Printable Form (By Fax or Mail)

APPLICATION FOR IMMIGRATION / PERMANENT RESIDENCY 1. Please specify category for which you are applying       Business Class:   Family Class / Sponsorship Investor Student Entrepreneur Skilled Worker Self-employed 2. PERSONAL INFORMATION Title:   Mr. Ms. Mrs. First Name:   Last Name:   Middle Name:   Date of Birth (day/mo/yy):   Place of Birth:   Country of Citizenship:   3. EDUCATION Highest Level of completed education: Secondary / High School Bachelor’s degree Vocational/Trade/Apprenticeship Master’s degree / PhD College Others (specify)   Current Occupation:   How long?   Year(s): Month(s):       4. Marital Status Married Widow/widower Single Common-Law Divorced/Separated     5. Language proficiency Principal Applicant Language Excellent Very Good Good Fair           English French Others (Specify) Spouse Language Excellent Very Good Good Fair           English French Others (Specify) 6. Spouse Detail (if married) Title:   Mr. Ms. Mrs. First Name:   Last Name:   Middle Name:   Date of Birth (day/mo/yy):   Place of Birth:   Country of Citizenship:   N.B. Additional information on your spouse (if applicable), i.e. education, work experience could be provided on extra Space below 7. Children’s Detail (if any)   Name Date of Birth (day/mo/yy) Place of Birth 1 2 3 4 8. DO YOU HAVE ANY RELATIVES IN CANADA? Yes No 9. WHERE DO YOU INTEND TO LIVE IN CANADA? City / Town:   Province:   10. CONTACT DETAILS Address:   Tel:   Fax:   Email:     Please fill application and mail to: Canadian Provincial Nominee & Immigration Services, 4665 Yonge St., Suite 306, Toronto, Ontario, M2N 0B4, Canada. Tel 01-416-447-7033 / fax 01-416-447-7002 / Email: inquiry@cpnis.com