Form view – Canadian Provincial Nominee & Immigration Services

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PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING	Family Class
PERSONAL INFORMATION	PERSONAL INFORMATION
Title	Mr.
First Name	Erlangga
Middle Name	Vidyamurti
Last Name	Sutrisno
Place of Birth	Jakarta
Country of Citizenship	Indonesia
EDUCATION	Others (specify)
Other Eduction	Diploma in Audio Engineer
Current Occupation	Former Marketing at Audio Visual Rent Companu
Occupation in Years	Production at Bellow The Line Agency
Occupation in Months	Senior Production at Bellow The Line Agency
LANGUAGE PROFICIENCY	LANGUAGE PROFICIENCY PRINCIPAL APPLICANT
English	Good
French	Fair
Specify Other Language	Dutch, Fair
MARITAL STATUS	Married
LANGUAGE PROFICIENCY SPOUSE	LANGUAGE PROFICIENCY SPOUSE
English	Good
French	Fair
SPOUSE DETAIL	SPOUSE DETAIL
Title	Mrs.
First Name	Eliza
Middle Name	Daniella Johannes
Last Name	Sutrisno
Birth Date (m/d/y)	090379
Place of Birth	Jakarta
Country of Citizenship	Indonesia
N.B. Additional information on your spouse (if applicable), i.e. education, work experience could be provided on extra Space below	High School Degree
CHILDREN'S DETAIL (IF ANY)	CHILDREN'S DETAIL (IF ANY)
1. Name	Dexter Nathaniele Sutrisno
Date of Birth (mm/dd/yyyy)	21032009
Place of Birth	Jakarta
2. Name	Bianca Evangeline Sutrisno
Date of Birth (mm/dd/yyyy)	09122014
Place of Birth	Jakarta
DO YOU HAVE ANY RELATIVES IN CANADA?	Yes
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	Jl Mawar No 111 Komp Bukit Nusa Indah Tangerang Selatan 15414 Indonesia
Contact Number	(021) 736-1972
Email Address	Email hidden; Javascript is required.
Fax Number	+6281310236780