دریافت فرم

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
SamanFadavi APPLICANT 1976-02-21 Mashhad Married MechanicalSupervisor 168Brown No335thBozorgmehrShomaliSajjadBLVDMashhadIran9187800989153146027fadaviDOTsamanATgmailDOTcom
SamiraHojjat SPOUSE 1979-03-28 Mashhad Married CommercialManager 165Brown No335thBozorgmehrShomaliSajjadBLVDMashhadIran9187800989153146027fadaviDOTsamanATgmailDOTcom
MinooPartovi MOTHER 1948-09-27 Tehran Widow Retired 157Brown 5155SheppardEastAveTorontoCanadaM1B0C8
AliAkbarFadavi FATHER 1942-02-06 Quchan 2013-03-11 Mashhad

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
SamarFadavi Sister 1971-09-14 Tehran Married Dentist 50HargraveLaneTorontoOntarioM4N0A4

Passport Information

Passports / Country of Citizenship Other than your Country of Origin Passport Number Country of Issue Passport Issue Date Passport Expiry Date
Iran Z55909177 Iran 2022-02-16 2027-02-16

Presently – Where do you live?

Country Status (Citizen / Worker / Student / Business Resident / Other... ( Please Explain) From Date To Date
Iran Ciziten 2022-08-29

information of address

From Date To Date Street Number Apartment / Suite Number Street Name City Country Postal Code Status Citizen / Residence / Permanent Residence
2022-08-29 5 33 BozorgMehrShomali Mashhad Iran 91878 Citizen

Spouse Information and Marital Status

Marital Status Date Of Your Marriage (If You Are Married) Spouse First Name Spouse Last Name
Married 1997-11-28 Samira Hojjat

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 WhatsApp Email
00985137615019 00989153146027 00989153146027 fadavi.saman@gmail.com

Education History

From Date To Date Level of Study Field of Study Diploma Issued Completed /Not Completed Institute / School / University Name City Country
1982-09-23 1987-05-22 Elementary School Completed Sajjad Mashhad Iran
1987-09-23 1990-05-22 Elementary School Completed Mellat guidance school Mashhad Iran
1990-09-23 1994-06-22 Elementary School Mathematics Completed Sajjad highschool Mashhad Iran
1995-09-23 2000-09-16 Elementary School Mechanical Engineering Completed Islamic Azad University Mashhad Iran

Activity History

From Date To Date Activity (position in your Job) Company Name / Employer Name City Country
2010-11-01 2022-08-29 MechanicalSupervisor PardisShahrTarh Mashhad Iran
2007-04-01 2010-11-01 MechanicalSupervisor No141ConsultationCompany Mashhad Iran
2006-11-01 2007-04-01 ToolSalesManager KavoshAzmoon Mashhad Iran
2005-08-01 2006-09-01 ToolManager AzinGhalebJam Mashhad Iran
2002-01-01 2005-08-01 ToolManager PartSazanPropellorShaft Mashhad Iran
2000-11-01 2001-03-01 ProductionManager SandaliBehAvar Mashhad Iran

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
Canada 2019-04-16 E732249331

Have you ever remained beyond the validity of your status in any Country? YES / NO If yes, please provide details

No

Have you previously applied to enter or remain in Canada? YES / NO If yes, please provide details.

Yes

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

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
IELTS 2022-05-28 60 55 65 6 60 Mashhad Iran

List your travel history for the last 10 years

From Date To Date City Country Reason (Leisure / Work / Business)
2021-10-25 2022-01-26 Toronto Canada Leisure
2019-07-03 2019-09-18 Toronto Canada Leisure
2019-03-22 2019-03-29 Bali Indonesia Leisure
2019-03-29 2019-03-30 Doha Qatar Transit
2018-01-10 2018-01-12 Istanbul Turkey Biometric
2018-09-07 2018-09-14 Bodrum Turkey Leisure
2016-07-02 2016-07-09 KusAdasi Turkey Leisure
2013-06-20 2013-12-19 NewYork USA Leisure
2012-12-18 2012-12-21 Dubai UAE US-Visa
2010-12-16 2011-03-06 Boston USA Leisure
2022-03-23 2022-03-27 Yerevan Armenia Leisure
2022-08-19 2022-08-26 Tbilisi Georgia Leisure

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?

No

Do you have any physical or mental disorder that would require social and/or health services, other than medication, during a stay in Canada?

No

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

Have you ever committed, been arrested for, or been charged with or convicted of any criminal offence in any country or territory?

No

Are you, or have you ever been a member or associated with any political party, or other group or organization which has engaged in or advocated violence as a means to achieving a political or religious objective, or which has been associated with criminal activity at any time?

No

Have you ever witnessed or participated in the ill treatment of prisoners or civilians, looting or desecration of religious buildings?

No