PR Initial Assessment – KSP Immigration Consulting Inc.

Family Name (Last Name) *

Middle Name (If Applicable)

Given Name (First Name) *

Your Full name written in your native language or script (e.g., Arabic, Cyrillic, Chinese, Korean, etc.) *

Given Name (First Name)

Middle Name(s)

Family Name (Last Name)

Given Name (First Name)

Middle Name(s)

Family Name (Last Name)

3. Do you have Unique Client Identifier (UCI) number?

4. Your Sex (Gender) * MaleFemaleUnknownAnother Gender

5. Your Date of Birth *

6. Your Place of Birth (City/Town & Country) *

Current Citizenship #1 *

Current Citizenship #2

Country/Territory *

Status (Citizen, Worker, Student, PR, or Other) *

If Other

During the past five years have you lived in any country or territory other than your country of citizenship or your current country or territory of residence (indicated above) for more than six months? * NoYes (Fill below)

Country/Territory

Status (Citizen, Worker, Student, PR, or Other)

If Other

Country/Territory

Status (Citizen, Worker, Student, PR, or Other)

If Other

Country/Territory *

Status (Citizen, Worker, Student, PR, or Other) *

If Other

b) (If you are married or in a common-law relationship) Provide the date on which you were married or entered into the common-law relationship.

Given Name (First Name)

Family Name (Last Name)

Canadian Citizen or Permanent Resident? NoYes

12. Have you previously been married or in a common-law relationship? (Y/N) *MarriedCommon-lawNo

Given Name (First Name)

Family Name (Last Name)

Date of Birth

Relationship Start Date

Relationship End Date

a) Do you have Children? (Y/N) *YesNo

b) How many Children do you have?

c) If you have children, please provide their names and ages

14.
a)Indicate whether you have: worked in/studied in/visited/never been to Canada *

b) Have you ever had a work or study permit to Canada? (Y/N) * YesNo

c) If you lived in Canada before, what were the date?

d) List the total amount of funds you have that are legal and transferrable (Do NOT include equity in real estate) *

e) Do you or your partner have close family members who are permanent residents or citizens of Canada and live in Canada now? (Y/N) *YesNo

f) If you answered YES to the question above, please state the relationship of the family member to you/your partner and the name of the city in Canada in which he/she resides.

Native language/Mother Tongue *

Are you able to communicate in English and/or French? * EnglishFrenchBoth

In which language are you most at ease? * EnglishFrench

Have you taken a test from a designated testing agency to assess your proficiency in English or French? * NoYes

IELTS or CELPIP *IELTSCELPIPN/A

Date of Test

General or Academic?GeneralAcademic

Test Result: Reading

Test Result: Writing

Test Result: Speaking

Test Result: Listening

Passport Number *

Country or Territory of Issue *

Issue Date *

Expiry Date *

For this trip, will you use a passport issued by the Ministry of Foreign Affairs in Taiwan that includes your personal identification number? *NoYes

For this trip, will you use National Israeli Passport? *NoYes

Do you have a national identity document? * NoYes (Fill below)

Document Number

Country of Issue

Issue Date

Expiry Date

Are you a lawful Permanent Resident of the United States?* NoYes (Fill Below)

U.S. Citizenship and Immigration Services (USCIS) number

Expiry Date

Current Mailing Address *

Residential Address *Same as mailing address? YesNo

Alternate Telephone No.

Fax No.

The original purpose for coming to Canada *

If Other

Purpose of your visit *

If Other

Funds available for your stay(CAD): *

Name

Relationship to you

Address in Canada

Name

Relationship to you

Address in Canada

Name

Relationship to you

Address in Canada

Name

Relationship to you

Address in Canada

Have you had any post secondary education (including university, college or apprenticeship training)? * NoYes (Fill below)

Field and level of study

Schoo/Facility Name

City/Town

Country or Territory

Province/State

Elementary/Primart School

Secondary/High School

University/Colletge

Trade school or other post-secondary school

Schoo/Facility Name

City/Town

Country

Field and level of study (Major)

Degree/Diploma/Certificate/Not Completed

Full-time or Part-time

Schoo/Facility Name

City/Town

Country

Field and level of study (Major)

Degree/Diploma/Certificate/Not Completed

Full-time or Part-time

Schoo/Facility Name

City/Town

Country

Field and level of study (Major)

Degree/Diploma/Certificate/Not Completed

Full-time or Part-time

Current Activity/Occupation

Company/Employer/Facility name

City or Town/Country

Country or Territory

Province/State

Current Activity/Occupation

Company/Employer/Facility name

City or Town/Country

Country or Territory

Province/State

Current Activity/Occupation

Company/Employer/Facility name

City or Town/Country

Country or Territory

Province/State

Current Activity/Occupation

Company/Employer/Facility name

City or Town/Country

Country or Territory

Province/State

From

Visa Issued (Y/N)YesNo

Country or Territory

Location

Purpose of Trip

From

Visa Issued (Y/N)YesNo

Country or Territory

Location

Purpose of Trip

From

Visa Issued (Y/N)YesNo

Country or Territory

Location

Purpose of Trip

From

Visa Issued (Y/N)YesNo

Country or Territory

Location

Purpose of Trip

a) Within the past two years, have you or a family member ever had tuberculosis of the lungs or been in close contact with a person with tuberculosis? * NoYes

b) Do you have any physical or mental disorder that would require social and/or health services, other than medication, during a stay in Canada? * NoYes

c) If you answered "Yes" to question 1a) or 1b), please provide details and the name of the family member (If applicable)

a) Have you ever remained beyond the validity of your status, attended school without authorization or worked without authorization in Canada? * NoYes

b) Have you ever been refused a visa or permit, denied entry or ordered to leave Canada or any other country or territory? * NoYes

c) Have you previously applied to enter or remain in Canada? * NoYes

d) If you answered “yes” to question 2a), 2b) or 2c), please provide details.

a) Have you ever committed, been arrested for, or been charged with or convicted of any criminal offence in any country or territory?* NoYes

b) If you answered "yes" to question 3a), please provide details.

a) Did you serve in any military, militia, or civil defence unit or serve in a security organization or police force (including non obligatory national service, reserve or volunteer unit)? * NoYes

b) If you answered "yes" to question 4a), please provide date of service and countries or territories where you served.

a) Are you, or have you ever been a member or associated with any political party, or other group or organization which has engaged in or advocated violence as a means to achieving a political or religious objective, or which has been associated with criminal activity at any time? * NoYes

a) Have you ever witnessed or participated in the ill treatment of prisoners or civilians, looting or desecration of religious buildings? * NoYes

Is there any other information that you feel is important to share as part of your preliminary assessment?

Print Your Full Legal Name*

Date

Passport Copy (Maximum Upload Size: 5mb)

Resume (Maximum Upload Size: 5mb)

Additional Documents 01 (Employer Reference Letter, Education Transcript, etc. Maximum Upload Size: 5mb)

Additional Documents 02 (Employer Reference Letter, Education Transcript, etc. Maximum Upload Size: 5mb)

Additional Documents 03 (Employer Reference Letter, Education Transcript, etc. Maximum Upload Size: 5mb)

PR Initial Assessment Form