| PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING | Other |
|---|---|
| PERSONAL INFORMATION | PERSONAL INFORMATION |
| Title | Mr. |
| First Name | Kwee |
| Middle Name | Henry |
| Last Name | Kurniawan |
| Place of Birth | Bandung city - West Java |
| Country of Citizenship | Indonesia |
| EDUCATION |
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| Current Occupation | Freelance in Financial Fields |
| LANGUAGE PROFICIENCY | LANGUAGE PROFICIENCY PRINCIPAL APPLICANT |
| English |
|
| French |
|
| MARITAL STATUS | Widow/Widower |
| LANGUAGE PROFICIENCY SPOUSE | LANGUAGE PROFICIENCY SPOUSE |
| English |
|
| French |
|
| Specify Other Language | Chinese |
| SPOUSE DETAIL | SPOUSE DETAIL |
| Title | Mrs. |
| First Name | Irene |
| Middle Name | Djumiaty |
| Last Name | Hidayat |
| Birth Date (m/d/y) | 11031969 |
| Place of Birth | Bandung city |
| Country of Citizenship | Indonesia |
| CHILDREN'S DETAIL (IF ANY) | CHILDREN'S DETAIL (IF ANY) |
| 1. Name | Jemima Priscilla |
| Date of Birth (mm/dd/yyyy) | 11041998 |
| Place of Birth | Bandung city, West Java , 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? |
| CONTACT DETAILS | CONTACT DETAILS |
| Address | Taman Kopo Indah III blok E 15 no.17, Bandung 40218, West Java, Indonesia |
| Contact Number | (628) 777-5964 |
| Email Address | Email hidden; Javascript is required. |
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