Form view – Canadian Provincial Nominee & Immigration Services

PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING	Skilled Worker
PERSONAL INFORMATION	PERSONAL INFORMATION
Title	Mr.
First Name	Komang
Last Name	Riana
Place of Birth	Sangsit
Country of Citizenship	Indonesia
EDUCATION	College
LANGUAGE PROFICIENCY	LANGUAGE PROFICIENCY PRINCIPAL APPLICANT
English	Good
French	Fair
MARITAL STATUS	Married
LANGUAGE PROFICIENCY SPOUSE	LANGUAGE PROFICIENCY SPOUSE
English	Good
French	Fair
SPOUSE DETAIL	SPOUSE DETAIL
Title	Mrs.
First Name	Ni Made
Last Name	Yuniari
Birth Date (m/d/y)	28/06/1984
Place of Birth	Denpasar
Country of Citizenship	Indonesia
CHILDREN'S DETAIL (IF ANY)	CHILDREN'S DETAIL (IF ANY)
1. Name	Putu Rama Valentino
Date of Birth (mm/dd/yyyy)	12/02/2008
Place of Birth	Denpasar
2. Name	Kadek Agus Wibawa Putra
Date of Birth (mm/dd/yyyy)	26/02/2013
Place of Birth	Sangsit
3. Name	Nyoman Dimas Agastya
Date of Birth (mm/dd/yyyy)	03/01/2019
Place of Birth	Sangsit
DO YOU HAVE ANY RELATIVES IN CANADA?	No
WHERE DO YOU INTEND TO LIVE IN CANADA?	WHERE DO YOU INTEND TO LIVE IN CANADA?
CONTACT DETAILS	CONTACT DETAILS
Address	Singaraja Bali Indonesia
Contact Number	(623) 622-7076
Email Address	Email hidden; Javascript is required.