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APPLICATION FOR PERMANENT RESIDENCE IN CANADA
INITIAL ASSESSMENT FORM
 
INSTRUCTIONS :
 
To obtain a paper copy, press the 'Print' button from your Browser.
 
To return the form by e-mail, copy & paste this form into a wordprocessor, such as MS Write,
MS Wordpad, or MS Word, fill it out, and e-mail to us as an attached file.
Or simply insert the copied form into your e-mail body.
 
 
I am applying for : Permanent Resident Visa / Dependant
 
1. First name ........................... Family name .........................
 
2. Sex  male/female ..................
 
3. Date of birth (day/month/year) .........../........... / ............... 
 
4. Place of birth : (country) ...................................
 
5. I am a citizen of ............................................
 
6. Current mailing address ..........................................
.....................................................................
.....................................................................
Telephone :
E-mail :
 
7. Present marital status : 
        never married/married/widowed/separated/divorced
 
8. Number of dependants over 19 years of age  : ...............(excluding spouse)
 
9. Number of dependants under 19 years of age : ...............
 
10. Ability in English
Speak   Fluently / Well / With difficulty / Not at all
Read    Fluently / Well / With difficulty / Not at all
Write   Fluently / Well / With difficulty / Not at all
 
11. Ability in French
Speak   Fluently / Well / With difficulty / Not at all  
Read    Fluently / Well / With difficulty / Not at all  
Write   Fluently / Well / With difficulty / Not at all  
 
12. Education (indicate number of years of school successfully completed) :
Primary & High school .............................. years,
Pre-University  .................................... years,
University / College ............................... years,
Apprenticeship / Training ...........................years      
 
13. Details of post-secondary education :
Dates   Name of Institution     Country         Type of Qualification
                                                including apprenticeship
.........................................................................
 
14. My present occupation is ............................................
 
15. Number of years of relevent experience ................. years
  Details of employment : (this is essential)
Dates     Employed as     Job duties
........................................................................
(alternatively, you may attach your recent resume)
16. Do you have a job offer from a person, employer or Organization in Canada ?
..................................................................................
 
17. Do you have any close relatives in Canada ? ................................
                                                (state relationship)
 
18. I have the following assets (show amount or value in Canadian Dollars):
Liquid Assets :  CAN............................/=
Property :       CAN............................/=
Other :          CAN............................/=
If 'Other', give details here .....................................................
...................................................................................
 
19. I have the following debts or legal obligations (e.g. child support payments) 
Amount  CAN............................/=
 
I certify that the information contained in this document is complete, accurate and factual.
I also realise that this is a preliminary questionaire, and further details may be required
before a final assessment with a money-back guarantee can be given.
 
                ................................................
                signature                       date
 
Upon completion of the form,
post to : 803-80 Forest Manor Road, North York,
          Toronto, Ontario M2J 1M6, Canada
or e-mail mcutchi@canada.com, 
or fax to : 001 (416) 491 6826

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