Last Name (as stated in your passport)
First Name & Middle Name (as stated in your passport)
Have you legally used any other names before the one currently on your passport? Select the correct option Yes No
Please provide the name you legally used before the one currently listed in your passport.
Marital Status Select the correct option Common-law relationship Married Divorce Single Widow
Gender Select the correct option Male Female
Place of birth (as stated in your passport)
Are you currently in Canada on a study permit? Select the correct option Yes No
Within the last five years have you lived or worked in any other country other than Jamaica for more than six months? Select the correct option Yes No
Country/territory
Status in the country Select the correct option Citizen Permanent resident Visitor Worker Student Protected person Refugee Claimant Foreign National
Country/territory
Status in the country Select the correct option Citizen Permanent resident Visitor Worker Student Protected person Refugee Claimant Foreign National
Spouse first and last name
Home address
Country
Occupation
Do you have life insurance with your common-law partner? Select the correct option Yes No
Does your common-law partner have insurance with you as the beneficiary? Select the correct option Yes No
Do you and your common-law partner have a joint bank account? Select the correct option Yes No
Do you and your common-law partner have a property in both of your names? Select the correct option Yes No
Do you and your common-law partner have a property or land in both of your names? Select the correct option Yes No
Do you and your common-law partner have a property lease in your name? Select the correct option Yes No
Were you previously married or in a common-law relationship? Select the correct option Yes No
Previous spouse Last name
Previous spouse: First name
Describe your previous relationship Select the correct option Common-Law Married
Passport Number
Country that Issued Passport
Parish/city where passport was issued
Passport expiration date (dd/mm/yyyy)
Current address in Canada
Phone Number in Canada
WhatsApp Number
State the airport you use to originally enter Canada
Which of the follow applies to you? Select the correct option I originally entered Canada as a international student I entered Canada with a different status and later changed it to a student status while I was in Canada.
What is your original status when you enter Canada prior to changing it to Student status? Select the correct option Family Visit Tourism Business Worker Other
Have you recently left and re-entered Canada since your original entry? Select the correct option Yes No
State the airport you use to re-enter Canada
Have you recently completed or graduated from a program in Canada? Select the correct option Yes No
School name
Program of study
School Address
State the Month and Year you started the school
State the Month and Year you completed the school
What is your employment status? Select the correct option Unemployed Employed
State the start month and year of your current employment
Job title *
Company Name *
Employer Full Address *
Were you previously employed? * Select the correct option Yes No
Previous employment - Company name *
Previous employment - Job title *
Full address of previous employment *
State the start month and year of your previous employment
State the end month and year of your previous employment
Previous employment - Company name *
Previous employment - Job title *
Full address of previous employment *
State the start month and year of your previous employment
State the end month and year of your previous employment
Have you ever been to Canada? Select the correct option Yes No
Have you ever done biometrics (Fingerprint) for Canada Visa in the last 10 years? Select the correct option Yes No
Please state the year you did the biometric (Fingerprint)
Have you ever been refused a Visa for any country? Select the correct option Yes No
State the countries where you have been refused a visa, along with the number of times you were refused a visa for each country. This information is extremely important. Please state your answer in the box below. Please Note: If you were refused a visa for any country and it was not stated your application can be refused and you get banned from Canada for 5 years. *
Have you had a medical exam performed by an Canadian authorized panel physician (doctor) within the last 12 months? Select the correct option Yes No
Have you ever been arrested, charged, or convicted of any criminal offense in any country, including matters related to immigration?? Select the correct option Yes No
In which country were you arrested, charged, or convicted of a criminal offense?
Please explain why you were arrested, charged, or convicted for a criminal offense
Did you serve in any Military, Civil Defense Unit, Security organization or Police force? Select the correct option Yes No
State the Military, Civil Defense Unit, Security organization or Police force that you served
State the country that you served below
