Canada Immigration Assessment Form for Business Immigration

Do you have a specific question?  Yes     No

About You :
1. Title:	Mr. Mrs. Ms. Miss Dr.
2. First Name/s*:
3. Last Name*:
4. Date of Birth*:
5. Place of Birth:
6. Gender:	Male        Female
7. Nationality:	United States Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Espana Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Republic of Korea (South) Kuwait Kyrgyzstan Lao Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa (Independent) San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia & South Sandwich South Korea Spain Sri Lanka St. Helena St. Pierre and Miquelon Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay USA Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wales Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe
8. Present Occupation:
11. Address:
12. Telephone No:
13. Fax No:
14. E-mail*:
15. Web Page:
16. Annual Income ($US):
Other details :
17. Are your plans for emigration Temporary or permanent?	up to one year up to three years Permanently
18. Do you have family or dependants who will emigrate with you?	Yes     No
If ‘Yes’ please give details:
Age Relationship to you Occupation
19. Do you have relatives or ancestors in Canada?
Age Relationship to you Occupation Nationality Immigration Status
20. Have you had any type of visa to Canada before?	Yes     No
If yes, please give the following details:
a. Type:
b. Date Issued:
c. Place Issued:
d. Length of validity:
21. Have you ever been refused a visa?	Yes     No
If yes, please give details:
22. How much do you have in the way of funds? (in US$)
a. Savings on deposit:
b. Value of other assets:
c. Amount you intend to take with you (Please be advised, that CAD 10,000 and CAD 2,000 for each dependent is recommended):
23. Which category are you considering for Immigration?*	Investor Entrepreneur Self-employed To the description of the categories click here
24. How much do you intend to invest (in US$)?*
25. In brief, what are your business plans?*
26. Please state your fluency in English below (PLEASE TICK):
Speaking:	No With difficulty Well Fluent
Reading:	No With difficulty Well Fluent
Writing:	No With difficulty Well Fluent
Understanding:	No With difficulty Well Fluent
27. Please state your fluency in French below (PLEASE TICK):
Speaking:	No With difficulty Well Fluent
Reading:	No With difficulty Well Fluent
Writing:	No With difficulty Well Fluent
Understanding:	No With difficulty Well Fluent
28. Have you or any of your immediate family members ever been convicted of any crime (however minor the offence)?	Yes     No
If yes, please include full details below:
29. Have you or any of your immediate family had any serious health problems?	Yes     No
If yes, please include full details below:
30. Why do you wish to emigrate?
Work Experience and Qualifications
31. Please provide full details of your educational qualifications.*
Dates of study University/ College/School Subject Qualification Country 1. From:     To:    2. From:     To:    3. From:     To:
32. Please provide full details of your work experience.*
Dates of Employment Employing Company Job Title Skills used / Responsibilities Country 1. From:     To:    2. From:     To:    3. From:     To:
33. FEEDBACK - Please provide any additional information that you think might help us evaluate your situation. Any comments on improvements that can be made to this form and other parts of our web-site are welcome: