Client Assessment Form Please note that this is a non refundable fee and one of our staff member will contact you via email or phone call to discuss your opportunities to migrate Canada Personal Information Name Email* Phone* Age in Years Date Of Birth Marital Status* SingleDivorcedMarried Current Residential Address Education History Canadian Education (if applicable) College/University Name From (MM-YYYY) To (MM-YYYY) Name of Degree/Diploma Field of Study City, Country Home Country Education (Bachelors, Masters or Diploma, if applicable) College/University Name From (MM-YYYY) To (MM-YYYY) Name of Degree/Diploma Field of Study City, Country Relatives In Canada Do you have any Brother/Sister with permanent resident status in Canada?* NoYes List all the family members residing in Canada: NAME RELATIONSHIP CITY AND PROVINCE Work Experience (If Any) Please provide the detailed Canadian employment record with date, name and address of employer and job designation held From (MM-YYYY) To (MM-YYYY) Name & Address of Employer Job Title Please provide the detailed Home country employment record with date, name and address of employer and job designation held (if applicable) From (MM-YYYY) To (MM-YYYY) Name & Address of Employer Job Title English Proficiency Did you take IELTS exam? (Yes/No) NoYes If Yes, what module "General or Academic" ? IELTS Score Obtained Listening Speaking Writing Reading Overall If No, when are you planing to take exam ? Visa Information Have you ever applied or issued student visa, visitor or PR for Canada or Any Other Country? NoYes Please provide details, date and reason Have you ever refused student visa, visitor or PR for Canada or Any Other Country? NoYes Please provide details, date and reason Did someone refer you to us? Choose Your Consulting Option* On PhoneIn Person
