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Assessment Form for Business People Interested in Canadian

Permanent Residence

Last Name: First:

Business Tel: Mobile Tel:

Home Tel: E-mail:

Skype: MSN:

Home Address:

Age: Sex: Nationality: Present Residency:

Highest Level of Education: Spouse’s Education:

Marital Status: __ Married __ Divorced __ Separated __ Common Law/Conjugal


Partner

Dependent Children (ages): ___, ___, ___, ___,____ (Children over 22 must be full-time
students)

Language Ability: (Indicate: Fluent, Well, With Difficulty, Not at All)


Speak Read Write Comprehend
English
French

Personal Net Worth (“Net” = Total assets less liabilities or loans) Indicate:__ $Can, __
$US, $ ____ Other
Cash Real Estate
Securities Other Property
Value of Other
Business

Do you own/manage a business? Describe:

Close Relative in Canada: _________

Do you know what type of business, if any, you are interested in pursing in
Canada?
Do you know where you would like to live in Canada? _______________

Referring Affiliate: _____________________ Date:

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