(name, address and copy of job offer, if you have one):
Name:
Address:
Telephone:
Relationship:
Kind of assitance offered:

NET WORTH

How much money will you have in your possession upon your arrival in ?:

I have the following assets: (show amount of value):

Transferable money Property Monthly transferable pension Other

I have the following debts or legal obligations (e.g. child support payments) owing to (give name of person(s) or organization):
Name: Total Debts:
How did you hear about our firm?:

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