Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out
Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

caf

VIEWS: 9 PAGES: 2

									                                    NORTHAM CONSULTING LIMITED
       6412 Longspur Road                                                             Tel: 905-785-1808
       Mississauga, Ontario, Canada, L5N 6E3                                           Fax: 905-785-1809
                                          Email: northamcanada@sympatico.ca
                                CONFIDENTIAL ASSESSMENT FORM
                             (Strictly confidential. Attach a recent photograph.)

1. NAME ______________________________ _______________________ _________________ SEX M F
(Per Passport)     (Last Name)               (First Name)       (Middle Name)
2. MAILING ADDRESS
____________________________________________________________________________________________
____________________________________________________________________________________________
 TELEPHONE _______________________________________ _____________________________________
                               (Home)                                       (Work)
 Best Time To Call You At Home (Your Time):________ conf. e-mail address: ________________________________


                           4.    MARITAL STATUS
 3. CITIZENSHIP                 Never Married Engaged         Married   Divorced    Widowed    Separated
______________________

5. NUMBER OF CHILDREN (a) Under Age 22 and Unmarried _____ (b) Age 22 or Over and unmarried ____
  Dates of Birth of Children: (dd/mm/yy) __________________________________________________________

6.                                                     APPLICANT                              SPOUSE
DATE OF BIRTH (dd/mm/yyyy):                          _______________                      _____________
TOTAL NO. OF YRS. OF EDUCATION:                      _______________                      _____________
EDUCATION COURSES:
 Course & Month/Year of Completion (a) ______________________
         [ e.g., B.Com. - July/1995 ]         (b) ______________________
                                              (c) ______________________
                                              (d) ______________________
                                              (Attach a separate sheet in case the space is insufficient)
WORK EXPERIENCE (LAST 10 YRS):
 (a) Job Title                                _________________________
         Employed Since (Month/Yr)            _________________________
         Name of Company                      _________________________
 (b) Job Title                                _________________________
         Employed Since (Month/Yr)            _________________________
         Name of Company                      _________________________
 (c) Job Title                                _________________________
         Employed Since (Month/Yr)            _________________________
         Name of Company                      _________________________
                                     (Attach a separate sheet in case the space is insufficient)
7(a) PERIOD OF STUDIES IN CANADA_________ 7(b) PERIOD OF WORK IN CANADA __________
8. SELF-EMPLOYED BUSINESSPERSON
     (a) Type of business (manufacturing/trading/services/other):
     (b) Brief description of business: __________________________
         ________________________________________________________ (c) In business for ________years.
9. NET WORTH IN U.S DOLLARS                  (Approx. amounts only, at this stage)               U.S.$
   (a) Transferable money in banks
   (b) Market value of saleable assets
   (c) Terminal benefits, gratuities on leaving employment
   (d) Real estate in ____________________ (country)
   (e) Equity in business
                                                                  TOTAL ASSETS:
   (f) LESS: Debts and Liabilities ---------------------------------------------------->
                            NET WORTH:

                                                                                    Contd.. On Reverse
                                                                            Assessment Form .. Page 2 of 2

10. RELATIVE LIVING IN CANADA (if any)
    Name: __________________________________
    Telephone No.____________________________
    Relationship to You________________________

11. KNOWLEDGE OF LANGUAGES (PLEASE CIRCLE APPROPRIATE ASTERISK)
           <<<ENGLISH PROFICIENCY>>>           <<<FRENCH PROFICIENCY >>>
           HIGH MODERATE    BASIC NONE         HIGH MODERATE    BASIC NONE

SPEAK            *            *              *        *                *          *             *        *
LISTEN           *            *              *        *                *          *             *        *
READ             *            *              *        *                *          *             *        *
WRITE            *            *              *        *                *          *             *        *
12.              [DEPENDENTS MEAN YOUR SPOUSE & CHILDREN ONLY]
                                                                                                 YES        NO
         (a) Have you or your dependents ever applied for immigration to Canada earlier ?
         (b) Have you or your dependents ever been refused any visa / admission to Canada ?
         (c) Have you or your dependents ever been criminally convicted ?
         (d) Have you or your dependents ever had any serious medical problems ?
       If the answer to any of the above is "YES", please provide full details on a separate sheet of paper

                                         ATTESTATION
I / We hereby solemnly declare that the aforesaid information provided by me/us is true and correct to the
best of my/our knowledge and all relevant supporting documents shall be provided when

All the above given information shall be kept in strict confidence and shall be used solely for the
preparation of prescribed documentation in support of an application for permanent residence in Canada
______________________________                                  ________________________________
 Signature of the Applicant                                     Signature of the Spouse (if applicable)
Place_________________ Date________________                       Place_________________ Date___________


<<<<<<<<<<<<<<<<<< FOR USE OF NORTHAM CONSULTING LIMITED ONLY >>>>>>>>>>>>>>>>>
Date _________________           Place_______________________       Consultant__________________
Remarks______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Acceptance Notified by_________________ On__________________ To_________________________________
Forwarded to Projects / Legal On_____________________ By_________________________________________
Referred By___________________________________________________________________________________
NC8_CAF (11-08)                          END OF ASSESSMENT FORM

								
To top