Immigration Consultancy Services Private Limited
Amar Hill, powai, Saki-Vihar Road, Andheri (E), Mumbai-72. Tel: +91-22-28572873, 28574149
Fax: +91-22-28577800 Email: coasttocoast@eth.net Website: www.coastcoast.ca Canada Fax # 001-604-6488718
(CONFIDENTIAL WHEN FILLED)
Full Name: Mr./Ms./Mrs. Date of Birth: Current Mailing Address: City: Pin Code: State: Country: Phone:Fax: Email: Marital Status (Never Married, Engaged, Married, Legally Separated, Divorced): If you are married or engaged provide details of your spouse or finance (e) Full Name: Mr./Ms./Mrs. Date of Birth: Education: Occupation: Experience (No. Of Years):
Full Name: Mr./Ms./Mrs. Date of Birth:
Current Mailing Address:
City: Pin Code: State: Country:
Phone:Fax: Email:
Marital Status (Never Married, Engaged, Married, Legally Separated, Divorced):
If you are married or engaged provide details of your spouse or finance (e)
Education: Occupation: Experience (No. Of Years):
Provide Details of all your children:
FULL NAME
DATE OF BIRTH
Relative in Canada if any: Please provide details of your relatives in Canada, who are Permanent Residents/Citizens of Canada, (Describe the relationship clearly such as father’s real brother, mother’s sister etc.):
NAME
RELATIONSHIP
ADDRESS
Educational Record: Please provide the Educational Record since matriculation with dates, names and addresses of Institutions attended, courses taken (i.e Business Administration, BE-Mechanical, Chemistry etc.), details of degree/ diploma/ certificate received. Include all full time and part time courses:
Period
Names And Addresses of Institutions & University
Courses Taken/
Subjects
Diploma/ Degree/
Certificates
Part/ Full time or Private/CC
From
To
Work History: Please provide detailed employment record with dates, names & addresses of employers and job designations held:
Names and Addresses of Employers
(Write name in full: do not use abbreviations)
Position Held
Gross monthly salary
Experience in Business Management: In this section tell us, in your own words about your past and present business management experience. Please include details as to how you started out, the type of nature of the businesses in which you have being involved, giving specific details of your responsibilities and duties within the company (ies). Specify your percentage of ownership, if any. Should you require more space, you may attach an additional page:
Ability to communicate in English: Fluent Well: With Difficulty: Not At All:
Your current net worth (All assets less liabilities)
Include all bank deposits, property, estimated current market value of your share of business and other assets. All assets must be your own personal holdings and must be documented. You may be asked by the Canadian Immigration Authorities o present financial documents to support the information provided in this statement.
Have you ever visited abroad? If yes, what all countries: Dates: From: To:
For which countries do you have valid visitors visas?
Have you ever being refused tourist or any other visas? If yes, please give details:
Have you ever been deported from any countries? If yes, Please give details:
How did you come to know about CCICS
I declare that information given in this application is truthful, complete and correct.
Business 1:
Name of Business: Type of Business:
You may attach a complete business profile of your company along with this application form.
Type of ownership:
If sole proprietorship, please also indicate date you became owner of the business.
If partnership: No. of partners Your percentage (%) of ownership:
If Limited Company: No. of Directors: Your Percentage of share holding:
Performance:
Year
Turnover
Net Profit
Loss Carried Over
Taxable Profits
No. of Employees
2003-2004
2003-2002
2002-2001
2001-2000
Business 2:
Business 3:
Business 4: