Diverse Immigration Services Info Collection Form

Applicant Information:

Name: Asraf Ali

Date of Birth: 15/04/1989
Mobile No.: +91-9047177238
Contact No.: -
Email: ashrafmch@gmail.com
Marital Status: Married
Going Alone / With Family: With Family
Total Experience (In years): 7 years
Current Address: Chennai, Tamilnadu

Permanent Address: Kallakkurichi, Viluppuram, Tamilnadu

Educational Qualification: Mention the commencement & conclusion, month & year.

From Till Aggregate Regular /

College / University Program
MM YY MM YY % age Correspondence
Jun 2007 May 2011 Anna University Tiruchirapalli B.E- Mechanical 76 Regular
Mar 2010 Apr 2010 NEBOSH HSE 75 Regular
May 2017 Jun 2017 IRCA Certified Lead Auditor ISO 9001:2015 72 Regular

Work Experience Details: Begin with the current job & designation. If working in the same organization on
different designations mention the duration of each designation. Also, specify if it was full time or part time.

From Till Full Time /

Firm, Organization, Company Designation
MM YY MM YY Part Time
Jan 2015 Mar 2018 LG Electronics QA/QC Engineer Full Time
Jan 2003 Nov 2014 GI-(YASREF) Project Quality Engineer Full Time
May 2011 Dec 2012 IND LAB Equipments Pvt. Ltd QC Engineer Full Time

Language Skills Details: Please tick (√) the appropriate column and indicate your ability to communicate.

English High Moderate Basic No French High Moderate Basic No

Speaking √ Speaking √
Reading √ Reading √
Writing √ Writing √
Listening √ Listening √
1
Contact No.: +91 9999408064 ● Email: info@dimsindia.com
 Diverse Immigration Services Info Collection Form

Overseas Work Experience: Did you or your spouse ever worked full time and completed a year or more either
in Canada, Australia, New Zealand or Singapore?

From Till Full Time /

Name of the Employer Country Designation
MM YY MM YY Part Time
Not Applicable
Not Applicable
Not Applicable

Overseas Study History: Did you or your spouse ever completed two years of full time Post Secondary study
either in Canada, Australia, New Zealand or Singapore? If yes, please mention the following information in the
column:

Certificate /
From Till Full Time /
Name & Country of the Institute Course Pursued Diploma /
MM YY MM YY Part Time
Degree
Not Applicable
Not Applicable
Not Applicable

Financial Details:

CTC (Annual Income) 12,00,000 Indian Rupees

Medical Details: Do you, your spouse or children have any serious medical problem? If yes, please mention the
details in the column.

Name Medical Description

NO
NO
NO

Dispute / Illicit Details: Is there any Civil / Police Complaint / Criminal Case pending against you or your spouse?
Please mention YES / NO: ___NO__________

Children Details: Please mention the details of your child / children below:

Full Name Date of Birth

Zainab Bint Asraf 17-02-2017

2
Contact No.: +91 9999408064 ● Email: info@dimsindia.com
 Diverse Immigration Services Info Collection Form

Spouse Information:

Name: Ayeesha Farveen

Date of Birth: 21/04/1994
Mobile No.: +91-9788107581
Contact No.:
Email: Ayeesha_farveen@gmail.com
Current Address: Kallakurichi, Viluppuram, Tamil Nadu

Permanent Address: Kallakurichi, Viluppuram, Tamil Nadu

Educational Qualification: Mention the commencement & conclusion month & year.

From Till Aggregate Regular /

College / University Program
MM YY MM YY % age Correspondence
May 2011 Aug 2014 Aiman College of Arts and Science B.Sc-Computer 72% Regular

Work Experience Details: Begin with the current job & designation. If working in the same organization on
different designations mention the duration of each designation. Also, specify if it was full time or part time
work.

From Till Full Time/

Firm, Organization, Company Designation
MM YY MM YY Part Time
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Not Applicable

Language Skills Details: Please tick (√) the appropriate column and indicate your ability to communicate.

Moderat Moderat
English High Basic No French High Basic No
e e

Speaking √ Speaking
Reading √ Reading
Writing √ Writing
Listening √ Listening

3
Contact No.: +91 9999408064 ● Email: info@dimsindia.com
 Diverse Immigration Services Info Collection Form
Declaration by the Applicant: I declare that all the information given above is complete, correct & certifiable.

4
Contact No.: +91 9999408064 ● Email: info@dimsindia.com