Assessment Form                                                                                 [All the details filled in the form will be strictly confidential]
Please provide as much details as possible.
Family Name:  
First Name:  
Email-ID:  
Phone No :  
Date of Birth:  
Country of Current Residence & Address & how long have you been living there:  
Country of Citizenship:  
Married / Single:  
Male / Female:  
Number of Children:
 Ages of Children:
 Are these your birth children?
Past one Year Earnings:
 
* Spouse details -
Family Name:
 First Name:
         
Date of Birth:
 Country of Current Residence:
 Country of Citizenship:
  Male / Female
List the countries you and your spouse have lived in during last 10 years:
QUALIFICATIONS of Applicant - Include exact dates studied (month / year), MAJOR SUBJECTS, grades, division, pass mark
FULL NAME OF QUALIFICATION
(GIVE FULL DETAILS)
 NAME OF UNIVERSITY,
CITY, COUNTRY
 FROM
dd/mm/yy
 TO
dd/mm/yy
 MAJOR
SUB.		 F-T
Or P-T		 Pass Grade?
 
Principal Application – In last 3 years, how long have you worked?
yrs months.
– In last 4 years, how long have you worked?
yrs months.
QUALIFICATIONS of Spouse- Include exact dates studied (month / year), MAJOR SUBJECTS, grades, division, pass mark
FULL NAME OF QUALIFICATION
(GIVE FULL DETAILS)
 NAME OF UNIVERSITY,
CITY, COUNTRY
 FROM
dd/mm/yy
 TO
dd/mm/yy
 MAJOR
SUB.		 F-T
Or P-T		 Pass Grade?
 
 
Spouse  
  – In last 3 years, how long have you worked?
yrs months.
– In last 4 years, how long have you worked?
yrs months.
EMPLOYMENT - List ALL work experience, latest first.
NAME OF EMPLOYER
 POSITION and DUTIES
 FROM
dd/mm/yy

 TO
dd/mm/yy
 FULL-TIME or
PART-TIME		 How Many
Years
           
Principal Applicant:
  
Recent Job Duties in DETAIL:
           

EMPLOYMENT - List ALL work experience, latest first.
NAME OF EMPLOYER
 POSITION and DUTIES
 FROM
dd/mm/yy

 TO
dd/mm/yy
 FULL-TIME or
PART-TIME		 How Many
Years
 
Spouse:
 :
Recent Job Duties in DETAIL:
Please select your responses :
1. English ability of Principal Applicant:
 Fluent, very good conversational limited none
     
2. English ability of Spouse:
 Fluent, very good conversational limited none
         
3.
Do you have Blood Relations
who are residents in 		Australia?
 In Canada?
In NewZealand?
If YES, - What relationship? (brother, sister, parent, blood uncle/aunt, etc)
Which place do they live? Resident for how long?
   
 
4.
Have you visited Australia, Canada or UK?
If Yes, Where?
How long?
   
5.
Have you STUDIED there?
 If Yes, Where?
How long?
   
6.
Have you WORKED there?

If Yes, Where?
How long?
   
7.
Indicate MAXIMUM FUNDS
you can bring in
   
For Business Applicants only
1.
Do you currently own a business? Describe the nature of your business. Sole Propritore  Partnership Limited Company Others
Your Net worth. Indicate currency.
No of employees ?
Share of ownership (%)
Indicate the sales in the last 5 years
Indicate the net profits in last 5 years
Indicate the Equity Capital in last 5 years
Are you interested in OWNING a business in Canada / Australia ?


What type of business are you interested in?
   
   
2.
Have you been involved in bankruptcy?
Give Details
   
3.
Are YOU and YOUR FAMILY in good health?

 Any disabilities?
Deported from any country?
   
4.

OTHER INFORMATION (e.g. previous visas lodged, rejected, awaiting decision, Employment offers, etc:)