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.
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:
Reason for visit: Visiting family member Visiting friend (no family relationship) Business Sightseeing (tourist) Studying (less than 6 months)
Street Address where you'll be staying while in Canada :
City: Province: Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Length of stay in Canada :
Will any family members be accompanying you to Canada ? Yes No
If yes, how many and what is their relationship to you?
What is the amount of funds you have to support yourself, and accompanying family members, during your stay?
Do you, or any of your accompanying family members, have a criminal record? Yes No
Do you, or any of your 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:
