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Contact
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First Name
*
Middle Name
*
Last Name
*
Date of Birth
*
YYYY-MM-DD
Gender
*
Male
Female
Other
Passport Number
*
Passport Issue Date
*
YYYY-MM-DD
Passport Expiry Date
*
YYYY-MM-DD
Have you held a Canadian visitor visa in the past 10 years?
*
No
Yes
Do you currently hold a valid U.S. nonimmigrant visa?
*
No
Yes
Are you travelling to Canada by air?
*
No
Yes
Country or Territory where you were born?
*
e.g. Philippines
City or town you were born?
*
e.g. Laoag City, Ilocos Norte
Are you a citizen of more than one country or territory?
*
No
Yes
Country/ies or territory/ies are you a citizen of?
*
Format: Country - Status - From (YYYY-MM-DD) E.g. Philippines - Citizen - 1998-03-20
National Identity Number
Put N/A if not applicable
National Identity Card Issuance and Expiry Date
YYYY-MM-DD to YYYY-MM-DD. Put N/A if not applicable.
Full Address
*
Must include all that applies. Street Number, Apartment Number, House Number, City/Town, Province, Country and Zip Code.
List your current country or territory of residence, then add all other countries or territories where you've lived for the past five years, for more than 6 months.
*
Format: Country - Status - YYYY-MM-DD to YYYY-MM-DD. E.g. Philippines - Citizen 1998-02-20 to 2023-01-19.
Have you ever studied at a post-secondary school (university, college or vocational school)? You don't need to have completed a degree or diploma.
*
No
Yes
Give details of each program you have studied and are currently studying.
*
Format: Institution/School Name - Duration (YYYY-MM-DD to YYYYY-MM-DD) - Program of Study - Full Address of Institution/School. E.g. Centro Escolar University - 2000-06-03 to 2004-04-05 - Bachelor of Arts in Mass Communication - 9 Mendiola St, San Miguel, Manila, 1008 Metro Manila, Philippines. PUT N/A IF NOT APPLICABLE
Did you serve in any military, militia, civil defence unit, security organization or police force (including non-obligatory service, reserve or voluntary units)?
No
Yes
If yes, provide details
Location where you serve, duration, position
Give details of all your employment and activities since the age of 18. THERE SHOULD BE NO GAPS.
*
Format: Duration (YYYY-MM-DD to YYYY-MM-DD) - Position - Company/Employer Name - Main Duties - Full Address. If there you are a STUDENT or UNEMPLOYED during some periods in the last 10 years, please put these periods as well.
During the past 5 years have you travelled to a country or territory other than the one where you're a citizen or where you live now?
*
No
Yes
Have you ever stayed in Canada beyond the validity of your status, attended school in Canada without authorization, or worked without authorization in Canada?
*
No
Yes
Have you ever stayed in Canada beyond the validity of your status, attended school in Canada without authorization, or worked without authorization in Canada?
*
No
Yes
If you answer yes to either one of the last 2 questions, give details.
Provide, type of application, date and reasons of refusal.
Have you had a medical exam performed by an IRCC authorized panel physician (doctor) within the last 12 months?
*
No
Yes
If known, please provide your Immigration medical examination (IME) or Unique medical identifier (UMI) number.
In the last 2 years, were you diagnosed with tuberculosis?
*
No
Yes
In the last 5 years, have you been in close contact with a person with tuberculosis?
*
No
Yes
Are you currently receiving dialysis treatment?
*
No
Yes
Have you had a drug or alcohol addiction causing you to be a threat to yourself or others, or to be hospitalized?
*
No
Yes
Have you had a mental health condition causing you to be a threat to yourself or others, or to be hospitalized?
*
No
Yes
Have you ever been diagnosed with syphilis?
*
No
Yes
What is your current marital status?
*
Single
Married
Common-law
Divorced
Annulled
Spouse Full Name (if married)
Spouse Date of Birth (if applicable)
YYYY-MM-DD
Spouse's Current Occupation
Date of Marriage (if applicable)
YYYY-MM-DD
Date of Separation/Divorce/Annulment (if applicable)
YYYY-MM-DD
Do you have children?
*
No
Yes
Details of Child/ren (if applicable)
Provide Full Name, Date of Birth (YYYY-MM-DD), Current Address - Current Occupation. E.g. James Sanchez - 2014-06-17 - Brgy. 10, Vintar, Ilocos Norte, Philippines, 2915 - Student
Father's Full Name
*
Father's Date of Birth
*
YYYY-MM-DD
Father's Date of Death (if applicable)
YYYY-MM-DD
Father's Current Occupation
*
Father's Full Address
*
Mother's Full Name
*
Include Maiden Name
Mother's Date of Birth
*
YYYY-MM-DD
Mother's Date of Death (if applicable)
YYYY-MM-DD
Mother's Current Occupation
*
Mother's Full Address
*
Siblings Information
Please provide full name, date of birth (YYYY-MM-DD), full address, current occupation and type of relationship. E.g. Paul Sanchez - 1987-04-21 - Brgy. 4, San Miguel, Sta. Ana, Cagayan, Philippines 1234 - Bank Manager - Brother
Email
*
Phone Number
*
Must include country code E.g. +63 1234567890
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