Form view – Canadian Provincial Nominee & Immigration Services

PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING	PNP
PERSONAL INFORMATION	PERSONAL INFORMATION
Title	Ms.
First Name	Dina
Last Name	Mardiyanti
Place of Birth	Indonesia
Country of Citizenship	Indonesia
EDUCATION	Bachelor's Degree
Current Occupation	Retail store owner
Occupation in Years	Early childhood educator, social worker
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	Mr.
First Name	Warsito
Last Name	Warsito
Birth Date (m/d/y)	12/04/1976
Place of Birth	Indonesia
Country of Citizenship	Indonesia
CHILDREN'S DETAIL (IF ANY)	CHILDREN'S DETAIL (IF ANY)
1. Name	Muhammad Ulung Cakra Wardana
Date of Birth (mm/dd/yyyy)	31/01/2004
Place of Birth	Indonesia
2. Name	Nourille Aisya Cakrawardana
Date of Birth (mm/dd/yyyy)	13/08/2008
Place of Birth	Indonesia
3. Name	Iffat Akila Cakrawardana
Date of Birth (mm/dd/yyyy)	21/07/2009
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	Halifax
Province	Nova scotia
UPLOAD RESUME	inbound8376910421657461761.pdf
CONTACT DETAILS	CONTACT DETAILS
Address	Desa Pasuruhan Rt 03 Rw 01 Kecamatan Kayen kabupaten Pati
Contact Number	(628) 213-6919
Email Address	Email hidden; Javascript is required.