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Evaluation of chances to immigrate to Canada

Full name and surname as shown in the National Identity Document
Do you have a valid passport/travel document?
Full name and surname as shown in the passport/travel document?
Passport issuing country
Passport issuing date
Passport expiry date
Date of birth
Place of birth (city, country)
Citizenship
Native language
Current country and city of residence
Since when have you been living there?

CONTACT DETAILS

Residential address (Apartment number, Street number, Street name, District, City/Town, Country, Province/State, Postal code)
Telephone Number (Enter the phone number in full format: code, city / area code Example:.: +38 048 735 37 40)
E-mail

MARITAL STATUS

Marital status
Marriage registration date
Common-Law partnership start date
Marriage registration date
Duration of relationship
Divorce date
Date of spouse’s death
Do you have children?
Sex
Date of Birth
Do you plan to immigrate with this child?
Does the child have National Identity Document?
Full name and surname as shown in the National Identity Document
Does the child have valid international passport?
Full name and surname as shown in the international passport?
Does the child have child’s travel document?
Full name and surname as shown in the child’s travel document?
Citizenship of the child
Residential address of the child: (1. If the child lives with you, there is no need to repeat the address, specify - "lives with me"; 2. Country, city, district, street, house number, apartment number, zip code)
Does your child has personal contacts?
Number of child's phone
Full name and surname (as shown in the birth certificate)
Did you have any previous marriages?

Previous marriage info

Type of marriage
duration of your relations from
duration of your relations till
Spouse full name
Spouse birthdate

EDUCATION

Work experience (profession, in which you have experience of least of 1 year during the last 10 years):

INFORMATION ABOUT ADDITIONAL FAMILY MEMBER (SPOUSE)

Are you planning to immigrate together with this family member?

ADDITIONAL INFORMATION (RELATED TO ALL FAMILY MEMBERS)

Have you or your spouse ever visited Canada?
yes
no
Who visited?
Describe the details: (Please write whether you or anyone of family members previously have visited Canada, specify dates of arrival and departure, cities visited, and purpose of the trip)
Do you or your spouse have close relatives in Canada?
yes
no
Related to:
Describe the details: (Please provide full name, address, zip code, status in Canada and exact relationship to you (for example: instead of "Uncle" write "the younger brother of wife’s mother")
Did you or your spouse work in Canada with a work permit?
yes
no
Who worked?
Worked from:
till:
Describe the details:
Did you or your spouse study in Canada, having a study permit?
yes
no
Who studied?
Worked from:
till:
Describe the details:
Have you ever been refused in any kind of visa to Canada or elsewhere?
yes
no
Describe the details:
Where do you prefer to live in Canada? (if there is no preference, please choose "not sure, consultation on the choice of place of residence is required". To select several cities - hold the CTRL key while selecting the city.)
Have you or any of your family members ever been convicted of a crime?
yes
no
Description of convictions (If someone in your family has a record, you must report it. Also provide description of previous convictions, when and for what reason they were obtained).
Do you or any of your family members have serious diseases?
yes
no
Identify any serious diseases (Serious diseases include those involve the necessity of expensive treatment, need of care, disability, and those that are dangerous for the society (for instance, AIDS, sexually transmitted diseases, tuberculosis, hepatitis, etc.)
Would you like to indicate additional information about yourself?
yes
no
Additional information about your background (you can note additional information about yourself that from your point of view may be useful. For example, you can specify your achievements in any field, participation in any movement, additional skills etc.)
Availability of funds in the amount of (information is to obtain additional points)
How did you find out about «Palleonn» Centre
Internet (forums, Google, Yandex, etc.)
Friend’s reference (if possible, please indicate friend’s name)
Other types of advertising (please specify below: television, radio, etc.)
Regional Representative (specify below)
Other (specify below)
Would you like to receive our news and offers?
yes
no
Choose preferable way?
E-mail
Phone
Skype
Another way
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