Standard Questionnaire Form For Evaluation

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Immigration Assessment Form

Personal Information
Name:
Date of birth:
Nationality:
Gender (Male/Female):

Contact number:

Email id:

Family Composition
Marital status:
Number of children:

Child Age:

Dependent person or number of persons in your family:


Education

Duration (Month and Year)


Name of
Academic and
Marks School or
Professional
Obtained University
From To Qualification
with country

Employment Details
Total Experience in months and years:
Current CTC:

Duration (Month and Year) Name of the Company Designation and


Job Profile
From To
Ability in language: English(High/Moderate/Basic/None) Either mention IELTS result
Speaking:
Listening:
Reading:
Writing:

Ability in Language: French if applicable(High/Moderate/Basic/None)


Speaking:
Listening:
Reading:
Writing:

Information of Spouse:
Name:
Date of birth:
Sex (Male/Female):

Education

Duration (Month and Year)


Academic & Marks Name of
Professional School/University
From To Obtained
Qualification with country
Ability in language: English(High/Moderate/Basic/None) Either mention IELTS result
Speaking:
Listening:
Reading:
Writing:

Ability in language: French(High/Moderate/Basic/None)


Speaking:
Listening:
Reading:
Writing:
Work History of Spouse
Total number of years’ experience in past 10 years:

Duration (Month and Year)


Designation and Job
Name of the Company
Profile
From To
Any self-employed profession by applicant or spouse during last 5 years kindly mention below.

Present Address:

Permanent Address:

PROTECTION OF PERSIONAL INFORMATION

The personal information appearing on this form, and in any documents that must be appended to it, is required for processing your
application for immigration to specific country, the Regulation respecting the selection of foreign nationals, the Regulation respecting the
immigration consultants and their administrative regulations.
Your personal information is confidential and may not be disclosed without your consent unless explicitly authorized by you.

DECLARATION

I declare that the information contained in this application and appended documents, if any, is complete and accurate and I will notify the
representative of any change in answers given on this form before the submission of application to Immigration department.
I acknowledge that I have read the notice on the protection of personal information in the section above.
I further acknowledge that by saving this document and sending the same to my legal representative electronically, constitute my consent
to use the information and no physical signature is required.
I also agree that Pleco Migration will be making an initial assessment on the basis of the limited information provided on this form.

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