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- Does your Canadian provincial or territorial certificate of nomination still valid?*
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- Have you or spouse/common law partner or dependent children ever been convicted of or currently charged with any crime or offence in any country*
- Have you or spouse/common law partner or dependent children ever applied previously for an immigrant visa to Canada*
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- Where did you hear about us?*
- I certify that the information furnished by me in this entire assessment form is true and correct, to the best of my knowledge, and is provided for the sole purpose of my assessment regarding Immigration to Canada.*
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- Assessment's Date*
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- Should be Empty: