Details For Canada PR (Express Entry Pathway)

Date: Referred by: Program: Express Entry

Surname:
Primary Applicant Full Name
1
(as shown on passport)
Given Name:
Surname:
Have you ever used any other
2
name (if yes then answer)
Given Name:
3 Sex (male / Female):

4 Date of Birth
Place of Birth
5
(City/Town/Country)
6 Residential Address
Current postal address if
7
different from above
8 Contact No with country code

9 Alternative Contact

10 Email Id (must)

11 Citizenship

12 Current country of residence

From:(year/mm/dd) To:(year/mm/dd)
13 Status:

During the past 6 years have you lived in any county other than your country
14 of citizenship or your current country of residence for more than six months?
(YES/NO)
15 If yes to (14) then, if you need more space you can use separate sheet

Status (Citizen, PR, From To

Country Other
Visitor, Student etc.) Date Date

16 Country of Issue of passport and Passport Number

17 Passport issue date

18 Passport expiry date

19 Marital status (married, single, divorced, widowed)

20 Date of marriage

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 Details For Canada PR (Express Entry Pathway)

Education :
21 Have you had any Secondary / post-secondary education
(yes or no)
22 If yes to (21) then provide the following details:
Medium Full Time/
Start Date Finish Date Name of School / City/ Distance
(MM/YYYY) (MM/YYYY) Field of Study College/ University
of
Country Learning/ Open
Education University

10th

12th

Diploma

Degree
Master/
PhD
ITI or other
Technical
Programs
Give details of your employment for the past 10 years. (without any gap) If you need more space you can
23
use separate sheet of paper
To Current occupation/
From (YY/MM) Company/Firm Name City/Country
(YY/MM) Designation

Have you ever been refused a Visa before for Canada/USA or any other country by any
24
country? (Yes/No)
25 If yes to (24), then

Which country When Reason of refusal Which visa

Have you ever applied for any type of Immigration for Canada/USA (For example: New
26 Express entry)? (Yes/No)

If yes, please provide details: Express Entry Number :

27 Were you ever removed from Canada/USA or any other country? (Yes/No)

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 Details For Canada PR (Express Entry Pathway)

If yes, please provide details……………………………………………………………

Have you ever visited Canada/USA before? (Yes/No)
28
If yes, please provide details :
Have you ever overstayed your authorized stay in any country where you were legally
29
admitted? (Yes/No)
30 Have you ever been convicted of a criminal offence? (Yes/No)

31 Do you suffer from a serious medical condition? (Yes/No)

32 Do you currently hold a valid Canadian or USA visa? (Yes/No)
33 Are you currently in Canada or the USA? (Yes/No)
34 Do you have applied for Express Entry before? (Yes/No)
35 Do you have made profile for Express Entry? (Yes/No)
36 Do you have made any application to Provincial Nominee Programs? (Yes/No)

37 Principal Applicants IELTS/Other language testing system result DATE :

General/Academic General Overall Score

Listening Reading Writing Speaking

38 If you have not taken IELTS test, please write the expected score

39 Details of your Spouse, Father, Mother, Children, Brothers, Sisters

Count Marita
Relati Date of
Full name ry of l Present Address Occupation
onship Birth
Birth Status

Spouse Details

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 Details For Canada PR (Express Entry Pathway)

Surname :
1 Full Name (as shown on passport)
Given Name:
Surname : NA
2 Have ever used any other name
Given Name:

3 Sex (Male/Female)

4 Date of Birth
5 Place of Birth (Town/City/country)
6 Citizenship
7 Current Country of Residence
8 Status
During the past 6 years have you lived in any county other than your country
9 of citizenship or your current country of residence for more than six months?
(YES/NO)
10 If yes to (9) then

Status (Citizen, PR, From To

Country Other
Visitor, Student etc.) Date Date

Country of Issue of passport and

11
Passport Number
12 Passport issue date

13 Passport expiry date

Education :
14
Have you had any Secondary / post-secondary education (yes or no)
15 If yes to (14), then provide the following details:
Medium Full Time/
Start Date Finish Date Name of School / City/ Distance
(MM/YYYY) (MM/YYYY) Field of Study College/ University
of
Country Learning/ Open
Education University

10th

12th

Diploma

Degree
Master/
PhD
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 Details For Canada PR (Express Entry Pathway)

ITI or other
Technical
Programs
Give details of your employment for the past 10 years. (without any gap) If you need more space you can use
16
separate sheet of paper
Current
From (YY/MM) To (YY/MM) occupation/ Company/Firm Name City / Country
Designation

Have you ever been refused a Visa before for Canada/USA or any other country
17
by any country? (Yes/No)
18 If yes to (17), then

Which country When Reason of refusal Which visa

Have you ever applied for any type of Immigration for Canada/USA (For example: New
19 Express entry)? (Yes/No)

If yes, please provide details: Express Entry Number :

Were you ever removed from Canada/USA or any other country? (Yes/No)
20
If yes, please provide details……………………………………………………………
Have you ever visited Canada/USA before? (Yes/No)
21
If yes, please provide details :
Have you ever overstayed your authorized stay in any country where you were legally
22
admitted? (Yes/No)
23 Have you ever been convicted of a criminal offence? (Yes/No)

24 Do you suffer from a serious medical condition? (Yes/No)

25 Do you currently hold a valid Canadian or USA visa? (Yes/No)
26 Are you currently in Canada or the USA? (Yes/No)
27 Do you have applied for Express Entry before? (Yes/No)
28 Do you have made profile for Express Entry? (Yes/No)
29 Do you have made any application to Provincial Nominee Programs? (Yes/No)

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 Details For Canada PR (Express Entry Pathway)

30 Spouse IELTS/Other language testing system result Date :

General/Academic General Overall score

Listening Reading Writing Speaking

31 If you have not taken IELTS test, please write the expected score
Do you or your spouse have any friends / relatives in Canada, If yes then fill
32
the next row
Full name of
Relative/Friend in Canada
Address
Relationship
Status (PR/Citizen) Citizen

33 Details of your Spouse, Father, Mother, Children, Brothers, Sisters

Countr
Relatio Date of Marital
Full name y of Present Address Occupation
nship Birth Status
Birth

In case if you need more space, use a separate sheet

DISCLAIMER:
I UNDERSTAND THAT MY FIRST MEETING WITH THE GLOBEWALKING TEAM INCLUDES AN INITIAL BRIEF FREE ASSESSMENT OF MY CIRCUMSTANCES
AND ELIGIBILITY TO SEE IF I QUALIFY FOR MAKING AN APPLICATION FOR IMMIGRATION TO CANADA. GLOBEWALKING TEAM WILL NOT ACCEPT
CLIENTS WHO DO NOT QUALIFY UNDER CURRENT IMMIGRATION PROGRAM.

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.

THE GLOBEWALKING TEAM WOULD ALSO LIKE TO MAKE IT CLEAR THAT FACTORS LIKE IELTS TEST RESULTS, ECA ASSESSMENT, PERSONAL
INFORMATION VALIDITY, BACKGROUND CHECKS AND CRIMINAL REFERENCE CHECKS AS WELL AS MEDICAL TESTS ARE ALL THE PERSONAL
RESPONSIBILITY OF THE APPLICANT, WE DO NOT CHARGE FOR ANY OF THESE ACTIVITIES AND WE ARE STRICTLY NOT INVOLVED IN MANAGING OR
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 Details For Canada PR (Express Entry Pathway)

TRACKING ANY OF THESE ABOVE MENTIONED ACTIVITIES. THE APPLICANT IS COMPLETELY AND SOLELY RESPONSIBLE FOR THESE FACTORS AND THE
DECLARATION OF THE FACTS THEREIN.

THE GLOBEWALKING TEAM WILL ALSO NOT BE INVOLVED IN ANY UNDERHANDED ACTIVITIES, WE DO NOT BELIEVE IN BRIBING AND HAVE A VERY
STRICT ANTI BRIBERY POLICY. APPLICANTS ARE REQUESTED TO REFRAIM FROM ASKING OUR TEAM TO GET INVOLVED IN ANY SORT OF BRIBERY
RELATED MATTERS AND CAN REPORT ANY SUCH ACTIVITIES TO THE MANAGEMENT. WE ONLY CHARGE FOR OUR TIME AND CONSULTING MATERIAL AS
WELL AS MANAGE THE INTERACTION CHANNEL FOR THE APPLICANT WITH THE CANADIAN GOVT VIA OUR INDIRECT / DIRECT GUIDANCE AND
SUPPORT.

ANY MISREPRESENTATION OR FALSE INFORMATION PROVIDED WILL HAVE EFFECT ON YOUR ASSESSMENT AS WELL AS OUTCOME OF
YOUR APPLICATION. WE WILL NOT BE LIABLE FOR SUCH INFORMATION. DO YOU AGREE _______________________?

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