Name 姓名

Nickname 绰号

Telephone 电话号码

Mobile 手提电话

Fax 传真号码

Current Address 现住址

Mailing Address 邮寄地址

Citizenship 国籍

Passport 护照编号

Passport Issue Date 护照发行期

Passport Expiry Date 护照失效期

Resident Status 加拿大签证或身份 （留学生，外劳，等）

Visa Issue Date 签证发行期

Visa Expiry Date 签证失效期

Unique Client Identifier 客户独特识别码

Marital Status 婚姻情况

Background Information 背景信息

Have you ever been denied entry into a country? 是否曾被拒签？

是否 （Y/N）

Have you ever been in the military or held a government position? 是否曾担任兵役或政府职责？

是否 （Y/N）

Have you sponsored another person or still have an existing undertaking? 是否曾担保别人或现有担保承诺？

是否 （Y/N）

Have you been convicted of a crime or offence in Canada for which a pardon has not been granted under the Criminal Records Act of Canada? 是否曾被加拿大政府定罪，但未得到政府赦免？

是否 （Y/N）

Have you been convicted of, or are you currently charged with, on trial for, or party to a crime or offence, or subject of any criminal proceedings in any other country? 是否曾在其他国家被定罪，被控， 被审判，参加犯罪等？

是否 （Y/N）

Have you made previous claims for refugee protection in Canada or at a Canada visa office abroad, in any other country or countries, or with the United Nations High Commissioner for Refugees (UNHCR)? 是否曾有向加拿大或政府，加拿大领事馆，申请难民身份？

是否 （Y/N）

Have been refused refugee status, an immigrant or permanent resident visa (including a Certificat de selection du Quebec (CSQ))? 是否曾被拒难民身份分，其他移民签证包括魁北克的？

是否 （Y/N）

Have you been involved in an act of genocide, a war crime or in the commission of a crime against humanity? 是否曾参与种族大屠杀，战争罪，危害人类罪？

是否 （Y/N）

Have you been associated with a group that used, uses advocated or advocates the use of armed struggle or violence to reach political, religious or social objectives?
是否有或跟组织在达到政治，宗教，或社会目标中用过或支持武装斗争或暴力？

是否 （Y/N）

Been member of an organization that is or was engaged in an activity that is part of a pattern of criminal activity? 是否曾当过有或曾有执行犯罪活动组织的成员？

是否 （Y/N）

Have you been detained, incarcerated or put in jail? 是否曾被拘留，监禁， 或投入监狱？

是否 （Y/N）

Had you any serious disease or physical or mental disorder? 是否有严重，身体上，或请神上的病疼？

是否 （Y/N）

Have you been previous married/common law relationship and/or children? 是否曾结婚/同居或有孩儿？

是否 （Y/N）

Will any family members accompany you? 是否会有家人陪同？

是否 （Y/N）

Your Email (required)

Subject

If you answered yes to any of the questions above, please describe in detail below.
若果，您在以上问题答“是“， 请在下边详细解释.

Please write down your educational, living, and employment history since the age 18 or the last ten years, whichever is more recent. 请描述从18岁开始或致近十年您的学历（用最近的段时间）住址历史，学历，及就业历史。

Please describe briefly your situation and what you would like me to do for you. 请描您的个人情况及您需要的移民服务.