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|
|Saman Fadavi||APPLICANT||1976-02-21||Mashhad||Married||Mechanical Supervisor||168 Brown||No335thBozorgmehrShomaliSajjadBLVDMashhadIran9187800989153146027fadaviDOTsamanATgmailDOTcom|
|Samira Hojjat||SPOUSE||1979-03-28||Mashhad||Married||Commercial Manager||165 Brown||No33,5thBozorgmehrShomaliSajjadBLVDMashhadIran9187800989153146027fadaviDOTsamanATgmailDOTcom|
|Minoo Partovi||MOTHER||1948-09-27||Tehran||Widow||Retired||157 Brown||5155SheppardEastAveTorontoCanadaM1B0C8|
|Ali Akbar Fadavi||FATHER||1942-03-06||Quchan||2010-03-16||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|
|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|
|5||33||BozorgMehrShomali Sajjad Blvd||Mashhad||Iran||9187844763||Citizen|
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|
|Home Phone Number||Cell Phone Number|
|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 Elementary School||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 High School||Mashhad||Iran|
|1995-09-23||2000-09-16||Elementary School||Mechanical Engineering||Completed||Islamic Azad University||Mashhad||Iran|
|From Date||To Date||Activity (position in your Job)||Company Name / Employer Name||City||Country|
|2010-11-01||2022-08-31||Mechanical Supervisor||Pardis Shahr Tarh||Mashhad||Iran|
|2007-04-12||2010-11-01||Mechanical Supervisor||No141 Consultation Company||Mashhad||Iran|
|2006-11-01||2007-04-01||Tool Sales Manager||Kavosh Azmoon||Mashhad||Iran|
|2005-08-01||2006-09-01||Tool Manager||Azin Ghaleb Jam||Mashhad||Iran|
|2002-01-01||2005-08-01||Tool Manager||Part Sazan Propellor Shaft||Mashhad||Iran|
|2000-11-01||2001-03-01||Production Manager||Sandali Beh Avar||Mashhad||Iran|
Do you own your company?
|If Yes Company Name||Business Registration Date||Number of Employees in the Business|
|Countries||Issue Date or Refusal Date||File Number or email from Visa office||If refused Refusal Reason|
|Schengen Area Countries||FRTH/210817/0034/01|
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|
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|
List your travel history for the last 10 years
|From Date||To Date||City||Country||Reason (Leisure / Work / Business)|
|2012-12-18||2012-12-21||Dubai||UAE||US Visa interview|
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|
Have you ever committed, been arrested for, or been charged with or convicted of any criminal offence in any country or territory?
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?
Have you ever witnessed or participated in the ill treatment of prisoners or civilians, looting or desecration of religious buildings?