FAMILY CLASS ASSESSMENT FORM

All information provided in this form will be kept in the strictest confidence and will not be shared with anyone other than authorized personnel of Global Immigration Services Agency.   

This form is to be completed by the SPONSOR and not the person immigrating.

Last Name (surname, family name):

First Name (given name):                    

Date of birth (day/month/year):            

Nationality:                                                 

Street Address:   

City:                                                                       Province:              Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Postal Code:                                                       Phone Number:                

E-mail address:                                                  

Gender:                 Male      Female                                                                                 Marital Status:    Married Common Law Divorced Separated Widow Single      Number of children:

ELIGIBILITY OF SPONSOR

Current status in Canada : Canadian Citizen Permanent Resident Temporary Resident

Do you presently live in Canada ?                                                     Yes       No

Have you defaulted on any of the following?

• a prior sponsorship undertaking;
• an immigration loan;
• court ordered support payment obligations;
• a performance bond (an amount you agreed to pay as a guarantee of performance of an obligation under immigration legislation).

                                                                                                                  Yes       No

Do any of the following statements apply to you?

• you are in prison;
• you are an undischarged bankrupt;
• you are in receipt of social assistance for a reason other than disability ;
• you were convicted of a sexual offence or an offence against the person with respect to
• one of your family members or relatives,
• one of your spouse's or common-law partner's family members or relatives,
• your conjugal partner or one of your conjugal partner's family members or relatives, if applicable, unless you were granted a pardon or five years have passed after the expiration of the sentence imposed on you;
• you were adopted outside Canada and subsequently obtained a revocation of your adoption for the purpose of sponsoring an application for permanent residence by your biological parent;
• you are subject to a removal order; or
• you have been convicted of a serious criminal offence, have provided false information to Immigration, or have not met conditions of entry.

                                                                                                                 Yes       No

What is your annual income?            

FAMILY MEMBER TO BE SPONSORED

Last Name (surname, family name):

First Name (given name):                    

Date of birth (day/month/year):            

Nationality:                                                                   Country of Permanent Residency:   

Street Address:   

City:                                                                       Province/State:  

Postal/Zip Code:                                                 Country:               

E-mail address:                                                  Phone Number:

Gender:                 Male      Female                                                                                 Marital Status:    Married Common Law Divorced Separated Widow Single      Number of children:

Relationship to Sponsor: Spouse, Common-law or Conjugal partner Dependent child Mother/Father Grandmother/Grandfather Adopted Child Brother/Sister/Nephew/Niece/Grandson/Granddaughter Other

If you aswered "Other" to the question above, please explain the relationship:

Does the person being sponsored, or any of their accompanying family members, have a criminal record?                     Yes       No

Does the person being sponsored, or any of their accompanying family members, have any medical conditions?          Yes       No

If you answered yes to the above question please explain what the medical condition is and who suffers from it.

Additional Comments: