Assessment Form Preliminary Assessment Questionnaire For Express Entry Permanent Residency / Temporary Residency Web Form : Please fill up the web form below with complete details and submit it.Applicant's First Name* Middle Name (If applicable) Last Name* Any other Name used previously Date of Birth (dd/mm/yyyy)* DD slash MM slash YYYY Place of Birth (Place, Country)* Full Mailing Address* Residentail Address If different Home Phone Number With Country and Area CodeCell Phone Number With Country and Area Code*Whatsapp Number with country code if differentEmail* Other Email (If Applicable) Gender*MaleFemaleMarital Status* Date of Marriage (dd/mm/yyyy) DD slash MM slash YYYY Nationality* Referred By Principal Applicant: Write all your academic activities starting with most recent graduation. Educational History*Type of GraduationUniversity / College Name / CountryFrom (mm/yyyy)To (mm/yyyy) Principal Applicant: Write all your experience you have gained after your graduation. Employment HistoryCompany NameDesignationFrom (mm/yyyy)To (mm/yyyy) Principal Applicant: Language TestHave you completed any languages test within past 2 years i.e. IELTS, CELPIP etc? Yes No Not yet preparing for language exam ModuleIELTS - GeneralIELTS - AcademicCELPIP - GTEF - FrenchTCF - FrenchDate of Test Result (MM/YYYY) Are you willing to appear for exam? Yes No When you are planning to appear for language test? (MM/YYYY) Which language test you are planning to appear for?IELTS - GeneralIELTS - AcademicCELPIP - GTEF - FrenchTCF - FrenchWhen you are planning to appear for language test? (MM/YYYY) Listening Reading Writing Speaking Overall Band Spouse Information Spouse First Name Middle Name (If applicable) Last Name Any other Name used previously Date of Birth (dd/mm/yyyy) DD slash MM slash YYYY Place of Birth (Place, Country) Full Mailing Address if different than Applicant's Email Cell Number with Country and Area CodeSpouse : Write all your academic activities starting with most recent graduation. Educational HistoryType of GraduationUniverisity / College Name / CountryFrom (mm/yyyy)To (mm/yyyy) Spouse : Write all your experience you have gained after your graduation. Employment HistoryCompany NameDesignationFrom (mm/yyyy)To (mm/yyyy) Spouse : Language Test Result - if availableHave you completed any languages test within past 2 years i.e. IELTS, CELPIP etc? Yes No Not yet preparing for language exam ModuleIELTS GeneralIELTSAcedemicCELPIP - GTEF - FrenchTCF - FrenchDate of Test Result (MM/YYYY) Are you willing to appear for exam? Yes No When you are planning to appear for language test? (MM/YYYY) Which language test you are planning to appear for?IELTS GeneralIELTSAcedemicCELPIP - GTEF - FrenchTCF - FrenchWhen you are planning to appear for language test? (MM/YYYY) Listening Reading Writing Speaking Overall Band Children Information Children InformationFull NameDate of BirthNationalityGender Do you or your spouse have applied / Refuse for Canada or any other Country? i.e. PR Application, Student, Visitor, Work Permit, etc. (If yes write full details below) Any Immigration Application Refusal History - If ApplicableFull Name of the ApplicantCountry where AppliedCategory for AppliedDate of Refusal Do you or your spouse currently living in Canada? If yes, please provide detials below.Residency Information - If ApplicableFull Name of the Applicant In CanadaStatus in Canada (i.e. Visitor, Worker, Student)Permit Start DatePermit Expiry Date Do you or your spouse have any relatives in Canada? i.e. Parents, Grand Parents, Brother, sister, nephew, cousin, uncle, aunt. (If yes write full details below) In Canada Relative's Information - If ApplicableFull Name of Relative in CanadaAddress of Relative City / State name onlyRelationshipStatus of Relatives PR/Citizen Travel Information (If you have travel outside of your origin country please write full details below)Travel Information - If ApplicableName of the CountryStatus in Foriegn CountryFrom (dd-mm-yyyy)To (dd-mm-yyyy) You may provide additional information that you think would be relevant to your immigration assessment. Would you like to add information at this time? Yes No Additional Information* "I understand that my first meeting with PD Immigration Consultancy Inc (PDICI) includes an initial brief free assessment of my circumstances to see if I qualify for making an application to Canada Immigration. PD Immigration will not accept clients who do not qualify. I will declare at the beginning of the meeting if I am here to discuss any matters that deal with an existing problem with Canada Immigration, an application that has already been submitted, to go into depth on my personal immigration circumstances, or an application which I intend to prepare and submit on my own, as these are NOT included in PDICI' free assessment, and I agree to pay for the entire consultation at PDICI' current hourly rate. I agree to provide complete and truthful information in the interview"
