STUDYPERMITQUESTIONNAIRE

Complete this questionnaire using the space provided. Read the questions carefully and
answer all applicable questions.

1) Disclose the name of the agent or representative who assisted you with your
admission forms and study permit application. NOTE: Failure to disclose an
agent or representative could negatively affect the decision on your study
permit application.

Agent or representative’s name: MS. Varsha Jain

Business address: CANAM CONSULTANTS LTD

_113, IST FLOOR, NEW DELHI HOUSE, 27 BARAKHAMBHA ROAD, AT METRO STATION

Phone: +91 1141571125- 26

E-mail: _NEWDELHI@CANAMGROUP.COM

Your name: Prachi Darmwal

Your address: 5/3,VILL-DHAULAKHERA PO-ARJUNPUR,HALDWANI,NAINITAL,

263139,UTTARAKHAND,INDIA

Your Phone: 91-8527044478

Your E-mail: prachidarmwal.21@gmail.com

2) Provide the details of your education/work experience since the age of 18. Start with the most
recent information. Under “Activity” write your course of study or details of job if you were
working. If you were not working or studying, provide information on what you were doing. For
example: unemployed, traveling, etc. DO NOT leave any gaps.

From To Name of company, Type of certificate or

employer, school, as Activity diploma issued(if
M M applicable studying) / Position
Y Y title if working
FEB 2018 SEPT. 2018 JAYPEE GROUP INTERNSHIP CERTIFICATE

SEPT. 2017 AUG 2018 PEARL ACADEMY INTERIOR CERTIFICATE

SYLING AND
DECORATION
JULY 2013 JUNE 2017 AMITY SCHOOL OF B.TECH DEGREE
ENGINEERING AND COMPUTER
TECHNOLOGY SCIENCE AND

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 3) Complete the following chart with regard to a) your parents and b) any other
individual, including yourself, who is a primary financial support for your
program of studies, where applicable.

Note: enter Place of Employment or Net Income: Primary Source of

“not Business: from Income:
1)street and mailing address; preceding
applicable” calendar
2) telephone number; (e.g. salary,
where 3) e-mailaddress; year in business, property
appropriate 4) position or title rents)

FATHE 1) I.V.R.I  Izatnagar, Bareilly INR 6,68,032 Salary

R 2) 9411163081
NAME: CAD 12,604
3) narendradarmwal1962@gmail.c
om
1 CAD$= 53

4) Technical officer

MOTHE 5) Lal Kuan

1)RUPS INR 7,32,323 Salary
R 2)9761238427
NAME: CAD 13,817
3)ashadarmwal.12@gmail.com

4)Assistant Teacher

OTHER (1): INR

NAME: CAD
RELATIONSHIP 1 CAD$= 53
TO APPLICANT:
SPOUSE.

4) If your course of study includes English as a second language (ESL)

component, please explain how long it will take to complete English as a
second language (ESL) requirement and how much it will cost.

N.A

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