Permanent Residency Information Form

Personal Information

UCI Number *

(8 digits number on your Residence Permit/Visa)

Name *

First

Last

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Marital Status

Date of Marriage

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Date of Birth *

dd/mm/yy

Place of Birth *

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Eye Color *

Height *

Gender *

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Phone Number *

Email *

Current Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Address in Your Home Country (If applicable)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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Passport Number *

Issue Date *

Expiry Date *

Country of Issue *

Educational History of Applicant

Please complete the information in this format: from (dd/mm/yy) to (dd/mm/yy) – Institute and City – Course

Educational History

Example : 30/01/1990 to 31/12/1990 – University name Kelowna – Business Administration

Please upload all education documents. (Original copy & translated if not in English or French) *

Click or drag a file to this area to upload.

Work History from your 18th Birthday (Please start from your most recent position)

Please complete the information in this format: from (dd/mm/yy) to (dd/mm/yy) – designation, job, duty – company name and complete address.

Work History

Example : 30/01/1990 to 31/12/1990 – Supervisor – ABC Company at 123 Apple Street, Kelowna BC V1X V1X Canada

Work History Document Upload (You may also upload your work history in Word, Excel, or PDF)

Click or drag a file to this area to upload.

Activity History From Your 18th Birthday or Last 10 Years (Please start from your most recent activity and do not leave any gaps)

Please complete the information in this format: from (dd/mm/yy) to (dd/mm/yy) – activity (job,study, tourism, vacation) – address, city – Country – Company Name (Institution name)

Activity History

Example : 30/01/1990 to 31/12/1990 – Job – ABC Company at 123 Apple Street, Kelowna BC V1X V1X Canada

Activity History Document Upload (You may also upload your activity history in Word, Excel, or PDF)

Click or drag a file to this area to upload.

Address History Of The Main Applicant Since Their 18th Birthday or Last 10 Years (Please start from your most recent address and do not leave any gaps)

Please complete the information in this format: from (dd/mm/yy) to (dd/mm/yy) – Address – City/State – Postal Code – Country

Address History *

Example : 30/01/1990 to 31/12/1990 – 123 Apple Street, Kelowna BC V1X V1X Canada

Address History Document Upload (You may also upload your address history in Word, Excel, or PDF)

Click or drag a file to this area to upload.

Travel History Outside Country of Residence & Origin Of The Main Applicant Since Their 18th Birthday or Last 10 Years (Please start with the most recent)

Please complete the information in this format: from (dd/mm/yy) to (dd/mm/yy) – Place (City, Country) – Purpose of travel (Vacation/work)

Travel History

Example : 30/01/1990 to 31/12/1990 – 123 Apple Street, Kelowna Canada – Vacation

Travel History Document Upload (You may also upload your travel history in Word, Excel, or PDF)

Click or drag a file to this area to upload.

Family Details

Spouse, father, and mother information

Spouse's Name *

First

Last

Date of Birth *

dd/mm/yy

Place of Birth *

Occupation *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Father's Name *

First

Last

Date of Birth *

dd/mm/yy

Place of Birth *

Occupation *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Mother's Name *

First

Last

Date of Birth *

dd/mm/yy

Place of Birth *

Occupation *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Brothers & Sisters of Main Applicant

Please input information in this order: Name, relation, date of birth, maritial status, occupation and their current address.

Brothers and sisters information

Do you have any children? *

Yes
No

How many children?

1-4
5+

Children's Information

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Name *

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Height

Feet; Inches

Eye Color

Son or Daughter

Date of Birth

Country of Birth

Marital Status

Occupation

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Height

Feet; Inches

Eye Color

Son or Daughter

Date of Birth

Country of Birth

Marital Status

Occupation

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Height

Feet; Inches

Eye Color

Son or Daughter

Date of Birth

Country of Birth

Marital Status

Occupation

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Height

Feet; Inches

Eye Color

Son or Daughter

Date of Birth

Country of Birth

Marital Status

Occupation

Additional Children (Name, Address, Height, Eye Color, Son or Daughter, DOB, Country of Birth, Marital Status, and Occupation)

Details of Relatives in Canada

Name *

First

Last

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Relationship

PR/Citizen (Relative)

Yes
No

Status in Canada

PR or Citizen *

PR
Citizen

Where do they live?

Date PR/Citizenship Acquired *

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Have you ever applied for any application to Canada? *

Yes
No

When and for what *

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Have you been denied or refused a visa or permit of any country in the past? *

Yes
No

For what reason? *

Please attach a copy of refusal letter *

Click or drag a file to this area to upload.

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Have you or your family members (Spouse/Dependants above 18 years old) arrested, detained or criminally charged anywhere? *

Yes
No

Please provide details *

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Have you or your family members (Spouse/Dependants above 18 years old) had any serious physical/mental disorder/disease? *

Yes
No

Please provide details *

IELTS score for each module

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Listening

Reading

Writing

Speaking

Overall score

Extra notes (if applicable)

I certify that I have completed this application truthfully with the most accurate answers to the best of my knowledge and that my third party representative for the purpose of filling my immigration application for any immigration related program in Canada will use the information provided in this application. *

Yes
No

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