Name (Required) Gender (Required) MaleFemale Date of Birth (Required) Marital Status (Required) ---MarriedSingleDivorcedWidowed Address Phone Number (Required) Email (Required) Spouse's Name (if applicable) Spouse's Age (if applicable) # of Dependent Child (if applicable Have you ever tried to enter Canada? (Required) ---YesNo Entry Date (Required) Exit Date Purpose of Visit (Required) Have you ever been refused of Canadian Visa, Permanent Residency, or Immigration Program? (Required) ---YesNo Have you ever had any work experience as a working holiday visa? (Required) ---YesNo Start Date (Required) End Date (Required) [or assumed end date] Country (Required) Have you ever worked or operated a business abroad? (Required) ---YesNo Start Date (Required) End Date (Required) Employer's Name or Name of the Business (Required) Country (Required) Do you and your family have any mental or physical illness or disability that requires medical treatment during their stay in Canada? (Required) ---YesNo Do you and your family have any experience of living, studying or working abroad beyond the expiry of their visa? (Required) ---YesNo Please record the dates of overstay, reasons, and possible deportations (Required) Country (Required) Do you and your family have every violated, arrested, or committed a crime? (Required) ---YesNo Personal Asset (Required) ---20,000-50,000 CAD50,000-200,000 CAD200,000-500,000 CAD500,000-1,000,000 CAD1,000,000-2,000,000 CAD2,000,000-10,000,000 CADOver 10,000,000 CAD How much settlement funds do you think will be required in Canada per year until you have a permanent residency in Canada? (Required) ---Less than 30,000 CAD30,000 ~ 50,000 CAD50,000 ~ 70,000 CAD70,000 ~ 100,000 CADMore than 100,000 CAD How much money do you expect for monthly wage in Canada? (Required) ---Less than 2,000 CAD2,000 ~ 3,000 CAD3,000 ~ 4,000 CADMore than 4,000 CAD How much do you expect to pay for the representative fee for permanent residency? (Required) ---Less than 10,000 CAD10,000 ~ 30,000 CAD30,000 ~ 50,000 CADMore than 50,000 CAD When did you start thinking about immigrating to Canada? (Required) Do you have anything you want to do after you get your permanent residency in Canada? (Required) What is the biggest motive for immigration to Canada? (Required) A clean environmentsocial security systemFor children's education and futureFor myself after retirementTo be free from other people's interferenceMy family wants toI had great experience living abroadTo live abroadPlans/things to do after receiving permanent residency **You can select multiple things by holding down the Ctrl button. How did you find out about us? [If someone referred you to us, please write their name!] (Required) What do you think is the most important part when choosing an immigration firm? (Required) Professionalism and MoralityRepresentative FeesSpeedy ProcessVarious Case Experiences **You can select multiple things by holding down the Ctrl button. I have answered the questions contained in this document honestly and everything I have filled out is factual. Signature
