All of the following questions apply to the primary applicant.

Please read the questions carefully and do

not leave any questions blank. If the question does not apply to you, please mark as “N/A”

1. Answer the following questions about the primary applicant

First Name: John Fourth

Middle Name: Obeso
Last Name: Amatong
Maiden name (if applicable): N/A
Sex: Male
Eye colour: Brown
Height (cm or ft): 5’8 ft
Date of birth (YYYY-MM-DD): 1981-01-04
Place of birth (City, Country): Davao City, Philippines
Citizenship: Filipino
Complete current address: Blk 15 Lot 4, Sampaguita St. Green Meadows
Subd. Mintal, Davao City, Philippines
Current Occupation: Industrial Meat Cutter
What is your native language? (Tagalog, Tagalog
Ukrainian, French, Fijian, etc.)
Can you speak English? Yes
Can you speak French? No
Have you ever taken a designated English or Yes
French proficiency test such as IELTS?
Current phone number including area/country +639475242397
code: +639271123779
Current email address: johnfourthamatong@gmail.com
How much funds in any currency do you $250
currently have available? Please state each
amount.
Mother’s first name: Hespecia
Mother’s middle name at birth: Datoy
Mother’s last name at birth: Obeso
Mother’s complete current address: N/A
Mother’s date of birth (YYYY-MM-DD): 1954-05-21
Mother’s place of birth (City, Country): Davao City, Philippines
Mother’s email address: N/A
Mother’s current occupation: N/A
If deceased, please specify date of death (YYYY- 2016-05-05
MM-DD):
If deceased, please specify place of death (City, Davao City, Philippines
Country):
Father’s first name: Rolando
Father’s middle name: Hemedez
Father’s last name at birth: Amatong
Father’s complete current address: Purok 10, Redtops St. Tacunan Mintal, Davao City,
Philippines
Father’s date of birth (YYYY-MM-DD): 1957-09-24
Father’s place of birth (City, Country): Cabuyao, Laguna, Philippines
Father’s email address: None
Father’s Current Occupation: Farmer
If deceased, please specify date of death (YYYY- N/A
MM-DD):
If deceased, please specify place of death (City, N/A
Country):
Please specify your parents current marital Widowed
status:

2. Mark your current marital status with an “x” in the applicable cell.

Single: In a relationship: Married: Common Law: x Legally separated:

Divorced: Widowed Engaged:

:

3. Have you travelled outside your country within the past 10 years, even if for a few days? If yes,
please specify the following details below. No

From: To: Length: Destination: Purpose:

YYYY-MM-DD YYYY-MM-DD (city and country)
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A

4. Do you have any brothers, sisters, half-brothers, or half-sisters? If so, please provide the
following information below. If you have more than 1 sibling, copy and paste the table below as
needed.

First name: Harold

Middle name: Obeso
Last name: Amatong
Relationship: Brother
Date of birth (YYYY-MM-DD): 1977-02-21
Place of birth (City, Country): Davao City, Philippines
Marital status: Married
Present address including house number (Please Blk. 32 Lot 5 Luke Street, Phase 2, Emily Homes,
note if the sibling is working out of country you Cabantian, Davao City, Philippines
must state the out of country address):
Email address: None
Current Occupation: Football Coach
First name: George Ryann
Middle name: Obeso
Last name: Amatong
Relationship: Brother
Date of birth (YYYY-MM-DD): 1981-11-25
Place of birth (City, Country): Davao City, Philippines
Marital status: Married
Present address including house number (Please Blk. 10 Lot 34 Narra Street, Green Homes, Molino,
note if the sibling is working out of country you Bacoor City, Cavite, Philippines
must state the out of country address):
Email address: Geo81ryann@gmail.com
Current Occupation: Construction Project-Incharge

First name: Raymond

Middle name: Obeso
Last name: Amatong
Relationship: Brother
Date of birth (YYYY-MM-DD): 1989-04- 02
Place of birth (City, Country): Davao City, Philippines
Marital status: Single
Present address including house number (Please Phase 10, Redtops Street, Barangay Tacunan,
note if the sibling is working out of country you Davao City, Philippines
must state the out of country address):
Email address: Raymondamats.101@gmail.com
Current Occupation: Caregiver

First name: Mark Julius

Middle name: Obeso
Last name: Amatong
Relationship: Brother
Date of birth (YYYY-MM-DD): 1991-04-30
Place of birth (City, Country): Davao City, Philippines
Marital status: Single
Present address including house number (Please Phase 10, Redtops Street, Barangay Tacunan,
note if the sibling is working out of country you Davao City, Philippines
must state the out of country address):
Email address: Marko.hulyo11@gmail.com
Current Occupation: Customer Service Representative
 5. Please complete the following education information below for the primary applicant.

How many years of school have you successfully completed?

Elementary/Primary Secondary/High University/College: Trade School or other

School: School: post-secondary
school:
6 4 N/A Incomplete

Provide full details of all the secondary and post-secondary education you have had. Do not include
anything else please. Please include the exact month you started and ended each program.

From: To: Name of City and Type of Field of study

YYYY-MM YYYY-MM institution: country: certificate as as stated on
stated on diploma or
diploma or transcript:
transcript:
1993-06 1997-03 Holy Cross of Davao City, High School Secondary
Mintal Philippines Graduate Course
1999-06 2001-03 Interface Davao City, Incomplete Computer
Computer Philippines Associate
College
N/A N/A N/A N/A N/A N/A

6. For the primary applicant, please provide your personal history since the age of 18. Please do
not leave any gaps. Include any studying, work, and periods of unemployment. Be sure to
include exact months.

From: To: Job title or City or town Status in Name of

YYYY-MM- YYYY-MM-DD activity (if and country: country company,
DD unemployed (citizen, work employer,
please state so) permit, etc.): school, etc.:
1999-01-05 2000-03-29 Study Davao City, Citizen Interface
Philippines Computer
College
2000-03-30 2000-07-01 Farming Davao City, Citizen Family Farm
Philippines
2000-07-01 2001-02-28 Service Crew Davao City, Citizen Southern Bee
Philippines Foods
Corporation
(Jollibee)
2001-02-29 2001-03-01 Unemployed Davao City, Citizen None
Philippines
2001-03-01 2003-03-05 Farming Davao City, Citizen Family Farm
Philippines
2003-03-06 2003-08-12 Selling Clerk Davao City, Citizen SuperValue
Philippines Inc. (SM Store)
2003-08-13 2003-08-18 Unemployed Davao City, Citizen None
Philippines
2003-08-19 2004-04-30 Kitchen Crew Davao City, Citizen Fresh N
Philippines Famous Food
Inc.
(Chowking)
2004-05-01 2007-01-08 Lending Collector Davao City, Citizen Highlights
Philippines Lending
Corporation
2007-01-08 2008-01-05 Farming Davao City, Citizen Family Farm
Philippines
2008-01-06 2008-03-31 Butcher Trainee Davao City, Citizen Lisa's Tender
Philippines Lean Meats/
Agribusiness
Corp.
2008-04-01 2008-07-28 Welding Training Davao City, Citizen Joji Ilagan
Program Philippines Carrer Center
Foundation
Inc.
2008-07-29 2008-08-05 Unemployed Davao City, Citizen None
Philippines
2008-08-06 2008-08-30 OJT for Welding Davao City, Citizen Davao Light &
Philippines Power
Company
2008-08-31 2008-12-30 OJT for Welding Davao City, Citizen Jopir Builders
Philippines Construction
Corporation
2008-12-31 2009-01-05 Holiday Break Davao City, Citizen None
Philippines
2009-01-06 2010-01-31 Welder Davao City, Citizen Nakayama
Philippines Technology
Corporation
2010-02-01 2012-06-30 Freelance Welder Davao City, Citizen None
Philippines
2012-07-01 2012-09-04 Farming Davao City, Citizen Family Farm
Philippines
2012-09-05 2014-12-14 Company Driver Davao City, Citizen Leighton
Philippines Contractors
(Philippines)
Inc.
2014-12-15 2015-03-14 Unemployed Tagum City, Citizen None
Philippines
2015-03-15 Present Butcher/Industria Davao City, Citizen Editha B.
l Meat Cutter Philippines Sensano
2016-04-19 Present Service Driver Davao City, Citizen Ulticon
Philippines Builders Inc.
 7. For the primary applicant, have you had any membership or association with any organizations?
If so, complete the following table below. If not, please put N/A or NONE in one box below.

From: To: Name of Type of Activities or City and

YYYY-MM YYYY-MM organization: organization: positions country:
held:
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A

8. For the primary applicant, have you ever held any government positions? If so, complete the
table below. If not, please put N/A or NONE in one box below.

From: To: Country and level Department/branch: Activity/position

YYYY-MM YYYY-MM of jurisdiction: held:
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A

9. For the primary applicant, have you ever served or are currently serving in a military or
paramilitary service? If so, please complete the table below. If not please put N/A or NONE in
one box below.

From: To: Branch of Rank(s): Dates and Reason for

YYYY-MM YYYY-MM service, unit places of any end of service:
number, and active
name of combat:
commanding
officers:
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A

10. For the primary applicant, please provide a list of addresses you have lived at since your 18 th
birthday. This includes any bunk houses you stayed at for work, school dormitories, any out of
country residences, and any part-time and full-time residencies. Please do not leave any gaps.
Please include the exact months from which you moved to and moved away from each place
of residence.

From: To: Street and City or Province, Postal Country:

YYYY-MM YYYY-MM house town: state, or code/zip
number: district: code:
1999-01 2010-01 Ilang-iilang Davao City Davao del 8000 Philippines
St. Green Sur
Meadows
Subd. Mintal
2010-02 Present Blk. 15 Lot 4 Davao City Davao del 8000 Philippines
 Sampaguita Sur
Street,
Green
Meadows
Subd.,
Mintal
N/A N/A N/A N/A N/A N/A N/A

11. Please list any family or relatives you might have living in Canada: This includes: mother,
father, sister, brother, aunt, uncle, cousins, grandmother, grandfather
Do you have any family or relatives living in Canada?

Yes □ No X

If yes, please provide the following details for each relative:

Relation to You: N/A
Full Name: N/A
Date of Birth (YYYY-MM- N/A
DD):
Full Residential Address: N/A
Contact Number: N/A

Status in Canada: Permanent Resident □N/A Citizen □N/A Temporary Foreign Worker□N/A

12. Please answer the following questions about the primary applicant. Have you ever:

Questions: Yes No
Been charged or convicted of a criminal offence in Canada? No
Been charged or convicted of a criminal offence in another country? No
Made previous claims for refugee protection in Canada, a Canadian visa office, No
another country, or with the United Nation High Commissioner for Refugees
(UNHCR)?
Previously applied for immigration to Canada (Permanent Residence, Work No
Permit, Study Permit, Visitor Visa/Temporary Residence Visa) or to a Provincial
Nominee Program
Been refused refugee status, an immigrant or permanent resident visa, Visitor No
Visa/Temporary Resident Visa, Work Permit, or Study Permit to Canada or any
other country?
Been involved in an act of genocide, a war crime or in the commission of a crime No
against humanity?
Used, planned or advocated the use of armed struggle or violence to reach No
 political, religious or social objectives?
Been associated with a group that used, uses, advocated, or advocates the use of No
armed struggle or violence to reach political, religious, or social objectives?
Been a member of an organization that is or was engaged in an activity that is part No
of a pattern of criminal activity?
Been detained, incarcerated or put in jail? No
Had any serious disease or physical or mental disorder? No
If you answered yes to any of these questions, provide details below:
N/A

Please go back and review each question before submitting. It is important you answer each question
correctly and follow each instruction carefully. Failure to do so may result in a delay in our ability to
submit your application.

I, John Fourth Amatong hereby certify the information listed above to be accurate and truthful.

________________________________ _____________________________
Signature Date