User ID *
Last Name
First Name
Email Address *
Confirm your Email Address *
Current Address
Postal Code
Home Phone Number
Cell Phone Number
Fax Number
Gender
Date of Birth
Age
Nationality
Foreign Citizenship
Have you been divorced previously? *
If yes, the date of divorce
Do you and your sponsor have children? If yes, the number of children and their age. If none, enter “none”.
Net Assets
Current and expired status in Canada (type of visa/permit and valid period)
(EX)
2006.3 – 2007.2 Student Visa
2007.2 – 2007.8 Tourist Visa
Does any of your family members including yourself have an ongoing health issue? If yes, please provide the details.
Does any of your family members including yourself have a criminal record in or outside of Canada? If yes, please provide the details.
Has any of your family members including yourself been refused a visitor visa, a work permit, a study permit of Canada or any other country? If yes, please provide the details.
Has any of your family members including yourself been refused admission to, or ordered to leave, Canada or any other country?
Has any of your family members including yourself stayed in countries other than Canada after turning 18 years old over 6 months?
If yes to the question above, names of countries as well as names of states or territories if it was in Australia.
Family Name *
First Name *
Sponsor’s residential address *
Postal code *
Phone number (residential) *
Phone number (cell) *
Sponsor’s email address *
Sponsor’s gender *
Age *
Year of Birth
Month of Birth
Birth Day
Status in Canada *
Annual Income
In the past five years, did you become a permanent resident after being sponsored as a spouse, common-law or conjugal partner *
Have you previously been married or in a common-law relationship? *
If yes, type of relationship *
If yes, from YYYY-MM-DD to YYYY-MM-DD *
Are you in receipt of social assistance for a reason other than disability? *
Are you an undischarged bankrupt under the Bankruptcy and Insolvency Act? *
Have persons you previously sponsored or their family members received social assistance during the validity period of the undertaking? *
Did you co-sign an undertaking where the sponsored persons or their family members received social assistance during the validity period of the undertaking? *
Have you been ordered to leave Canada? *
Are you late in making a required payment on an immigration loan, a performance bond or any other amounts your agreed to pay under Canadian immigration legislation, and have not made arrangement to defer payments? *
Are you currently detained in jail, prison, penitentiary or reformatory? *
If yes, provide the details including date and place. *
Have you been convicted of a sexual offence or serious violent offence against anyone or an offence causing bodily harm against someone who is or was related to you, or an attempt to commit such an offence? *
Are you in default of a court order to make support payments to your spouse, former spouse, common-law partner, former common-law partner or child? *
Are you the subject of an application to revoke your Canadian citizenship? *
If yes, provide the details including date and place. *
Are you the subject of a report on inadmissibility? *
If yes, provide the details including date and place. *
Have you been charged with an offence under an Act of Parliament punishable by a maximum term of imprisonment of at least 10 years? *
If yes, provide the details including date and place. *
Have you previously sponsored a foreign nation for his/her permanent residence? *
If yes, when did the foreign national become a permanent resident?(YYYY-MM-DD) *
Relationship with Sponsor
When was the first time you met in person?(YYYY/MM)
When did your relationship start?(YYYY/MM)
Are you living together now? *
If yes, when did you start living together?(YYYY/MM)
If yes, do you have documents which can prove that you are living together?
When did you get married or did your common-law relationship start?(YYYY/MM/DD) *
Have you met Sponsor’s family members?
Has Sponsor met your family members?
What other documents to prove your relationship with Sponsor do you have?
Are there any periods when you and Sponsor were separated? If yes, please provide the details of those periods( ～ ).
Where did you find us? *
Enter the name of specific source or reference (ex. Google, From Mr. …) *
If you wish to add further information regarding your current status, please state here.
Signature: I agree that the information I provided in the above form is true and correct, to the best of my knowledge, and provided for the sole purpose of my assessment regarding Immigration to Canada. *
Tell us you are not a robot. *