Title TitleMr.Ms.Mrs.

Legal First Name

Legal Last Name / Surname

Date Of Birth (MM/DD/YY)

Age

City Of Birth

Country Of Birth

Citizenship (Please indicate all Citizenship's held)

Marital Status Marital StatusSingle / Never MarriedMarriedCommon-Law / De Facto RelationshipDivorced / SeperatedAnnulled MarriageSame Sex Relationship

Please indicate the start date of Common-Law / De Facto Relationship (MM/DD/YY)

Please indicate one of the following Please indicate one of the following Divorced Separated

Is the divorce legal and final? Is the divorce legal and final? Yes No

Please indicate the date of Seperation (MM/DD/YY)

Please indicate the date of Divorce (MM/DD/YY)

Spouse / Partner Name Title Spouse / Partner Name TitleMr.Ms.Mrs.

Spouse / Partner Legal First Name

Spouse / Partner Legal Last Name / Surname

Spouse / Partner Date Of Birth (MM/DD/YY)

Spouse / Partner Age

Spouse / Partner City Of Birth

Spouse / Partner Country Of Birth

Spouse / Partner Citizenship (Please indicate all Citizenship's held)

Did you take any of the following official language test ? Did you take any of the following official language test ? No Waiting For Results IELTS CELPIP - G TEF Canada TCF Canada

Enter Your IELTS Test Scores (Speaking, Listening, Reading, Writing)

Enter Your CELPIP Test Scores (Speaking, Listening, Reading, Writing)

Enter Your TEF Test Scores (Speaking, Listening, Reading, Writing)

Enter Your TCF Test Scores (Speaking, Listening, Reading, Writing)

Please indicate your level of English ability / proficiency Please indicate your level of English ability / proficiency Fluent Intermediate Basic

Please indicate your level of French ability / proficiency Please indicate your level of French ability / proficiency Fluent Intermediate Basic None

Do you or any of the family members you plan to include in this application have any medical conditions or chronic illnesses ? Do you or any of the family members you plan to include in this application have any medical conditions or chronic illnesses ? Yes No

Please state condition of the Illness

Do you have any family in Canada Do you have any family in Canada Yes No

Please define the relation (i.e brother, cousin, ...)

Please define their status in Canada (i.e citizen, permanent resident)

Have you ever resided outside your country of citizenship for 12 months or more? Have you ever resided outside your country of citizenship for 12 months or more? Yes No

Please list all the countries & duration in each country. (Example USA: 2 Years & 2 Months, Australia: 14 Months)

Have your spouse / partner ever resided outside your country of citizenship for 12 months or more? Have your spouse / partner ever resided outside your country of citizenship for 12 months or more? Yes No

Please list all the countries & duration in each country. (Example USA: 2 Years & 2 Months, Australia: 14 Months)

Do you have a child or children. This includes all children whether living with you or not, and, legally in your guardianship or not. Do you have a child or children. This includes all children whether living with you or not, and, legally in your guardianship or not. Yes No

Please include details about all of your children. This includes all children whether living with you or not, and, legally in your guardianship or not. (Include their Name, Sex, Date of Birth MMM/DD/YY, Living With You? Y/N, Immigrating With You? Y/N)

Is any of your dependent child not immigrating with you ? Is any of your dependent child not immigrating with you ? Yes No

Please Indicate Why ?

Please indicate your HIGHEST Level of education. (Please include completed qualifications only. Unfinished qualifications are not considered under Canadian Immigration Regulations)

Highest Qualification Start Date (MM/DD/YY)

Highest Qualification End Date (MM/DD/YY)

Please indicate your Spouse's HIGHEST Level of education. (Please include completed qualifications only. Unfinished qualifications are not considered under Canadian Immigration Regulations)

Spouse Highest Qualification Start Date (MM/DD/YY)

Spouse Highest Qualification End Date (MM/DD/YY)

Please indicate your level of assets (minus debts) (Note; In order to qualify for permanent residence to Canada applicants must have a minimum level of funds available)

The following questions applies to both you and accompanying family members. Please select I understand to continue. The following questions applies to both you and accompanying family members. Please select I understand to continue. I Understand

Are there any criminal or civil proceedings pending against you – or have you ever been convicted of a criminal offence – in any country? Are there any criminal or civil proceedings pending against you – or have you ever been convicted of a criminal offence – in any country? Yes No

Please provide additional information

Been refused a visa or entry to any country? Been refused a visa or entry to any country? Yes No

Please provide additional information

Applied for any type of visa to Canada and been refused? Applied for any type of visa to Canada and been refused? Yes No

Please provide additional information

Been detained, jailed, or imprisoned in any country? Been detained, jailed, or imprisoned in any country? Yes No

Please provide additional information

Been deported from any country ? Been deported from any country ? Yes No

Please provide additional information

Under investigation in any country? Under investigation in any country? Yes No

Please provide additional information

Have you ever studied or worked in Canada ? Have you ever studied or worked in Canada ? Yes No

Please Give Details (location, employer/school, etc) and duration (mm/yyyy to mm/yyyy) of Study or Work permit

Please include any additional information that you feel is important or pertinent to an application for permanent residence to Canada

Declaration Declaration I hereby state that the information I have provided in this pre-immigration questionnaire is an accurate and true representation of my current and past situation. I also accept that the information given in this declaration will be used – in part - as the basis for an application for a work permit and/or a permanent residence visa for Canada (should I elect to use the services of Arora Canadian Immigration Inc.) and that the decision to issue such a visa or permit is the sole decision of Canadian immigration authorities.