Client Intake Form "*" indicates required fields Step 1 of 11 9% Reference No* Main Applicant / Applicant Principal* First Name/Prénom Middle Name/Postnom Last Name/Nom de Famille Cellphone*Telephone/TéléphoneBusiness No/No de BureauEmail* Address / Adresse* Street Address/Adresse de la maison Mailing Address/Adresse Postale City/Ville State/Province/Région ZIP/Postal Code/Code Postal AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country/Pays Personal Information/Informations PersonnellesDate of birth/Date de naissance* DD slash MM slash YYYY Gender/Genre* Male/Homme Female/Femme Place of Birth/Lieu de Naissance* City/Ville State/Province/Région AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country/Pays Citizenship/Nationalité*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsMarital Status/Etat Civil* Never Married/Jamais Marié(e) Engaged/Fiancé(e) Married/Marié(e) Widowed/Veuf(ve) Separated/Séparé(e) Divorced/Divorcé(e) Living with same sex-partner for more than a year/Vivant avec un(e) partenaire du même sex depuis plus d'une année Living with common-law partner for more than one year/Vivant avec un(e) partenaire depuis plus d'une année Spouse Info/Informations sur l’Epoux(se)Full Name/Nom complet Date of Birth/Date de Naissance DD slash MM slash YYYY Citizenship/NationalitéAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsOccupation Experience/Expérience Date of Marriage/Date de Mariage DD slash MM slash YYYY Place/Lieu Education Info/Informations sur les études de l’époux(se)From/DeTo/ÀName & Address of Institutions/Nom et adresse de l’InstitutionCourses/CoursDegree / Diploma / Certificate Issued/Diplôme livré? Add RemoveTotal Years of school successfully completed/Année totale des études faites EducationHighest Completed/Niveau d’études le plus élevé Primary School/Ecole Primaire High School/Ecole Secondaire University Degree/Diplôme Universitaire 1 year University credential / Diplôme d’1 année d’Université 2 year University credential / Diplôme de 2 ans á d’Université 3 year University credential / Diplôme de 3 ans à d’université Bachelor’s degrees / Diplômes Universitaires 2 Bachelor’s degrees / 2 Diplômes Universitaires Master’s/Master Phd/Doctorat Non University Diploma/Diplôme non universitaire One year/1 an Two year/2 ans Three year/3 ans How many years of school have you completed / Combien d'années d'Etudes avez vous completées? Family Info/Informations sur la familleChildren/EnfantsFull Name/Nom CompletRelationship/RelationDate of Birth/Date de Naissance Son/FilsDaughter/Fille Add RemoveDo you have relatives in Canada/Avez vous de la famille au Canada? Yes No Relatives in CanadaFull Name/Nom CompletRelationship/RelationAddress/Adresse Son/FilsDaughter/Fille Add Remove Work Experience / Expérience professionnelleIntended Occupation In Canada/Occupation visée au Canada: Employment/Emploi Present Occupation/Occupation actuelle Current Monthly Earnings/Salaire mensuel actuelCurrency/MonnaieUS DollarOtherJob Description/Description des tâches:Total years of Work Experience/Année totale d'expérience professionneleHow many Years of work experience do you have in the last 10 years?/Combien d'année d’expériences professionnelles avez vous accomplies dans les 10 ans passés01234 & Up / 4 et Plus Language ability / LanguePlease indicate your ability to communicate in English and French by checking the appropriate column/Veuillez indiquer votre capacité de communiquer soit en Français soit en AnglaisEnglish Spoken/Anglais Parlé Fluently/Fluemment Well/Bien With Difficulty/Avec lacunes Not at all/ Pas du tout English Written/Anglais Ecrit Fluently/Fluemment Well/Bien With Difficulty/Avec lacunes Not at all/ Pas du tout English Read/Anglais Lu Fluently/Fluemment Well/Bien With Difficulty/Avec lacunes Not at all/ Pas du tout French Spoken/Français Parlé Fluently/Fluemment Well/Bien With Difficulty/Avec lacunes Not at all/ Pas du tout French Wtitten/Français Ecrit Fluently/Fluemment Well/Bien With Difficulty/Avec lacunes Not at all/ Pas du tout French Read/Français Lu Fluently/Fluemment Well/Bien With Difficulty/Avec lacunes Not at all/ Pas du tout Have you or could you pass a formal English Language Test?/Etes-vous capable de passer un examen d’Anglais? Yes/Oui No/Non Have you or could you pass a formal French Language Test?/Etes-vous capable de passer un examen de Français? Yes/Oui No/Non Transferable Funds / Assets/Argent et biens transferablesCash (in Cdn$)/Cash en $ CanProperty/biens Immobiliers (Valeur estimative en $ Can) Other Details/Autres detailsDo you hold a work permit for Canada/Etes-vous détenteur d’un permis de travail au Canada? Yes/Oui No/Non Do you have a job offer or potential job offer from a Canadian employer/Avez-vous un emploi ou un emploi potentiel d’un employeur canadien? Yes/Oui No/Non Have you or your spouse, common law partner or same sex partner ever worked in Canada for one full year/Avez-vous (ou votre époux(se)/partenaire) travaillé au Canada pour au moins une année? Yes/Oui No/Non Have you or your spouse, common law partner or same sex partner ever studied in Canada for more than two years/Avez-vous (ou votre époux(se)/partenaire) étudié au Canada pour au moins 2 ans? Yes/Oui No/Non Do you or your spouse, common law partner or same sex partner have a valid offer of employment in Canada upon your arrival/Avez-vous (ou votre époux(se)) un travail valide dès votre arrivée au Canada? Yes/Oui No/Non Do you have a spouse, common law partner or same sex partner who is a Canadian Citizen or Permanent Resident?/Avez vous un(e) partenaire ui soit Canadien ou Résident permanent au Canada? Yes/Oui No/Non Do you or your spouse, common law partner or same sex partner have any close family relationships in Canada?/Avez-vous (ou votre partenaire) un membre de famille restraint au Canada? Yes/Oui No/Non Have you or any member of your family ever suffered from any physical or mental disorder/Avez-vous (ou un membre de votre famille) déjà souffert d’une maladie mentale? Yes/Oui No/Non Have you or any member of your family been convicted for any crime in Canada or outside Canada/Avez-vous (ou un membre de votre famille) déjà été condamné pour un crime quelconque au Canada ou en dehors du Canada? Yes/Oui No/Non Have you or any member of your family ever been denied entry to Canada or any other country or been asked to leave Canada or any other country/Vous-a-il (ou un membre de votre famille) déjà été refusé l’entrée au Canada ou tout autre pays, ou avez-vous (ou un membre de votre famille) deja été refoulé du Canada ou de tout autre pays? Yes/Oui No/Non Have you or any member of your family filed for bankruptcy / Avez-vous (ou un membre de votre famille) déclaré faillite? Yes/Oui No/Non Are you willing to invest or start a business in Canada?/Êtes-vous prêt à investir ou à démarrer une entreprise au Canada? Yes/Oui No/Non BUSINESS APPLICANTS ONLY/POUR LES INVESTISSEURS SEULEMENTHave you in the last 5 years ever made a trip to Canada to explore business opportunities?/Au cours des 5 dernières années, avez-vous déjà fait un voyage au Canada pour explorer des opportunités d'affaires? Yes/Oui No/Non Do you have a personal net worth of at least $300,000 Cdn?/Avez-vous une valeur nette personnelle d'au moins 300 000 $ CAN? Yes/Oui No/Non Have you ever managed more than 5 people?/Avez-vous déjà managé plus de 5 personnes? Yes/Oui No/Non If yes, describe briefly?/Si oui, décrivez brièvement?Have you ever been self-employed as a musician or artist, or in other cultural activities?/Avez-vous déjà été travailleur indépendant en tant que musicien ou artiste, ou dans d'autres activités culturelles? Yes/Oui No/Non Have you ever owned or managed a farm?/Avez-vous déjà possédé ou géré une ferme? Yes/Oui No/Non Have you owned a company in the last 5 years?/Avez-vous été propriétaire d'une entreprise au cours des 5 dernières années? Yes/Oui No/Non Company details / Coordonnées de l'entrepriseComplete this section if you have owned a company in the last 5 years? If yes, email a complete business profile of your company to ron@ hartconsultant.ca / Remplir cette section si vous avez été propriétaire d'une entreprise au cours des 5 dernières années ? Si oui, envoyez par courriel un profil d'entreprise complet de votre entreprise à ron@hartconsultant.caHave you ever owned and operated your own business?/Avez-vous déjà possédé et exploité votre propre entreprise? Yes/Oui No/Non What percentage of the company did you own?/Quel pourcentage de l'entreprise déteniez-vous?How many people have you employed?/Combien de personnes avez-vous employé?Has your company had gross sales of more than $500,000 Cdn per year in at least 2 of the last 5 years?/Votre entreprise a-t-elle réalisé des ventes brutes de plus de 500 000 $ CAN par an au cours d'au moins 2 des 5 dernières années? Yes/Oui No/Non Has your company had net income of more than $50,000 Cdn per year in at least 2 of the last 5 years?/Votre entreprise a-t-elle eu un revenu net de plus de 50 000 $ CAN par an au cours d'au moins 2 des 5 dernières années ? Yes/Oui No/Non Has your company had net equity of more than $125,000 Cdn per year in at least 2 of the last 5 years?/Votre entreprise a-t-elle eu des capitaux propres nets de plus de 125 000 $ CAN par an au cours d'au moins 2 des 5 dernières années? Yes/Oui No/Non Turnover & Net Profit over the last 3 years/Chiffre d'affaires et résultat net sur les 3 dernières annéesYearTurnoverNet Profit Add RemoveNet Worth in CanadianBank/BanqueProperty/ PropriétéAssets/ActifsOthers/AutresTotal/TotaleIf others give details here/Si d'autres donnent des détails iciFunds available to be transferred to Canada/Fonds disponibles pour être transférés au Canada Additional Info / Information AdditionnelleHave you ever visited abroad?/Avez-vous déjà visité l'étranger? Yes/Oui No/Non If yes which countries / Si oui quel pays?AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsFor which countries do you have a valid visitors visa?/Pour quels pays avez-vous un visa de visiteur valide?AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsDo you have a work visa for any country?/Avez-vous un visa de travail pour n'importe quel pays? Yes/Oui No/Non Have you ever visited Canada?/Avez-vous déjà visité le Canada? Yes/Oui No/Non If yes, give details/Si oui, précisezWhereWhenPurpose Add RemoveHave you ever studied in Canada?/Avez-vous déjà étudié au Canada? Yes/Oui No/Non If yes, give details/Si oui, précisezInstitutionCourseFrom DateTo Date Add RemoveBriefly explain your interest in immigrating to Canada?/Expliquez brièvement votre intérêt à immigrer au Canada ?Any other information you believe that is relevant to this assessment?/D'autres informations que vous jugez pertinentes pour cette évaluation?How did you come to know about our Immigration Consultancy firm?/Comment avez-vous connu notre cabinet de conseil en immigration? Referral/Référence Friend/Ami Seminar/Séminaire Newspaper/Journal Internet Other/Autre Consent/Consentement* I declare that information given in this application is truthful, complete and correct./Je déclare que les informations fournies dans cette candidature sont véridiques, complètes et correctes.Information provided to our firm is strictly Private & Confidential. Les informations fournies à notre cabinet sont strictement privées et confidentielles.NameThis field is for validation purposes and should be left unchanged.
