Preliminary Assessment Questionnaire

For Permanent Residency Application / Temporary Residency Application

Applicant's First Name Middle Name (If applicable) Last Name

Place of Birth
Date of Birth (dd/mm/yyyy)
(Place, Country)
Residentail Address
Full Mailing Address
(If different)
Home Phone Number With Cell Phone Number With
Country and Area Code Country and Area Code

Email Other Email (If Applicable)

Skype Id Marital Status

Gender (Male/Female) Date of Marriage

Nationality Referred By

Principal Applicant: Write all your academic activities starting with most recent graduation.

Type of Graduation Univerisity / College Name Country

Principal Applicant: Write all your experience you have gained after your graduation.

Company Name and

Location (i.e. xyz Ltd. - Designation / Position Country
Gujarat, India)
Principal Applicant: IELTS Result (General Module)

Listening Reading Writing

Overall Band Test Pass Date

Spouse First Name Middle Name (If applicable) Last Name

Place of Birth
Date of Birth (dd/mm/yyyy)
(Place, Country)
Full Mailing Address
Number of Children
(if different than Applicant)
Cell Number with Country Full Name
and Area Code (First Name, Last Name)
Date of Birth
Email
(dd/mm/yyyy)
Full Name
Nationality
(First Name, Last Name)
Date of Birth
Gender (Male/Female)
(dd/mm/yyyy)

Spouse: Write all your academic activities starting with most recent graduation.

Univerisity / College Name /

Type of Graduation Country
Country
Spouse: Write all your experience you have gained after your graduation.

Company Name Designation Country

Spouse: IELTS Result (General Module) - if available

Listening Reading Writing

Overall Band Test Pass Date

Do you or your spouse have Applied for Express Entry / Refuse for Canada or any other Country? i.e.
Student, Visitor, Work Permit, etc. (If yes write full details below)

Do you or your spouse currently living in Canada? If yes, please provide detials below.
Full Name of the Applicant in Status in Canada
Permit Start Date
Canada (i.e. Visitor, Worker, Student)
Do you or your spouse have any relatives in Canada? i.e. Parents, Grand Parents, Brother, sister, nep
aunt. (If yes write full details below)
Full Name of Relative Address of Relative
Relationship
(in Canada) (City / State name only)

Travel Information (If you or your spouse have travel outside of your origin country please write full de
From
Country visited and Immigration
Name of the Applicant (dd-mm-
Status (i.e. England - Student)
yyyy)

For Office Use only

Approved Approved with modificaiton

Rejected Deffered
Questionnaire
Application / Temporary Residency Application

Any other Name used previously

ities starting with most recent graduation.

From (mm/yyyy) To (mm/yyyy)

have gained after your graduation.

From (mm/yyyy) To (mm/yyyy)

le)

Speaking

Any other Name used previously

with most recent graduation.

From (mm/yyyy) To (mm/yyyy)

d after your graduation.

From (mm/yyyy) To (mm/yyyy)

ble

Speaking

ntry / Refuse for Canada or any other Country? i.e. PR Application,

details below)

If yes, please provide detials below.

Permit Expiry Date

da? i.e. Parents, Grand Parents, Brother, sister, nephew, cousin, uncle,

Status of Relatives
(PR/Citizen)

el outside of your origin country please write full details below)

To
(dd-mm-yyyy)