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Personal Information Form

Please fill in all required information completely and correctly. The information provided below by the Principal Applicant is
used only in supporting the immigration process of the Principal Applicant. All collected information is confidential and will
not be used for any other purposes or shared with any other individual or third party without the Principal applicant’s
permission.
If there is not enough space for any section, please attach to this form a separate sheet of paper with further details.

I. PRINCIPAL APPLICANT’S INFORMATION

1. Personal information
Date of birth:
Family name: Gender:
(dd/mm/yyyy)
Height:
Given name: Place of birth:
(cm)

Native language: Country of citizenship: Eye color:

Date of issue:
ID card No. Place of issue:
(dd/mm/yyyy)
Date of issue: Date of expiry:
Passport No.:
(dd/mm/yyyy) (dd/mm/yyyy)

Mailing address:

Residential address

Home phone
Mobile phone No. Office phone No. Fax:
No.

Email 1: Email 2:

Date of marriage certification:

Marital status:
(dd/mm/yyyy)

Have you previously been married (once or more) or been in a common-law relationship: Yes No Time of cohabitation

Full name of Date of marriage certification: From: To:

previous partner: (dd/mm/yyyy) (dd/mm/yyyy) (dd/mm/yyyy)
Date of birth: Date of divorce certification:
(dd/mm/yyyy) (dd/mm/yyyy)

2. Language Ability

ENGLISH High Moderate Basic None FRENCH High Moderate Basic None

Speaking Speaking

Listening Listening

Reading Reading

Writing Writing

3. Education (give full details of all the secondary and post-secondary education)
Period Certificate or diploma
Name of institution City or town and country
(mm/yyyy – mm/yyyy) issued

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4. Personal history (start with the most recent activity, provide the details of your personal history since the age of 18; even when you’re not working:
housewife/househusband, unemployed, hospitalized, studying, traveling… Please ensure that you do not leave any gaps in time)
Period Name of company, employer, school, facility Average annual
Position City and country
(mm/yyyy – mm/yyyy) (as applicable) salary

5. Residential addresses (list all addresses you have lived since your 18th birthday, please ensure that you do not leave any gaps in time)
Period
Address
(mm/yyyy – mm/yyyy)

6. Membership or association with organizations (for example: political, social, youth or student organizations, trade unions, professional
organizations… if applicable)
Period Type of
Name of organization Position City and country
(mm/yyyy – mm/yyyy) organization

7. Government positions (such as civil servant, judge, police officer… if applicable)

Period Level of jurisdiction
Department or branch Position Country
(mm/yyyy – mm/yyyy) (e.g.: national, regional, municipal)

8. Military service (if applicable)

Period Country, branch of service, Names of your
Rank(s) Dates and places of any active combat
(mm/yyyy – mm/yyyy) unit numbers commanders

9. Principal applicant’s parents

Date of birth Place of birth
Full name Address
(dd/mm/yyyy) (City or town, country)

Father

Mother

10. Brothers and sisters(including half- and step-brothers and sisters) of Principal applicant
Full name Date of birth Place of birth Current
Marital status Address
(Relationship) (dd/mm/yyyy) (City or town, country) occupation

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II. THE INFORMATION OF PRINCIPAL APPLICANT’S SPOUSE

1. Personal information:
Date of birth:
Family name: Gender:
(dd/mm/yyyy)
Height:
Given name: Place of birth:
(cm)

Native language: Country of citizenship: Eye color:

Date of issue:
ID card No. Place of issue:
(dd/mm/yyyy)
Date of issue: Date of expiry:
Passport No.:
(dd/mm/yyyy) (dd/mm/yyyy)
Present residential
address:
Home phone
Mobile phone No. Office phone No. Fax:
No.

Email 1: Email 2:

Date of marriage certification:

Marital status:
(dd/mm/yyyy)

Have you previously been married (once or more) or been in a common-law relationship:Yes No Time of cohabitation

Full name of Date of marriage certification: From: To:

previous partner: (dd/mm/yyyy) (dd/mm/yyyy) (dd/mm/yyyy)
Date of birth: Date of divorce certification:
(dd/mm/yyyy) (dd/mm/yyyy)

2. Language Ability

English: French:

3. Education (give full details of all the secondary and post-secondary education)
Period Certificate or diploma
Name of institution City or town and country
(mm/yyyy – mm/yyyy) issued

4. Personal history (start with the most recent activity, provide the details of your personal history since the age of 18; even when you’re not working:
housewife/househusband, unemployed, hospitalized, studying, traveling… Please ensure that you do not leave any gaps in time)
Period Name of company, employer, school, facility Average annual
Position City and country
(mm/yyyy – mm/yyyy) (as applicable) salary

5. Residential addresses (list all addresses you have lived since your 18th birthday, please ensure that you do not leave any gaps in time)
Period
Address
(mm/yyyy – mm/yyyy)

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6. Membership or association with organizations (for example: political, social, youth or student organizations, trade unions, professional
organizations… if applicable)
Period Type of
Name of organization Position City and country
(mm/yyyy – mm/yyyy) organization

7. Government positions (such as civil servant, judge, police officer… if applicable)

Period Level of jurisdiction
Department or branch Position Country
(mm/yyyy – mm/yyyy) (e.g.: national, regional, municipal)

8. Military service (if applicable)

Period Country, branch of service, Names of your
Rank(s) Dates and places of any active combat
(mm/yyyy – mm/yyyy) unit numbers commanders

9. Parents of principal applicant’s spouse

Date of birth Place of birth
Full name Address
(dd/mm/yyyy) (City or town, country)

Father

Mother

10. Brothers and sisters(including half- and step-brothers and sisters) of Spouse
Full name Date of birth Place of birth C
Marital status u Address
(Relationship) (dd/mm/yyyy) (City or town, country)
rr

III. THE INFORMATION OF PRINCIPAL APPLICANT’S CHILDREN

1. Dependent child 1
Date of birth:
Family name: Gender:
(dd/mm/yyyy)
Height:
Given name: Place of birth:
(cm)

Native language: Country of citizenship: Eye color:

Date of issue:
ID card No. Place of issue:
(dd/mm/yyyy)
Date of issue: Date of expiry:
Passport No.: (dd/mm/yyyy)
(dd/mm/yyyy)
Present residential
address:

Education (give full details of all education level)

Period
Name of institution City or town and country Certificate or diploma issued
(mm/yyyy – mm/yyyy)

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2. Dependent child 2
Date of birth:
Family name: Gender:
(dd/mm/yyyy)
Height:
Given name: Place of birth:
(cm)

Native language: Country of citizenship: Eye color:

Date of issue:
ID card No. Place of issue:
(dd/mm/yyyy)
Date of issue: Date of expiry:
Passport No.: (dd/mm/yyyy)
(dd/mm/yyyy)
Present residential
address:

Education (give full details of all education level)

Period
Name of institution City or town and country Certificate or diploma issued
(mm/yyyy – mm/yyyy)

IV. THE INFORMATION OF PRINCIPAL APPLICANT’S PERSONAL NET WORTH

A. ASSETS

1. Current and savings accounts (if applicable)

Date opened
Account number Name of bank Current balance
(dd/mm/yyyy)

Total:

2. Fixed (term) deposits (if applicable)

Date of initial deposit Maturity date
Account number Name of bank Current balance
(dd/mm/yyyy) (dd/mm/yyyy)

Total:

3. Publicly traded stocks and other investments (if applicable)

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Estimated current
Description Quantity
market value

Total:

4. Real property (if applicable)

Estimated current
Address Year purchased Purchase price Mortgaged
market value

Total:

5. Business (if applicable)

Current book value Estimated current
Name % Owned
(Net assets) market value

Total:

6. Pensions and other assets (if applicable)

Description Amount

Total:

B. LIABILITIES

7. Real properties mortgaged (if applicable)

Description Current balance

Total:

8. Other personal or business debts (if applicable)

Description Amount

Total:

C. NET WORTH

Total assets (1, 2, 3, 4, 5, 6):

Less: –

Total liabilities (7, 8):

Net worth:

V. OTHER INFORMATION OF PRINCIPAL APPLICANT

Questions from No. 1 to No. 12 are applied for the principal applicant or any family members listed in this form

Have you (the principal applicant) or any of your family members listed in this form, ever YES NO

1. had or are you having any serious disease or physical or mental disorder?

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suffered or are you suffering from tuberculosis, or have you been in close contact with tuberculosis patients
2.
within the last two year?
previously sought refugee status in Canada, or applied for a Canadian immigrant or permanent resident visa
3.
or visitor or temporary resident visa?
been refused refugee status in, or an immigrant or permanent resident visa or visitor or temporary resident
4. visa to Canada or any other country, or have been refused a Certificate de selection du Québec (CSQ) to
Quebec?

5. been refused admission to, or ordered to leave, Canada or any other country?

been convicted of, detained or put in jail; or are you currently charged with, on trial for, or party to a crime
6.
or offence, or subject of any criminal proceedings in any country?

7. 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
8.
objectives?
been associated with a group that used, uses, advocated or advocates the use of armed struggle or violence
9.
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
10.
activity
If your answer to any of these questions is YES, please provide details below:

lived or stayed for six consecutive months or longer in any country or territory besides your own country
11.
within the last five year?
From To
If applicable

Full name Country

(dd/mm/yyyy) (dd/mm/yyyy)

12. Do you or your spouse have a relative living in Canada as a citizen or a permanent resident of Canada?
Time in Canada
Full name Date of birth Residential
(dd/mm/yyyy - Job Address
(Relationship) (dd/mm/yyyy) status
Present)
If applicable

I declare that the information I have given in this form is truthful, complete and correct; and I shall be responsible for the
authenticity of the above information. I understand that any false statements or concealment of a material fact may result in
the refusal of my permanent resident application to Canada, or being barred from entering Canada in two years, or my
immediate removal from Canada, and may be grounds for my prosecution under Canadian Immigration and Refugee
Protection Act and Regulations.

Signature of Principal applicant: Date:

(Please write your full name) (dd/mm/yyyy)

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