1 - Personal Information

Name:
Date of Birth :
Sex (Male/Female):
Contact Number:
Email:
2 - Family Composition
Present marital Status:
Number of Children and their !e(s):
"elati#es in Canada: (Please mention "elation)
3 Education
Canadian Immigration Assessment Form
Duration cademic $
Professional
%ualification
Mar&s
'btained
Name of School/(ni#ersit) *ith
countr)
From +o
4 - Wor !istory
+otal number of )ears of ex,erience *ith com,lete histor) of ,ast -. )ears:
" - A#ility in $anguage E%&$I'!: (/i!h/Moderate/Basic/None) Mention 0E1+S results
SPE20N3:
10S+EN0N3:
"ED0N3:
4"0+0N3:
( - A#ility in $anguage F)E%C!: (/i!h/Moderate/Basic/None)
SPE20N3:
10S+EN0N3:
"ED0N3:
4"0+0N3:
Information on 'pouse *Applicant+s !us#and or Wife,
Name:
Date of Birth :
Sex (Male/Female):
Duration
Name of
the
Com,an)
Desi!nation and 5ob Profile
From +o
MM 66 MM 66
- Education
. - A#ility in $anguage F)E%C!: (/i!h/Moderate/Basic/None)
SPE20N3:
10S+EN0N3:
"ED0N3:
4"0+0N3:
Duration cademic $
Professional
%ualification
Mar&s
'btained
Name of School/(ni#ersit) *ith
countr)
Fro
m
+o
/- A#ility in $anguage E%&$I'!: (/i!h/Moderate/Basic/None) Mention 0E1+S results
SPE20N3:
10S+EN0N3:
"ED0N3:
4"0+0N3:
10 - Wor !istory of 'pouse
+otal number of )ears of ex,erience *ith com,lete histor) of ,ast -. )ears:
--: n) self7em,lo)ed ,rofession b) a,,licant or s,ouse durin! last 8 )ears9
Si!nature of Staff:
Name of 'ffice:
Protection of personal information
The personal information appearing on this form, and in any documents that must be appended to it, is required for
processing your application for Immigration to Canada, Act respecting immigration to Canada, the Regulation respecting the
selection of foreign nationals, the Regulation respecting the immigration consultants and their administrative regulations.
Your personal information is confidential and may not be disclosed without your consent unless eplicitly authori!ed by you.
DECLARATION
I declare that the information contained in this application and appended documents, if any, is complete and accurate and I
will notify the representative of any change in answers given on this form before the submission of application to
Immigration "epartment #CIC$, CA%A"A.
I ac&nowledge that I have read the notice on the protection of personal information in the section above.
I further ac&nowledge that by saving this document and sending the same to my legal representative electronically,
constitute my consent to use the information and no physical signature is required.
I also agree that Asha &iran Immigration will be ma&ing an initial assessment on the basis of the limited information
provided on this form.
Duration
Name of
the
Com,an)
Desi!nation and 5ob Profile
From +o
MM 66 MM 66