Form view – Canadian Provincial Nominee & Immigration Services

PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING	Investor
PERSONAL INFORMATION	PERSONAL INFORMATION
Title	Mr.
First Name	Rachmat
Last Name	Fajar
Place of Birth	Jakarta
Country of Citizenship	Indonesia
EDUCATION	Bachelor's Degree
LANGUAGE PROFICIENCY	LANGUAGE PROFICIENCY PRINCIPAL APPLICANT
English	Very Good
French	Fair
Specify Other Language	Arabic
MARITAL STATUS	Married
LANGUAGE PROFICIENCY SPOUSE	LANGUAGE PROFICIENCY SPOUSE
English	Fair
French	Fair
SPOUSE DETAIL	SPOUSE DETAIL
Title	Mrs.
First Name	Meryem
Last Name	Benchlih
Birth Date (m/d/y)	29091985
Place of Birth	Youssoufia
Country of Citizenship	Indonesia
CHILDREN'S DETAIL (IF ANY)	CHILDREN'S DETAIL (IF ANY)
1. Name	Muhammad Sami Mubarak
Date of Birth (mm/dd/yyyy)	09112009
Place of Birth	Jakarta
2. Name	Anas Rahmat Mubarak
Date of Birth (mm/dd/yyyy)	16122013
Place of Birth	Jakarta
3. Name	Rakan Rahmat Mubarak
Date of Birth (mm/dd/yyyy)	07052018
Place of Birth	Jakarta
DO YOU HAVE ANY RELATIVES IN CANADA?	No
WHERE DO YOU INTEND TO LIVE IN CANADA?	WHERE DO YOU INTEND TO LIVE IN CANADA?
City/Town	Toronto
Province	Ontario
CONTACT DETAILS	CONTACT DETAILS
Address	Jalan Siaga Bappenas no. 45 Pejaten barat, Jakarta, Indonesia
Contact Number	(647) 490-5155
Email Address	Email hidden; Javascript is required.