1294E/1295E/5257E-Dummy form Canada

  • Fill in CAPITAL OR UPPER CASE

    Dummy form for 1294E / 1295E / 5257E
  • I AM APPLYING FOR (Choose only one option)*

  • Personal details

    Please give your details correctly

  • Choose yes in following condition in the following question.

    For female who have changed their name after marriage give your name before marriage. 

    Who have legally changed their name by giving advertisment in new paper and updated in Gazette

  • Have you ever use any other names?*
  • Date of Birth*
     - -
  • From which Date
     - -
  • To Which Date
     - -
  • 8. In past five year have you lived in any other country than your country of citizenship for more than 6 months?
  • Country where applying: is the same as current country of residence? If you are in India and applying within India select "yes"*
  • Date of Marriage
     - -
  • Have you previously been married or have common law partner?*
  • Date of Birth of Spose or common law partner
     - -
  • From which Date
     - -
  • To which date
     - -

  • Language(s)

  • Have you taken test from designated test agency?*

  • Passport

    Your passport expiry date must not be less than six months at the time of application of the visa.
  • Issue date*
     - -
  • Expiry date*
     - -
  • For this trip, will you use passport issues by the Ministry of Foreign Affairs in Taiwan that includes your personal Identification number?*
  • For this trip, will you use National Israeli passport?*
  • Do you have National identity document?*
  • Issue Date
     - -
  • Expiry Date
     - -
  • Are your a lawful permeant resident of United states?*
  • Expiry Date
     - -

  • Contact information

  • 1. Current mailing address (Give your current address where you can be contacted by post it could be different from your passport address if you have change your home)

  • 2. Residential Address

  • Is your residential same as mailing address?*

  • 3. Telephone number:

  • Choose One*
  • Format: 000-000-0000.

  • 4. Alternative telephone number:

  • Choose One
  • Format: 000-000-0000.

  • You can save your form and fill it later. Please make sure you put the correct email address. You will receive an email with link of your saved form. If you want to continue click next button.

  • ---------------------------------------------------------------------------------------------------------------
    Detail of Intendend Study in Canada
    ---------------------------------------------------------------------------------------------------------------

  • 1. I have been accepted at following educational institute

  • d) Complete address of school in Canada

  • 3. Duration of Expected study

  • From*
     - -
  • To*
     - -

  • 4. The cost of my study will be:

  • You can save your form and fill it later. Please make sure you put the correct email address. You will receive an email with link of your saved form. If you want to continue click next button.

  • ---------------------------------------------------------
    Detail of Intendend work in Canada
    ---------------------------------------------------------

  • If you Choose open work permit in following selection, you do not need to fill any other details on this page.

  • What type of work permit are you applying for?
  • Employment start date
     - -
  • Employment end date
     - -

  • You can save your form and fill it later. Please make sure you put the correct email address. You will receive an email with link of your saved form. If you want to continue click next button.

  • ---------------------------------------------------------
    Detail of visit to Canada
    ---------------------------------------------------------

  • Travel Start Date
     - -
  • Travel End Date
     - -

  • Name and Address of the person of organization, I will visit

    Please give hotel address in case if are visiting for leisure activities

  • Education (Section E)

    Give your highest degree here
  • Have you had any post secondary education? (E.g. University, College or apprenticeship training? )*
  • From when
     - -
  • To when
     - -

  • Employment

    Start with your latest employment. If you are student and not have an employment yet put your education details.

  • Before starting the following section. Please read this information carefully. 

     IF YOU ARE STUDENT:

    Start with your second highest education. E.x. in above education section you have put your Highest Edcaction as Bachelor Degree, Put your Diploma, HSC and SSC Details

    IF YOU ARE NOT STUDENT AND HAVE WORK EXPERIENCE OR HAVE BUSINESS:

    Then put your most recent work or business details and then any other business or work details.

    PLEASE NOTE THAT MAXIMUM YOU CAN FILL 3 DETAILS DUE TO RECETION ON THE FORM

  • Business / Employment / Education (ONE)

    Your most recent work or studies. CURRENTLY WHAT YOU ARE DOING

  • Business / Employment / Education (TWO)

    Your most recent work

  • Business / Employment / Education (THREE

    Your most recent work

  • Back ground Information

  • 1. A) Within the past two years, have yo or a family member ever had tuberculosis of the lungs or been in close contact with a person with tuberculosis?*
  • 1 B) Do you have any physical or mental disorder that would require social and /or health services, other than medication , during a stay in Canada?*
  • 2. A) Have you ever remained beyond the validity of your status, attended school without authorization or worked without authorization in Canada?*
  • 2. B) Have you evern been refulsed a visa or permit, denied entry or ordered to leave Canada or any other country?*
  • 2. C) Have you previously applied to enter or remain in Canada?*
  • 3 A) Have you ever committed, been arrested for, been charged with or convicted of any criminal offence in any country?*
  • 4 A) Did you serve in any military, militia, or civil defense unit or serve in a security organization or police force (including non obligatory national service, reserve or volunteer unit)*
  • 5 Are you or have you been a member of associated with any political party, or other group of organization which has engaged in or advocated violence as a means to achieving a political or religious objective, or which has been associated with criminal activity at any time?*
  • 6. Have you ever witnessed or participated in the ill treatment of prisoners or civilians, looting or descration of religious buildings?*

  • If you answered "yes" to any of questions 3 to 6 above, or upon request of a visa officer, you MAY BE REQUIRED to fill out IMM 5257 Schedule-1

  • Should be Empty: