| PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING | Family Class |
|---|---|
| PERSONAL INFORMATION | PERSONAL INFORMATION |
| Title | Mr. |
| First Name | Hendrik |
| Middle Name | Adi |
| Last Name | Wijaya |
| Place of Birth | Indonesia |
| Country of Citizenship | Indonesia (+62)81916699777 |
| EDUCATION |
|
| Current Occupation | Grab driver |
| Occupation in Years | 3 |
| Occupation in Months | Usd 1200 |
| LANGUAGE PROFICIENCY | LANGUAGE PROFICIENCY PRINCIPAL APPLICANT |
| English |
|
| French |
|
| MARITAL STATUS | Married |
| LANGUAGE PROFICIENCY SPOUSE | LANGUAGE PROFICIENCY SPOUSE |
| English |
|
| French |
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| SPOUSE DETAIL | SPOUSE DETAIL |
| Title | Mrs. |
| First Name | Mila |
| Middle Name | Rosiana |
| Last Name | Dewi |
| Birth Date (m/d/y) | 25/10/1987 |
| Place of Birth | Indonesia |
| Country of Citizenship | Indonesia (+62)8174782848 |
| CHILDREN'S DETAIL (IF ANY) | CHILDREN'S DETAIL (IF ANY) |
| 1. Name | Harlan orlando wijaya |
| Date of Birth (mm/dd/yyyy) | 08/01/2015 |
| Place of Birth | Imdonesia |
| 2. Name | Marielyn Melvyn Wijaya |
| Date of Birth (mm/dd/yyyy) | 08/07/2016 |
| 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 | Any city |
| Province | Any privince |
| CONTACT DETAILS | CONTACT DETAILS |
| Address | Jalan gunung kalimutu no 29A denpasar bali |
| Contact Number | (361) 747-8284 |
| Email Address | Email hidden; Javascript is required. |
Hi, How Can We Help You?
- Address: Madison Centre Tower | 4950 Yonge Street | Suite 1000 | Toronto | Ontario | M2N 6K1
- Email Address: inquiry@cpnis.com
