About You :
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1. Title:
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2. First Name/s*:
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3. Last Name*:
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4. Date of Birth*:
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5. Place of Birth:
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6. Gender:
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Male Female
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7. Nationality:
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8. Present Occupation:
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11. Address:
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12. Telephone No:
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13. Fax No:
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14. E-mail*:
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15. Web Page:
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16. Annual Income ($US):
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Other details :
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17. Are your plans for emigration Temporary
or permanent?
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18. Do you have family or dependants who
will emigrate with you?
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Yes No
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If ‘Yes’ please give details:
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19. Do you have relatives or ancestors in
Canada?
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20. Have you had any type of visa to Canada
before?
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Yes No
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If yes, please give the following details:
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a. Type:
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b. Date Issued:
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c. Place Issued:
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d. Length of validity:
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21. Have you ever been refused a visa?
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Yes No
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If yes, please give details:
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22. How much do you have in the way of
funds? (in US$)
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a. Savings on deposit:
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b. Value of other assets:
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c. Amount you intend to take with you
(Please be advised, that CAD 10,000 and CAD 2,000 for each dependent is
recommended):
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23. Which category are you considering for
Immigration?*
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To the description of the categories
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24. How much do you intend to invest (in
US$)?*
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25. In brief, what are your business plans?*
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26. Please state your fluency in English
below (PLEASE TICK):
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Speaking:
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Reading:
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Writing:
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Understanding:
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27. Please state your fluency in French
below (PLEASE TICK):
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Speaking:
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Reading:
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Writing:
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Understanding:
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28. Have you or any of your immediate family
members ever been convicted of any crime (however minor the offence)?
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Yes No
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If yes, please include full details below:
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29. Have you or any of your immediate family
had any serious health problems?
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Yes No
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If yes, please include full details below:
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30. Why do you wish to emigrate?
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Work Experience and Qualifications
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31. Please provide full details of your
educational qualifications.*
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32. Please provide full details of your work
experience.*
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33. FEEDBACK - Please provide any additional
information that you think might help us evaluate your situation. Any
comments on improvements that can be made to this form and other parts of
our web-site are welcome:
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