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	I Gede
Middle Name	Jeni
Last Name	Sastrawan
Place of Birth	Penyaringan
Country of Citizenship	Indonesia
EDUCATION	Bachelor's Degree
LANGUAGE PROFICIENCY	LANGUAGE PROFICIENCY PRINCIPAL APPLICANT
English	Fair
French	Fair
MARITAL STATUS	Married
LANGUAGE PROFICIENCY SPOUSE	LANGUAGE PROFICIENCY SPOUSE
English	Fair
French	Fair
SPOUSE DETAIL	SPOUSE DETAIL
Title	Ms.
First Name	I Ketut
Last Name	Widiastini
Birth Date (m/d/y)	24/05/1981
Place of Birth	Negara
Country of Citizenship	Indonesia
CHILDREN'S DETAIL (IF ANY)	CHILDREN'S DETAIL (IF ANY)
1. Name	I Putu Andika Prayoga
Date of Birth (mm/dd/yyyy)	20/01/2003
Place of Birth	Negara
2. Name	I Made Nova Cakra Prasetya
Date of Birth (mm/dd/yyyy)	10/11/2004
Place of Birth	Mataram
3. Name	I Komang Pryadi Tria Pramarta
Date of Birth (mm/dd/yyyy)	04/06/2008
Place of Birth	Cakranegara
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	Ontario
Province	Regina
UPLOAD RESUME	inbound1838296279.pdf
CONTACT DETAILS	CONTACT DETAILS
Address	Plawa street 1 /5 Baler Bale Agung Negara Bali
Contact Number	(081) 805-6629
Email Address	Email hidden; Javascript is required.