| PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING | Business Class |
|---|---|
| PERSONAL INFORMATION | PERSONAL INFORMATION |
| Title | Mr. |
| First Name | Okta |
| Middle Name | Trisetyo |
| Last Name | Wahono |
| Place of Birth | Kediri |
| Country of Citizenship | Indonesian |
| EDUCATION |
|
| LANGUAGE PROFICIENCY | LANGUAGE PROFICIENCY PRINCIPAL APPLICANT |
| English |
|
| French |
|
| Specify Other Language | Dutch |
| MARITAL STATUS | Married |
| LANGUAGE PROFICIENCY SPOUSE | LANGUAGE PROFICIENCY SPOUSE |
| English |
|
| French |
|
| Specify Other Language | Duchtce |
| SPOUSE DETAIL | SPOUSE DETAIL |
| Title | Mrs. |
| First Name | rini |
| Middle Name | Agustina |
| Last Name | Agustina |
| Birth Date (m/d/y) | 01-07-1982 |
| Place of Birth | 01-07-1982 |
| Country of Citizenship | Indonesia |
| CHILDREN'S DETAIL (IF ANY) | CHILDREN'S DETAIL (IF ANY) |
| 1. Name | Pritanaya |
| 3. Name | achmad aria sasmita wahono |
| 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 | Montreal |
| CONTACT DETAILS | CONTACT DETAILS |
| Address | jln. Gajah oyo, dusun sumberbahagia, kelurahan gadungan,kecamatan puncu, Kabupaten kediri, provinsi JAWATIMUR, negara Indonesia |
| Contact Number | (135) 815-2970 |
| Email Address | Email hidden; Javascript is required. |
| Fax Number | rinipenjahit88@gmail.com |
Hi, How Can We Help You?
- Address: Madison Centre Tower | 4950 Yonge Street | Suite 1000 | Toronto | Ontario | M2N 6K1
- Email Address: inquiry@cpnis.com
