Client Form

CLIENT PROFILE FORM
NOTE*: Please fill out the form carefully, as our suggestions will be based solely on the provided information. Incomplete or incorrect details may result in inaccurate guidance.
Full Name*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Marital Status *
D.O.B*

YearMonthDay
No. of Child *
Nationality*
How did you hear about us*
Enter your Friend Name
Services*
Current Status *
Starting Date*

MonthDayYear
Issue Date *

MonthDayYear
Expiry Date *

MonthDayYear
Your Address (including, street, city & country)*
Is your Brother/Sister PR in Canada*

YesNo
EDUCATION DETAILS (Both inside/outside Canada)*
Note* Please click add row for all your educational details.
Do you have work experience current or previous?*

YesNo
WORK HISTORY (Inside/Outside Canada) *
Note* Please click add row for more work history details.
ENGLISH LANGUAGE PROFICIENCY EXAM (IELTS, CELPIP, TOFEL ETC) *
Exam Type
Date of Attemped

MonthDayYear

Rows	Speaking	Listening	Reading	Writing	Overall Score
1

Questionnaire:*

Rows	Yes/No
1. Within past two years any medical issues?
2. Ever remained beyond the validity of your status attended school without authorization?
3. Have ever been refused for a visa for Canada or any other country? (Y/N)
4. Have you ever committed, been arrested for, or been charged with or convicted of any criminal offence in any country?
5. Have you ever done flag poling to USA?
6. Have you ever done biometrics within last 10 years?

If any of above is yes, please explain in below box: *
ACCEPTANCE OF POLICY
The personal information you provide to the Land2Air Immigration is secure and is collected for the purpose of assessing your potential for immigration/visiting to Canada. You may consult our Privacy Policy for complete details*

YesNo
Initials*

Rows	Speaking	Listening	Reading	Writing	Overall Score
1

Questionnaire:*

Rows	Yes/No
1. Within past two years any medical issues?
2. Ever remained beyond the validity of your status attended school without authorization?
3. Have ever been refused for a visa for Canada or any other country? (Y/N)
4. Have you ever committed, been arrested for, or been charged with or convicted of any criminal offence in any country?
5. Have you ever done flag poling before?

If any of above is yes, please explain in below box: *
ACCEPTANCE OF POLICY
The personal information you provide to the Land2Air Immigration is secure and is collected for the purpose of assessing your potential for immigration/visiting to Canada. You may consult our Privacy Policy for complete details*

YesNo
Initials*
Should be Empty: