English Proficiency Band (IELTS Score) -GT/Academic

Eligibility Assessment Questionnaire

Please complete the following form. The purpose of this form is to assess your eligibility for
immigration for job or Study.

Principal Applicant
Family Name Pokharel
Given Name Santosh
Passport Address Choprak,gorkha
Date of Birth 2044-04-04
Country of Citizenship 130271
Home Phone No.
Mobile Phone No. 9851066892
E-mail Address tiwarimanisha2073@gmail.com
Highest Level of Education Masters

Total Numbers of years of 18

education
Education
Qualification Year Completed Course Length Full/Part Name of Institution
Scored% Time
3.17 CGPA 2016 2yrs Full D.A.V
64.3 2011 4yrs Full Padhmashree
international college
60.57 2006 2yrs Full Amrit campus
68.62 2004 Full Nepal Yuval ma vi

Work Experience
Job Title & Institution From To

Trainee junior officer/chitwan 2068-07- 2069-03-

milk ltd 15 25
Production officer/sujal dairy 09-08-2012 20-05-2014
Pvt ltd
General manager/modern dairy 10-06-2014 till date
Pvt ltd
English Proficiency Band (IELTS Score) -GT/Academic

Spouse
Family Name Tiwari
Given Name Manisha
Passport address
Date of Birth 1987-11-23
Country of Citizenship 780/061
Highest Level of Education Masters running

Total Numbers of years of

education
Occupation Banker

Number of years in this 5 months

occupation
Previous Occupation Banker

Number of years in this Two year eleven month

occupation
Education
Qualification, Year Completed Course Length Full/Part Time
Institution &
Scored %
45.79 2011 3yrs Full
50.20 2006 2yrs Full
51.37 2004 Full

Work Experience
Job Title /Institution From To
Month
Front desk officer/synergy FM 01-08-2008 20-11-2009
Pvt ltd
Marketing assistant/synergy 25-11- 30-12-2010
FM Pvt ltd 2009
Junior assistant/fewa finance 15-05-2011 17-04-
ltd 2014
Trainee assistant/best 2017-10-
finance company limited 15
English Proficiency Band (IELTS Score) -GT/Academic

English Proficiency Band (IELTS Score) -GT/Academic-

Principal Applicant
Reading Writing Listening Speaking
6 5.5 7 6
Spouse

Reading Writing Listening Speaking

n/a
Children
Do you have any children? If yes, please fill out the following.

Number of Children 1
Gender Female
Family Name Pokharel
Given Name Samastika
Date of Birth 2071/12/10
Country of Citizenship
Child 2
Gender
Family Name
Given Name
Date of Birth
Country of Citizenship
Child 3
Gender
Family Name
Given Name
Date of Birth
Country of Citizenship
Other Information
Do you or your spouse have a close relative who is permanent Yes
resident of Canada?
If yes, what is the relationship? Uncle
Do you have any friends in Canada?
Yes
If yes, what province do they reside in?
English Proficiency Band (IELTS Score) -GT/Academic

For Business Applicants Only

Total number of years of business experience
Total Net worth in $ CDN