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: Mon

Middle Name: Dis-ing
Last Name: Cuario
Maiden name (if applicable): N/A
Sex: Male
Eye colour: Brown
Height (cm or ft): 165 cm
Date of birth (YYYY-MM-DD): 1991-12-11
Place of birth (City, Country): Sablan Benguet
Citizenship: Filipino
Complete current address: #401 Purok 4 East Upper Gibraltar, Baguio City
Current Occupation: Swine Technician
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 +63948-076-8954
code:
Current email address: dmcuario25@gmail.com
How much funds in any currency do you Bank 191 pesos
currently have available? Please state each On hand 20,000 pesos
amount.
Mother’s first name: Rose
Mother’s middle name at birth: Masegman
Mother’s last name at birth: Dis-ing
Mother’s complete current address: #401 Purok 4 East Upper Gibraltar, Baguio City
Mother’s date of birth (YYYY-MM-DD): 1953-03-08
Mother’s place of birth (City, Country): Besao Mt. Province, Philippines
Mother’s email address: N/A
Mother’s current occupation: Housewife
If deceased, please specify date of death (YYYY- 2005-03-12
MM-DD):
If deceased, please specify place of death (City, Gibraltar Baguio City, Philippines
Country):
Father’s first name: Julian
Father’s middle name: Gabriel
Father’s last name at birth: Cuario Sr.
Father’s complete current address: Coplo Sablan, Benguet
Father’s date of birth (YYYY-MM-DD): 1925-04-25
Father’s place of birth (City, Country): Lunec Pangasinan, Philippines
Father’s email address: N/A
Father’s Current Occupation: WW2 Veteran
If deceased, please specify date of death (YYYY- 2002-04-02
MM-DD):
If deceased, please specify place of death (City, Coplo Sablan, Benguet
Country):
Please specify your parents current marital Married
status:

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

Single: x In a Married: Common Law: Legally

relationship: 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.

From: To: Length: Destination: Purpose:

YYYY-MM-DD YYYY-MM-DD (city and country)
EX: 2016-05-05 2016-06-08 1 Month, 3 days Winnipeg, Canada Vacation
2014-12-12 2015-11-09 11months,28days Hachioji Tokyo, Japan Work

4. Do you have any brothers, sisters, half-brothers/sisters, step-brothers/sisters, deceased

brothers/sisters or adopted brothers/sisters? If so, please provide the following information
below. If more than 1 sibling please use additional page provided.

First name: Fernando

Middle name: Dis-ing
Last name: Ladip
Relationship to you: Sibling (step-brother)
Date of birth (YYYY-MM-DD): 1969-09-11
Place of birth (City, Country): Besao Mt. Province, Philippines
Marital status: Single
Present address including house number (Please #401 Purok 4 East Upper Gibraltar, Baguio City
note if the sibling is working out of country you Benguet, Philippines
must state the out of country address):
Email address: N/A
Current Occupation (be specific): Backhoe Operator
If deceased, please specify date of death (YYYY- 2022-02-04
MM-DD):
If deceased, please specify place of death (City, Baguio City, Philippines
Country):
 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 years 6 years N/A 3 months

Give the 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 as
YYYY-MM YYYY-MM institution: country: certificate as stated on
stated on diploma or
diploma or transcript:
transcript:
2004-06 2010-03 Tuba National Tuba Benguet, High School N/A
High School Philippines Diploma
2010-05 2010-07 RTC-TESDA Baguio City, Certificate of Building Wiring
Baguio Philippines Training Installation NC2

6. For the primary applicant, please provide your personal history for the past 10 years, or since
the age of 18. any gaps Please do not leave. Include any studying, work, and periods of
unemployment. Be sure to include exact months

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

YYYY-MM- YYYY-MM- (if unemployed and country: country company,
DD DD please state so) (citizen, employer,
work permit, school, ect:
ect):
2010-08-08 2014-07-28 Electrician/Steelfixer Baguio City, Citizen N/A
Mason/Painter Philippines
2014-12-12 2016-02-09 Reinforcing Bar Tokyo Japan Work Yamagata
Green
2016-02-10 2017-11-30 Unemployed Baguio City, Citizen N/A
Philippines
2017-12-01 Up to Swine Technician Sablan Citizen Sonnet
present Benguet Integrated
Farm

7. For the primary applicant, have you had any membership of association with any organization?
If so complete the following table below. If not please put N/A or NONE in one box bellow.

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

YYYY-MM YYYY-MM organization: organization: positions country:
held:
N/A
 8. or 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 bellow.

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

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

9. For the primary applicant, have you ever or are currently served 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

10. For the primary applicant, please provide a list of addresses you have lived at for the past 10
years, or since your 18th 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 time gaps. Please include the exact months from which you moved to and
moved away.

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

YYYY-MM YYYY-MM and state, or code/zip
house district: code:
number:
2009-12 2010-03 N/A Nangalisan Benguet 2603 Philippines
Tuba
2010-04 2014-06 401 Gibraltar Benguet 2600 Philippines
Baguio City
2014-07 2014-08 N/A Las Piñas Metro Manila 1747 Philippines
2014-09 2014-11 401 Gibraltar Benguet 2600 Philippines
Baguio City
2014-12 2015-11 3-15 Tamachi Tokyo 192-0064 Japan
Hachioji
2015-12 Up to 401 Gibraltar Benguet 2600 Philippines
present Baguio City

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

Status in Canada: Permanent Resident □ Citizen □ Temporary Foreign Worker □

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

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

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, MON DIS-ING CUARIO hereby certify the information listed above to be accurate and truthful.

________________________________ _____________________________
Signature Date