CANADA VISA FORM

1.    Full Name

    Family name
(as shown on your passport or travel document)

    Given name(s)
(as shown on your passport or travel document)

    Have you ever used any other name (e.g. Nickname, maiden name, alias, etc.) ?

2.    Sex

3.     Date of Birth

4.     Place of Birth

5.     Citizenship

6.    Current country of residence:

    Previous countries of residence: During the past five years have you lived in any country other than your country of citizenship or your current country of residence (indicated above) for more than six months?

    Country where applying Same as current country of residence?

a.    Have you previously been married or in a common-law relationship?

b.    Provide the following details for your previous Spouse/Common-law Partner

*    Passport number

*    Country of issue

*    Issue date

*    Expiry date

a.    Native language/Mother Tongue

b.    If your native language is not English or French, which language do you use most frequently?

c.    Are you able to communicate in English and/or French?

d.    Have you taken a test from a designated testing agency to assess your proficiency in English or French?

.    Current mailing address

.    Residential address

    Contact adress Same as Residential address?

a.    Purpose of my visit

    Indicate how long you plan to stay

    Name, address and relationship of any person(s) or institution(s) I will visit

1   Citizenship and immigration canada

2     Have you had any post secondary education (including university, college or apprenticeship training)?

     Give details of your employment for the past 10 years, including if you have held any government positions (such as civil servant, judge, police officer, mayor, Member of Parliament, hospital administrator, employee of a security organization). Do not leave gaps. If retired, not working or studying, please indicate. If you are retired, please provide the 10 years before your retirement.

   Current Activity/Occupation

    Previous Activity/Occupation

    You must complete this section if you are 18 years of age or older

1 a)     Within the past two years, have you 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?

1 c)     If you answered "yes" to question 1 a) or 1 b), please provide details and the name of the family member (if applicable).

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 ever been refused 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?

2 d)     If you answered “yes” to question 2 a), 2 b), or 2 c) please provide details

3 .    Have you ever committed, been arrested for, been charged with or convicted of any criminal offence in any country?

4 .    Did you serve in any military, militia, or civil defence unit or serve in a security organization or police force (including non obligatory national service, reserve or volunteer units)?

5.    Are you, or have you ever been a member or associated with any political party, or other group or 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 desecration of religious buildings?