Canasialogo TEL +604-590-8228
TEL +91-172-432-1111		 Business Inquiries
franchisee@canasiaimmigration.com		 General Inquiries
info@canasiaimmigration.com
Assessment Form
1. Last Name: First Name: Middle Name:
2. Sex 3. Date of birth 4. Place of birth 5. Citizenship
 male female
6. Current Mailing address:
Telephone Number:
Off: Resi: Mobile: Email ID:
7. Your country Preference:  Canada Australia United Kingdom USA
8. IELTS score if qualified:
Proficiency Score/Band Proficiency Score/Band Date of Exam
Speaking Writing
Reading Listening
9. Details of education since matriculation:
(Full time / part time)
Period From/To Details of Diploma or Degree Mode of study Regular of Correspondence Name of Institution or Board or University Grade Division
10. Details of work history for last 10 years
Period From/To Name of the organization/company Occupation/Position
11. Spouse Education: Date of birth:
Period From/To Details of Diploma or Degree Mode of study Regular of Correspondence Name of Institution or Board or University Grade Division
12. Spouse work history
Period From/To Name of the organization/company Occupation/Position
13. Blood Relatives in:  canada australia uk usa
I declare that the information given in this
application is truthful, complete and correct to best of my knowledge.
Write your name here:



SUITE 105-A, 12830-80th AVENUE, SURREY,
BC CANADA V3W 4G2.		 TEL +604-590-8228
TEL +91-172-432-1111		 Business Inquiries
franchisee@canasiaimmigration.com		 General Inquiries
info@canasiaimmigration.com