1. 2. 3. 4. 5.

Name (Family Name, Given Name) NEHA VIJAYKUMAR KAPADIYA Nick Name/ Alias (Family Name, Given Name) NEHA Date of Birth 14/08/1986 Place of Birth & Country BHARUCH, GUJARAT, INDIA Current Country of Residence INDIA Country INDIA Status (Citizen, Permanent Resident, Visitor, Worker, Student, other), PERMANENT RESIDENT Date (From --- To)

6. Previous Country of Residence: During the past 5 years have you lived in any country other than your country of citizenship or your current country of residence for more than six months? NO if yes, Country Status (Citizen, Permanent Resident, Visitor, Worker, Student, other) Date (From ---To) 7. Your current Marital Status MARRIED 8. If Married or In common law relationship Provide the Date on which you were Married or entered into the common-law relationship.- DATE OF MARRIAGE 28.01.2013 Name of Spouse / Common-law partner VISHALKUMAR K TAILOR 9. Have you previously been married or in a common-law relationship? if yes NO Family Name Given Name Type of Relationship (Married, Common-Law) Date (From ---To) 10. Passport Number G9238785 11. Country of Issue INDIA 12. Issue Date , Expiry Date 19/08/2008 , 18/08/2018 13. Current Mailing Address With Pin Code A-21, SARASWATI NAGAR, P.O. CHHANI 390024, GUJARAT, INDIA 14. Residential Address with Pin Code A-21, SARASWATI NAGAR, P.O. CHHANI 390024, GUJARAT, INDIA 15. Telephone Number (O) +91 365 3093278 (M) +91 9998368759 Canada/US or Other Type : Residence, Cellular , Business Telephone Number with Country Code 16. Alternate Telephone Number (R) +91 9426848409 (R) +91 9725022190 Canada/US or Other Type : Residence, Cellular , Business Telephone Number with Country Code 17. Fax Number (B) +91 2652240943 (B) +91 2652240119

Canada/US or Other Fax Number with Country Code 18. Email Address kapadianeha@gmail.com ; nvkapadia@gsfcltd.com 19. Purpose of Visit (Business , Tourism or Other) BUSINESS 20. How Long You Plan to Stay (Date From To) 21. Fund Available for Stay in Canada (Canadian Dollar) 22. Name Address and Relationship of person or institution to visit in Canada 23. Have you had any post secondary education(including University, College and Apprenticeship Training ) if Yes, Filed of Study School/Facility Name Dates of Attendance (From To) City/Town Country Province/State 24. Employment Give the Details of your Employment for the last 10 years (If Retired, Not Working, Student Please indicate. If you are retired, provide the 10 years before your retirement) From (MonthYear) 08/2007 To (Month Year) TILL DATE Current Activity/Occupation CHEMICAL ENGINEER (PROJECT CELL) Company/Employer/Facility Name GUJARAT STATE FERTILIZERS AND CHEMICALS LTD City/Town - VADODARA Country - INDIA Province/State GUJARAT 25. Within The Past Two Years, Have you or Family member ever had Tuberculosis of the Lungs or been in the close contact a person with Tuberculosis? if Yes , Provide the Full Details - NO 26. Do you have any Physical or Mental disorder that would require Social and/or Health Services, other than medication, During Stay in Canada ? - NO 27. Have you ever previously applied for any Canadian Visas (e.g. Permanent Resident, Student, Worker, Temporary Resident(Visitor), Temporary Resident Permit) ? - NO If Yes, Visa Number Place of Issue Visa Type Date of Issue Date of Expiry 28. Have you ever been refused any kind of Visa to travel to Cananda? NO

If yes, Provide the Details 29. Have you ever been refused admission or been ordered to leave Canada or any other country? - NO If Yes, Provide the Details 30. Have you ever Committed, been arrested for or been charged with any criminal offence in any county? If Yes, Provide the Details- NO 31. Have you ever been in Military, Militia or Civil Defense unit ? - NO If Yes, Provide the Details 32. Have you ever served in an intelligence organization or Police Froce? NO If Yes, Provide the Details Have you ever held a position of Authority in any Government or Judiciary or a Political Party?-NO If Yes, Provide the Details 33. Have you ever in period of either Peace or War, been involved in the commission of war crime or crime against humanity , such as : Willful Killing, Torture, Attacks upon, Enslavement, Starvation or other inhumane acts committed against civilians or prisoners of war or deportation of civilians? NO If Yes, Provide the Details (If you answered YES any of question no. 30 to question no.33 above, Must fill out IMM5257 SCHEDULE 1.