Wesley Resources Pvt Ltd

Safeway Immigration Consultants Inc.

Client Assessment Form

Last Name: / First: / Middle:
Mailing Address /

House No

/ Street / City
State / Country / Postal Code
Telephone /

Home: 5

/ Business:
Fax: / Email:

Personal Information

Date of Birth: / Day: 1 / Month: / Year: / Sex: / Male / Female
Place of Birth: / City: / State: / Country:
Citizenship:
Marital Status: / Never Married / Engaged / Married
Widowed / Separated / Divorced
Living with same sex-partner for more than a year
Living with common-law partner for more than one year
Spouse Info: / If you are married or engaged please provide details of spouse
Full Name:
Date of Birth: / Day: / Month: / Year:
Citizenship:
Occupation:
Experience:
Date of Marriage: / Day / Month / Year / Place

Education

Highest Completed / University Degree / Non University Diploma
Primary School / 1 year University credential / One year
High School / 2 year University credential / Two year
3 year University credential / Three year
2 Bachelor’s degrees
Masters
Phd

Years of School: / How many years of school have you completed? / ______Total Years
Family Info: / None
Children / Full Name / Son / Daughter / Date of Birth
 / 
 / 
Indicate Relatives in Canada if any: / Name / Relationship / Address

Education Info

Period / Name & Address of Institutions / Courses / Degree / Diploma / Certificate Issued
From / To
Total Years of school successfully completed / ______Years
Employment:
Intended Occupation In Canada
Work History
Date / Name & Address of Employer / City & Country / Job Designation
From / To
Present Occupation / Current Occupation / Current Monthly Earnings
Job Description: / Please attach a separate Sheet giving a detailed description of the job responsibilities performed by you on a day to day basis:
Total Work Experience: / How many Years of work experience do you have in the last 10 years?
0 / 1 / 2 / 3 / 4 & Up
Language Ability / Please indicate your ability to communicate in English and French by checking the appropriate column

English

/ Fluently / Well / With Difficulty / Not at all
Speak /  /  /  / 
Read /  /  /  / 
Write /  /  /  / 

French

/ Fluently / Well / With Difficulty / Not at all
Speak /  /  /  / 
Read /  /  /  / 
Write /  /  /  / 

Language Test

/ Have you or could you pass a formal English/French Language Test?
English / French
Yes / No / Yes / No
Transferable Funds / Assets: / Cash (in CDN$) / Property

Other Details

Yes / No
 /  / Do you hold a work permit for Canada?
 /  / Do you have a job offer or potential job offer from a Canadian employer?
 /  / Have you or your spouse, common law partner or same sex partner ever worked in Canada for one full year?
 /  / Have you or your spouse, common law partner or same sex partner ever studied in Canada for more than two years?
 /  / Do you or your spouse, common law partner or same sex partner have a valid offer of employment in Canada upon your arrival?
 /  / Do you have a spouse, common law partner or same sex partner who is a Canadian Citizen or Permanent Resident?
 /  / Do you or your spouse, common law partner or same sex partner have any close family relationships in Canada?
 /  / Will you be able to bring with you more than CDN$25000 when you immigrate?

BUSINESS APPLICANTS ONLY

Yes / No
 /  / Are you willing to invest or start a business in Canada?
 /  / Have you in the last 5 years ever made a trip to Canada to explore business opportunities?
 /  / Do you have a personal net worth of at least $300,000 CDN?
 /  / Have you ever managed more than 5 people?
 /  /

If yes, describe briefly?

 /  / Have you ever been self-employed as a musician or artist, or in other cultural activities?
 /  / Have you ever owned or managed a farm?
 / 
Company Details: / Complete this section if you have owned a company in the last 5 years? If yes, email a complete business profile of your company to .
 /  / Have you ever owned and operated your own business?
 / ___% / What percentage of the company did you own?
__ / People / How many people have you employed?
 /  / Has your company had gross sales of more than $500,000 CDN per year in at least 2 of the last 5 years?
 /  / Has your company had net income of more than $50,000 CDN per year in at least 2 of the last 5 years?
 /  / Has your company had net equity of more than $125,000 CDN per year in at least 2 of the last 5 years?
Turnover & Net Profit over the last 3 years / Year / Turnover / Net Profit
Net Worth in Canadian $ / Bank / Property / Assets / Other / Total
If others give details here:
The Value of all your assets
Funds available to be transferred to Canada

Additional Info

Visit Abroad / Have you ever visited abroad? If yes which countries?
 /  /  / N/A
For which countries do you have a valid visitors visa?
 /  /  / N/A
Do you have a work visa for any country?
 /  /  / N/A
Canada
Have you ever visited Canada? / Yes / No
Where / When / Purpose
Have you ever studied in Canada? If yes, give details:
Institution / Course / Date
Why Canada? /

Briefly explain your interest in immigrating to Canada?

Any other information you believe that is relevant to this assessment?
How did you come to know about our Immigration Consultancy firm?
Referral / Friend / Seminar
Newspaper / Internet / Other ______
I declare that information given in this application is truthful, complete and correct.
Date: Signature:
Information provided to our firm is strictly Private & Confidential.