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
Masoumeh Maleki APPLICANT 1975-06-18 Esfahan Single IT Project Manager 158 Brown 511 Saleh Bin Lahij Majan Dubai UAE POBox 93268 00971551177884 Nellymaleki8gmailcom
SPOUSE
Firoozeh Islami MOTHER 1945-03-23 Farsan 2020-03-25 Al Ain
Jumoa Maleki FATHER 1942-12-26 Farsan Widow Partner 176 Brown 371 AL Wasit St Al Goaz Sharjah UAE 2608 00971544630166

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
Maryam Maleki Sister 1965-06-25 Farsan Single 371 AL Wasit St Al Goaz Sharjah UAE 2608 00971506463057
Mitra Maleki Sister 1969-06-26 Esfahan Married House wife 6th Yas Alley El Yaseen Blvd Chamran Expressway Plaque121 2rd floor Esfahan Iran 00983116503614
Mina Maleki Sister 1970-06-30 Esfahan Married House wife 6th Yas Alley El Yaseen Blvd Chamran Expressway Plaque121 3rd floor Esfahan Iran 00989130614297
Azita Maleki Sister 1972-01-05 Esfahan Married House wife Abban Alley, 4th Alvand St., Shahed Blvd, Sepahan Shahr,Niakan Complex, 3rd floor, Esfahan, Iran 8179973551 00989132706068
Zahra Maleki Sister 1980-10-26 Esfahan Married Pharmacist 5926 Gate House drive, Glen Allen, Virginia 23059 USA 0018048785330 r1kyzyahoo.co.uk
Nasrollah Maleki Brother 1963-09-30 Farsan Married Construction Engineer 701 Maliky BLDB Al Nuaimia1 St Al Nuamia Area Ajman UAE 17013 00971506317283 nasrullah.maliky@yahoo.com
Mohd Reza Maleki Brother 1982-08-21 Dubai 2001-07-27 Dubai
Ahmed Reza Maleki Brother 1984-03-17 Dubai Married Partner 303Maliky BLDC Al Mowaihat3 area Ajman UAE 17013 gka9899@hotmail.com 00971504619999
Huma Maleki Sister 1962-08-26 Farsan 1962-12-16 Farsan

Passport Information

Passports / Country of Citizenship Other than your Country of Origin Passport Number Country of Issue Passport Issue Date Passport Expiry Date
Iran X96591836 Iran 2020-02-24 2025-02-23

Presently – Where do you live?

Country Status (Citizen / Worker / Student / Business Resident / Other... ( Please Explain) From Date To Date
United Arab Emirates Resident 2020-02-25 2030-02-24

information of address

From Date To Date Street Number Apartment / Suite Number Street Name City Country Postal Code Status Citizen / Residence / Permanent Residence
2022-03-10 Saleh bin Lahij Building 511 Majan Wadi Al Safa3 Dubai United Arab Emirates 932680 Resident
2021-02-25 2022-02-24 BLVD Hieghts 2504 Burj Khalifa Downtown Dubai United Arab Emirates 932680 Resident
1994-01-01 2021-02-24 AL Goaz area Villa 371 AL Wasit St Sharjah United Arab Emirates 2608 Resident

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
Syed Mojtaba Hosseini 1999-05-24 2018-04-26

Contact Information

Home Phone Number Cell Phone Number WhatsApp Email
00971551177884 00971551177884 Nellymaleki8gmailcom

Education History

From Date To Date Level of Study Field of Study Diploma Issued Completed /Not Completed Institute / School / University Name City Country
2010-09-01 2012-06-20 University (ii) Master MBA Completed Hult International Business School Dubai and London United Arab Emirates and UK
1993-09-01 1996-06-18 University (i) Bachelor Computer Engineering Completed Islamic Azad University Dubai United Arab Emirates
1990-09-01 1993-06-18 Secondary School Science Completed Khadijeh Kobra High School Dubai United Arab Emirates

Activity History

From Date To Date Activity (position in your Job) Company Name / Employer Name City Country
2020-12-06 IT Project Manager Empire360 Dubai United Arab Emirates
2009-11-01 2020-12-03 General Finance Manager Maliky Real Estate LLC Ajman United Arab Emirates
2005-11-13 2009-02-28 Officer Unsecured Credit EmiratesNBD Bank Dubai United Arab Emirates
2003-01-01 2004-10-31 Operation Assistance Standard Charted Bank Dubai United Arab Emirates
1996-05-04 2002-12-31 Computer Engineer Iranian Hospital in Dubai Dubai United Arab Emirates

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 2019-02-24
Canada 2018-08-30
United Kingdom 2010-02-03
Other Countries 2021-11-21

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 Tourist Visa

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
IELTS
IELTS
IELTS

List your travel history for the last 10 years

From Date To Date City Country Reason (Leisure / Work / Business)
2019-03-04 2020-02-08 Virginia United States Leisure
2019-02-09 2019-02-12 Baku Azerbaijan Leisure
2018-04-02 2018-04-08 Moscow Russia Leisure
2017-02-13 2017-02-18 Kathmandu Nepal Leisure
2016-10-26 2016-10-29 Maldives Maldives Leisure
2015-10-08 2016-02-07 Virginia United States Leisure
2015-09-20 2015-09-24 Bangkok Thailand Leisure
2014-08-30 2015-10-08 Virginia United States Leisure
2013-03-06 2013-07-09 Virginia United States Leisure
2012-07-14 2012-07-19 Milan Dusserduf Amsterdam Italy Germany Holland Leisure
2012-04-22 2012-04-30 Paris Hungary French Budapest Leisure
2011-05-05 2011-06-16 London United Kingdom Student
2020-08-10 2020-11-15 Esfahan Iran Leisure
2022-02-13 2022-02-13 Muscat Oman 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