Please fill out below schedule about your family information in ENGLISH. If any of these persons passed away, indicate the date of death and city of death instead of their address.
| Full name First Name, LAST NAME (Based on your Passport) | Relationship | DATE OF BIRTH | City of Birth | If Deceased, Date of Death | City of Death | Marital Status (Married / Single / Widow) | Current Occupation | Height, Eye color | FULL ADDRESS + Postal Code + Phone Number + Email Address |
|---|---|---|---|---|---|---|---|---|---|
| APPLICANT | |||||||||
| SPOUSE | |||||||||
| MOTHER | |||||||||
| FATHER |
information of children
| Full name First Name, LAST NAME (Based on your Passport) | Relationship (son / daughter / Adopted) | DATE OF BIRTH | If over age of 18, Married or Single | Current Occupation | FULL ADDRESS If same as above parent’s address, please mention same as above. | If the parents are divorced, who has custody of the child along with the address |
|---|
information of sister or brother
| Full name First Name, LAST NAME (Based on your Passport) | Relationship (Brother / Half Brother/ Sister/ Half Sister) | DATE OF BIRTH | City of Birth | If Deceased, Date of Death | City of Death | Marital Status (Married / Single / Widow) | Current Occupation | FULL ADDRESS + Postal Code + Phone Number + Email Address |
|---|
Passport Information
| Passports / Country of Citizenship Other than your Country of Origin | Passport Number | Country of Issue | Passport Issue Date | Passport Expiry Date |
|---|---|---|---|---|
Presently – Where do you live?
| Country | Status (Citizen / Worker / Student / Business Resident / Other... ( Please Explain) | From Date | To Date |
|---|---|---|---|
information of address
| From Date | To Date | Street Number | Apartment / Suite Number | Street Name | City | Country | Postal Code | Status Citizen / Residence / Permanent Residence |
|---|
Spouse Information and Marital Status
| Marital Status | Date Of Your Marriage (If You Are Married) | Spouse First Name | Spouse Last Name |
|---|---|---|---|
Have you previously been married? If yes Fill out the Information below
| Previous Spouse First Name | Previous Spouse Last Name | Previous relationship: From | Previous relationship: End |
|---|---|---|---|
Contact Information
| Home Phone Number | Cell Phone Number | ||
|---|---|---|---|
Education History
| From Date | To Date | Level of Study | Field of Study | Diploma Issued Completed /Not Completed | Institute / School / University Name | City | Country |
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Activity History
| From Date | To Date | Activity (position in your Job) | Company Name / Employer Name | City | Country |
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Do you own your company?
| If Yes Company Name | Business Registration Date | Number of Employees in the Business |
|---|---|---|
Applied History
| Countries | Issue Date or Refusal Date | File Number or email from Visa office | If refused Refusal Reason |
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Have you ever remained beyond the validity of your status in any Country? YES / NO If yes, please provide details
Have you previously applied to enter or remain in Canada? YES / NO If yes, please provide details.
Did you attend in military service/police office/Army/…? If yes, please indicate from when to when and what was the name of branch that you did your obligation? And in which city you did?
| From Date | To Date | Forces: Army, The Revolutionary Guards, Police | Rank/Title/Degree | Location/Place/ City where stationed | Province | Country |
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Have you ever taken a test from designated testing agency to assess your proficiency in language English or French?
| language | Score for WRITING | Score for LISTENING | Score for SPEAKING | Score for READING | Average Score | Test Date | City Test Taken | Country |
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List your travel history for the last 10 years
| From Date | To Date | City | Country | Reason (Leisure / Work / Business) |
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Within the past two years, have you or your family member ever had tuberculosis of the lungs or been in close contact with a person with tuberculosis?
Do you have any physical or mental disorder that would require social and/or health services, other than medication, during a stay in Canada?
Have you ever held any government positions (such as civil servant, judge, police officer, mayor, Member of Parliament, hospital administrator)? Do not use abbreviations.
| From Date | To Date | Country | Level of jurisdiction (eg. National, regional, municipal) | Rank/Title/Degree | Department/Branch | Activities and/or positions held |
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