Canadian Pre-Immigration Questionnaire

Please complete the following questionnaire in order for us to better serve

your needs and chances for successful immigration to Canada.
*Once completed please forward this questionnaire to our offices, by either
fax, email scan or post. If you require an earlier Microsoft Word version of this
document, please let us know and we will forward it to you as soon as
possible.
Full Legal Surname:
Full Legal First Name(s):
Title: Mr. Ms. Ms. Mrs.
Full Legal Surname (Spouse):
Full Legal First Name(s) (Spouse):

Title: Mr. Ms. Ms. Mrs.

1) Age (please include date of birth) (MM/DD/YY):
________________________________________________________________________
2) Spouse/Partner; Age (please include date of birth) (MM/DD/YY):
________________________________________________________________________
3) Country and City of Birth: _____________________________
4) Spouse/Partner; Country and City of Birth: ___________________________
3) Your Citizenship
(Please
indicate
all
citizenships
________________________________________________

held):

Spouse/Partner;
Citizenship
(Please
indicate
______________________________________

all

citizenships

held):

4) Do you or any of the family members you plan to include in this

application have any medical conditions or chronic illnesses? Yes/No
If Yes, please state condition:
______________________________________________________________________________
5) Please Indicate Your Languages Abilities:
Fluent Intermediate Basic
English
Fluent Intermediate Basic
French
Have you taken any language test? (IELTS) _______________
Date Taken? / Score:
________________________________
6) Do you have any family in Canada: Yes/No
If Yes, please define the relation (i.e brother, cousin): If Yes, please define
their status in Canada (i.e citizen, permanent resident):
______________________________________________________________________________
7. Have you ever resided outside your country of citizenship for 12 months or
more?
Yes/No If Yes, please define:

________________________

Country Duration: __________________________

Spouse/Partner; Have you ever resided outside your country of citizenship for
12 months or more? Yes/No If Yes, please define: Country Duration
______________________________________________________________________________
8) What is your marital status? Status Please Place an X Married Single
Divorced De Facto Relationship Same Sex Relationship Separated
______________________________________________________________________________
9) If you are in a De Facto Relationship, please indicate the date it began
(MM/DD/YY):
______________________________________________________________________________
10) IF Divorced is the divorce legal and final? Yes/No
If
Yes,
please
give
________________________________________________

date

(MM/DD/YY):

If Separated, please give date starting (MM/DD/YY): _________________Please

Initial Here

11) Please include details about all of your children (if any). This includes all
children whether living with you or not, and, legally in your guardianship or
not;
Name of Child Sex Date of Birth (MM/DD/YY) Living With You? Y/N
Immigrating With You? Y/N ?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

12) IF any of your dependent children are not immigrating with you, please
indicate why:
13) Please indicate your HIGHEST Level of education. Note: Please include
completed qualifications only. Unfinished qualifications will not be considered
under Canadian Immigration Regulations:
Highest Qualification:
__________________________________________
Start Date: (Month/Year)
__________________________________________
Completion (Month/Year)
__________________________________________
Spouse/Partner;
Highest
__________________________________________

Qualification:

14) Please indicate your level of assets (minus debts) (Note; In order to
qualify for permanent residence to Canada applicants must have a minimum
level of funds available):
______________________________________________________________________________
15) The following applies to both you and accompanying family members;
Start Date: (Month/Year) Completion
Date (Month/Year) ____________________Please Initial Here
Are there any criminal or civil proceedings pending against you or have
you ever been convicted of a criminal offence in any country? Yes/No

 Been refused a visa to any country? Yes/No

Applied for any type of visa to Canada and been refused? Yes/No
Been detained, jailed, or imprisoned in any country? Yes/No
Been deported from any country? Yes/No
Under investigation in any country?
Yes/No If you have answered yes to any of the above questions please
provide additional information below and attach and additional sheet if
necessary:
______________________________________________________________________________

16) Have you ever studied or worked in Canada? Yes/No If Yes, Please Give
Details (location, employer/school, etc) and duration (mm/yyyy to mm/yyyy)
of Study or Work permit:
______________________________________________________________________________

Please include here any additional information that you feel is important or
pertinent to an application for permanent residence to Canada:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Declaration I hereby state that the information I have provided in this preimmigration questionnaire is an accurate and true representation of my
current and past situation.
I also accept that the information given in this declaration will be used in
part - as the basis for an application for a work permit and/or a permanent
residence visa for Canada
The decision to issue such a visa or permit is the sole decision of Canadian
immigration authorities.

Signature X
Date:

_____________________________________________________
_____________________________________________________