| PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING | Skilled Worker |
|---|---|
| PERSONAL INFORMATION | PERSONAL INFORMATION |
| Title | Mr. |
| First Name | SURANTO |
| Middle Name | - |
| Last Name | - |
| Place of Birth | INDRAMAYU |
| Country of Citizenship | INDONESIA |
| EDUCATION |
|
| LANGUAGE PROFICIENCY | LANGUAGE PROFICIENCY PRINCIPAL APPLICANT |
| English |
|
| French |
|
| MARITAL STATUS | Married |
| LANGUAGE PROFICIENCY SPOUSE | LANGUAGE PROFICIENCY SPOUSE |
| English |
|
| French |
|
| SPOUSE DETAIL | SPOUSE DETAIL |
| Title | Mrs. |
| First Name | LIA |
| Middle Name | - |
| Last Name | THALITA |
| Birth Date (m/d/y) | 06 May 1989 |
| Place of Birth | JAKARTA |
| Country of Citizenship | INDONESIA |
| CHILDREN'S DETAIL (IF ANY) | CHILDREN'S DETAIL (IF ANY) |
| 1. Name | ALVAREEN REZQIANO |
| Date of Birth (mm/dd/yyyy) | 08 SEPTEMBER 2015 |
| Place of Birth | BEKASI |
| 2. Name | ALVIANDI BACHTIAR |
| Date of Birth (mm/dd/yyyy) | 18 SEPTEMBER 2020 |
| Place of Birth | Bekasi |
| 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 | VILLA INDAH PERMAI C 19 NO 31 RT 04 RW 037 TELUKPUCUNG BEKASI UTARA 17121 |
| Contact Number | (006) 287-8839 |
| Email Address | Email hidden; Javascript is required. |
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- Email Address: inquiry@cpnis.com
