Pre-Immigration Assessment Form

In order for us to assist you better with your immigration to Canada, please fill out the following questionnaire.

Once you have completed it, kindly sign and submit it.

We will get back to you within 2 business days. Kindly check your spam/junk mail for our response.

What would you like to do in Canada?*

WorkVisitStudyOther

If you answered "Other" please let us know what you want to do in Canada?

Applicant's Name*

First NameMiddle NameLast Name

Applicant's Phone Number*

Please enter a valid phone number.

Applicant's Email*

example@example.com

Applicant's Date of Birth*

Date

Applicant's Age*

Applicant's Civil Status*

Applicant's Gender*

Applicant's Place of Birth*

City and Country

Applicant's Citizenship*

Applicant's Passport Information*

Does the Applicant hold citizenship in another country?*

YesNo

Which other countries does the Applicant hold citizenship for?

If you are Common-law or Married , Please indicated the Date of Common-Law or Marriage

Date

If you are Divorce, Please indicate the date of the finalization of Divorce

Date

If you are Separated, Please indicate the date of separation

Date

Has the Applicant resided outside the country of citizenship for 12 months or more?*

YesNo

If you answered yes to the previous question, which country and how long for?

Name of Applicant's Spouse

First NameMiddle NameLast Name

Date of Birth of Applicant's Spouse

Date

Applicant's Spouse Age

Place of Birth of Applicant's Spouse

Gender of Applicant's Spouse

Applicant's Spouse Passport Information

Does the Applicant's Spouse hold citizenship in another country?

YesNo

Which other countries does the Applicant's Spouse hold citizenship for?

Has the Applicant's spouse resided outside the country of citizenship for 12 months or more?

YesNo

If you answered yes to the previous question, which country and how long for?

Number of Children

Please include details about your children (if any). This includes all children whether living with you or not, and legally in your guardianship or not.

If any of your dependent children are not immigrating with you, please indicate why?

Do you or any of your family members you plan to include in your application have any medical conditions or chronic illness*

YesNo

If you answered yes to the above question, Please state the conditions and who has them.

Please indicate the Applicant's language level ability in English*

FluentIntermediateBasic

Please indicate the Applicant's language level ability in French*

FluentIntermediateBasic

Has the Applicant taken a Language Assessment exam such as IELTS, CELPIP or TEF in the past two years*

YesNo

If yes, indicate the date completed the assessment

Date

If the Applicant has taken the IELTS, CELPIP or TEF, what were the scores

	Applicant's IELTS Score	Applicant's Celpip Score	Applicant's TEF Score
Reading
Writing
Speaking
Listening

Please indicate the Applicant's HIGHEST level of Education. NOTE: Please indicate completed qualifications ONLY. Unfinished qualifications will not be considered under Canadian Immigration Regulations*

Has the Applicant applied for an Education Credential Assessment through a credited Credential Assessment Centre, i.e. WES/IQAS?*

YesNo

If you answered yes to the previous question, what were the results of the ECA and from which Assessment Centre

Has the Applicant ever studied or worked in Canada*

YesNo

If you answered yes to the previous question, please provide details

Please indicate the Applicant's Spouse language level ability in English

FluentIntermediateBasic

Please indicate the Applicant's Spouse language level ability in French

FluentIntermediateBasic

Has the Applicant's Spouse taken a Language Assessment exam such as IELTS, CELPIP or TEF in the past two years

YesNo

If yes, indicate the date completed the assessment

Date

If the Applicant's Spouse has taken the IELTS, CELPIP or TEF, what were the scores

	Applicant's Spouse IELTS Score	Applicant's Spouse Celpip Score	Applicant's Spouse TEF Score
Reading
Writing
Speaking
Listening

Please indicate the Applicant's Spouse HIGHEST level of Education. NOTE: Please indicate completed qualifications ONLY. Unfinished qualifications will not be considered under Canadian Immigration Regulations

Has the Applicant's Spouse applied for an Education Credential Assessment through a credited Credential Assessment Centre, i.e. WES/IQAS?

YesNo

If you answered yes to the previous question, what were the results of the ECA and from which Assessment Centre

Has the Applicant's Spouse ever studied or worked in Canada

YesNo

If you answered yes to the previous question, please provide details

Does the Applicant or the Applicant's Spouse have any family in Canada*

YesNo

If yes, please define the relation (Brother, Cousin, etc.)

If yes, please define the relative's status in Canada (Citizen, Permanent Resident, etc.)

Please indicate the level of assets (minus debt) (NOTE: In order to qualify for Temporary or Permanent Residence in Canada, applicants and their families must have a minimum level of funds available)*

Please indicate in Canadian Dollars

The following applies to the Applicant, the Applicant's Spouse and any accompanying family members*

	Yes	No
Are there any criminal or civil proceedings pending against you or have you been convicted of a criminal offence in ANY country
Have been refused a VISA for any other country
Have applied for any type of Visa to Canada and been refused
Have been deported from any country
Have been under investigation in any country

Please include any additional information that you feel is important or pertinent to an immigration application for Canada

If you were referred to us by someone, please indicate who:

First NameLast Name

Declaration:

By submitting this Pre-Immigration Questionnaire, I certify that the information provided is true and accurate to the best of my knowledge. I understand that the information given will be used as part of my application for immigration to Canada if I choose to utilize the services of Topline Immigration Consulting Services. I acknowledge that the final decision regarding the issuance of a visa or permit is solely at the discretion of Immigration Refugee Citizenship Canada (IRCC) and its authorities.

Signature of the Applicant*

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Signature of the Spouse

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Canadian Pre-Immigration Questionnaire