Form view – Canadian Provincial Nominee & Immigration Services

PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING	Self Employed
PERSONAL INFORMATION	PERSONAL INFORMATION
Title	Mr.
First Name	Edo
Last Name	Susanto
Place of Birth	Indonesia
Country of Citizenship	Indonesia
EDUCATION	Bachelor's Degree
Other Eduction	Accounting
Current Occupation	Accounting
Occupation in Years	4 years
Occupation in Months	Manager Shrimp Farm
LANGUAGE PROFICIENCY	LANGUAGE PROFICIENCY PRINCIPAL APPLICANT
English	Good
French	Fair
Specify Other Language	Indonesia
MARITAL STATUS	Married
LANGUAGE PROFICIENCY SPOUSE	LANGUAGE PROFICIENCY SPOUSE
English	Good
French	Fair
SPOUSE DETAIL	SPOUSE DETAIL
Title	Ms.
First Name	Reni
Last Name	Anastasia
Birth Date (m/d/y)	16-01-1979
Place of Birth	Indonesia
Country of Citizenship	Indonesia
CHILDREN'S DETAIL (IF ANY)	CHILDREN'S DETAIL (IF ANY)
1. Name	Matthew Alexander
Date of Birth (mm/dd/yyyy)	28-04-2005
Place of Birth	Indonesia
2. Name	Keiko Alexandra
Date of Birth (mm/dd/yyyy)	1-03-2009
Place of Birth	Indonesia
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	Quibec
Province	Canada
CONTACT DETAILS	CONTACT DETAILS
Address	Pondok Karangasri 23, Jalan Sahara, Kebonagung, Kraksaan, Kabupaten Probolinggo,Jawa Timur, Indonesia
Contact Number	(822) 137-5878
Email Address	Email hidden; Javascript is required.
Fax Number	+6282213758789