PERSONAL DETAILS-MAIN APPLICANT

1. Last name:

2. Given name:

3. Title:

4. Date of Birth:

5. Street Address:

6. Suburb:

7. City:

8. Country:

9. Email Address:

10. Telephone:

11. Mobile:

12. Fax:

13. Marital Status:

14. How long have you lived together?:

15. Have you ever been divorced?:

Yes No

16. If divorced, state date?

PERSONAL DETAILS - SPOUSE OR PARTNER

17. Last name:

18. Given name:

19. Title:

20. Date of Birth:

21. Street Address:

22. Suburb:

23. City:

24. Country:

25. Email Address:

26. Telephone:

27. Mobile:

28. Fax:

29. Marital Status:

30. How long have you lived together?:

31. Are you a Canadian Citizen or Resident?

Yes No

32. Have you ever been divorced?If Yes, state date?

PERSONAL DETAILS - CHILDREN ( including those from a previous relationship)

33. Full name

34. Date of birth

35. Sex( M/F)

Male Female

36. Country of Citizenship

37. Country of residence

38. Adopted ( Yes / No)

Yes No

39. Do you have full custody ( Yes/ No)

Yes No

Langauge Proficiency - you can gain extra points for proficiency in English and French

40. Main Applicant or Spouse/Partner?

41. Language

42. Read

43. Write

44. Listen

45. Speak

CHARACTER

Please list ALL countries you or anyone included in this application aged 17 years or over have spent a total of 10 years(not necessarily consecutively) in the last 10 years including your country of residence.

46. Main Applicant or Spouse/Partner or Child

47. Country

48. Date of entry:

49. Date of departure:

Has any person included in this application spent a total of 5 years or more(not necessarily consecutively)in any countrysince their 17th birthday? If so , please provide the relevant details below

50. Name

51. Country

52. Date of Entry

53. Date of Departure

VISA HISTORY

54. Has any person associated with this application ever had an application for temporary or permanent visa declined by any government or country, or have been deported/removed at any time from any country?

Yes No

55. Name

56. Provide Details :

IMMEDIATE FAMILY ( parents, brother, sister, step and half brothers, sisters)

Please list all immediate family members for YOU below-

57. Name

58. Date of birth

59. Country

60. Immigration status

61. Relationship to you

Please list all immediate family members for YOUR SPOUSE/PARTNER below-

62. Name

63. Date of birth

64. Country

65. Immigration status

66. Relationship to you

YOUR EDUCATION AND QUALIFICATIONS (please incldude short & long term coures latest to previous)

67. Type of school

68. Name of School

69. Start Date

70. Finish date

71. Qualification acheived

YOUR SPOUSE's / PARTNER's EDUCATION AND QUALIFICATIONS (please incldude short & long term coures latest to previous)

72. Type of school

73. Name of School

74. Start Date

75. Finish date

76. Qualification acheived

YOUR WORK EXPERIENCE

77. TOTAL EXPERIENCE : _______________ years

78. Job title

79. Company name

80. Country

81. Start date

82. Finish date

83. Full/part time

84. Evidential docs(Yes/No)

Yes No

85. If Yes:

YOUR SPOUSE'S / PARTNER'S WORK EXPERIENCE

86. TOTAL EXPERIENCE : _______________ years

87. Job title

88. Company name

89. Country

90. Start date

91. Finish date

92. Full/part time

93. Evidential docs(Yes/No)

Yes No

94. If Yes:

OFFER OF EMPLOYMENT OR CURRENTLY EMPLOYED IN CANADA

Do you have a avlaid offer of employment or are currently in New Zealand and having either an Offe rf employment or currently employed / Please furnish these details below

95. Name of Employer

96. Location

97. Job Position & brief Description

98. Type of job ( Casual/Full/Part time)

99. Start Date

100. Wage/ Salary offered

101. Current Visa type

102. Visa expiry date

AVAILABLE FUNDS

We seek this infrmation from you to ascertain whether you are eligible under certain categories of immigration instructions. This information will be treated with strcitest confidenceand will not be released to any third party without your express permission

103. What is your estimated (combined) net worth including Cash, prpoerty, investments and other assets/

104. Do you have net worth (assets or transefrable funds) in excess of 2 million CAD?

105. Would you be prepared to transfer a minimum of CAD 500K- $1.5 million to Canada within 12 months of your visa being successful?

106. Are you part of a group of investors /business wth a Start-up Business idea that Canada might be interested in?

107. Provide a brief of your business idea?

BUSINESS EXPERIENCE - Only consider if you are considering owning a business in Canada

108. Have you ever owned a business?

Yes No

If YES, please provide the following details:

109. Type of business

110. Your shareholding in that business( if applicable)

111. Years in operation

112. Average revenue / sales/ turnover over the last three trading years

113. Number of staff employed

114. Have you ever been involved in a failing business or been bankrupted?

115. What type and nature of business you want to establish in Canada

116. Have you done any research into purchasing or establishing a business in Canada? If yes , please list below:

Research:

117. What sort or level of capital do you think you would need to purchase or establish this business?

118. Would the business you propose to start be Innovative or export oriented?

119. How many employees Would your proposed business potentially employ?

120. Estimated turnover of this proposed business?

HEALTH

121. 'Do you or any person included in this application have any current medical condition that requires medication,monitoring or care by your Doctor or Specialist? If YES, please provide details of this condition , date of diagnosis, duration of this condition, any treatment or prognosis, - in the space below-

Yes No

122. Details:

123. 'Have you or any person included in this application had any medical condition for which you/they were referred to a Specialist or spent time in the hospital? If YES, please provide details below-

Yes No

124. Details:

EDUCATIONAL BACKGROUND - children over 16 years of age

125. Name

126. Country you completed Secondary/High school education

127. Highest qualification and year you achieved it

128. Language of Instruction

129. How would you rate your English Language Skills ( scale of 1-10 , 1 =poor,10 + Excellent)

130. Have you ever appeared for a IELTS exam ?

131. Date and score of IELTS exams

EdVantage International Consulting Limited

address

Ground Floor, 82 Symonds Street, Grafton, Auckland 1010, New Zealand

phone

+6421909861

Email

[email protected]

ELIGIBILITY ASSESSMENT QUESTIONNAIRE FOR MIGRATION TO CANADA

Full Name

1. Last name:

2. Given name:

3. Title:

4. Date of Birth:

5. Street Address:

6. Suburb:

7. City:

8. Country:

9. Email Address:

10. Telephone:

11. Mobile:

12. Fax:

13. Marital Status:

14. How long have you lived together?:

15. Have you ever been divorced?:

16. If divorced, state date?

17. Last name:

18. Given name:

19. Title:

20. Date of Birth:

21. Street Address:

22. Suburb:

23. City:

24. Country:

25. Email Address:

26. Telephone:

27. Mobile:

28. Fax:

29. Marital Status:

30. How long have you lived together?:

31. Are you a Canadian Citizen or Resident?

32. Have you ever been divorced?If Yes, state date?

33. Full name

34. Date of birth

35. Sex( M/F)

36. Country of Citizenship

37. Country of residence

38. Adopted ( Yes / No)

39. Do you have full custody ( Yes/ No)

40. Main Applicant or Spouse/Partner?

41. Language

42. Read

43. Write

44. Listen

45. Speak

Please list ALL countries you or anyone included in this application aged 17 years or over have spent a total of 10 years(not necessarily consecutively) in the last 10 years including your country of residence.

46. Main Applicant or Spouse/Partner or Child

47. Country

48. Date of entry:

49. Date of departure:

50. Name

51. Country

52. Date of Entry

53. Date of Departure

54. Has any person associated with this application ever had an application for temporary or permanent visa declined by any government or country, or have been deported/removed at any time from any country?

55. Name

56. Provide Details :

Please list all immediate family members for YOU below-

57. Name

58. Date of birth

59. Country

60. Immigration status

61. Relationship to you

62. Name

63. Date of birth

64. Country

65. Immigration status

66. Relationship to you

67. Type of school

68. Name of School

69. Start Date