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Client Assessment Form

Please note that this is a non refundable fee and one of our staff member will contact you via email or phone call to discuss your opportunities to migrate Canada

Personal Information

Name

Email*

Phone*

Age in Years

Date Of Birth

Marital Status*

Current Residential Address

Education History

Canadian Education (if applicable)

College/University Name

From (MM-YYYY)

To (MM-YYYY)

Name of Degree/Diploma

Field of Study

City, Country

Home Country Education (Bachelors, Masters or Diploma, if applicable)

College/University Name

From (MM-YYYY)

To (MM-YYYY)

Name of Degree/Diploma

Field of Study

City, Country

Relatives In Canada

Do you have any Brother/Sister with permanent resident status in Canada?*

[group relatives_in_canada]

List all the family members residing in Canada:

NAME

RELATIONSHIP

CITY AND PROVINCE

[/group]

Work Experience (If Any)

Please provide the detailed Canadian employment record with date, name and address of employer and job designation held

From (MM-YYYY)

To (MM-YYYY)

Name & Address of Employer

Job Title

Please provide the detailed Home country employment record with date, name and address of employer and job designation held (if applicable)

From (MM-YYYY)

To (MM-YYYY)

Name & Address of Employer

Job Title

English Proficiency

Did you take IELTS exam? (Yes/No)

[group ielts_exam_gr]

If Yes, what module "General or Academic" ?

IELTS Score Obtained

Listening

Speaking

Writing

Reading

Overall

[/group]
[group ielts_exam_no]

If No, when are you planing to take exam ?

[/group]

Visa Information

Have you ever applied or issued student visa, visitor or PR for Canada or Any Other Country?

[group applied_visa]

Please provide details, date and reason

[/group]

Have you ever refused student visa, visitor or PR for Canada or Any Other Country?

[group refused_visa]

Please provide details, date and reason

[/group]

Did someone refer you to us?

Choose Your Consulting Option*

Client Assessment Form

Personal Information

Education History

Relatives In Canada

Work Experience (If Any)

English Proficiency

Visa Information

DHALIWAL Immigration Solutions

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