Form view – Canadian Provincial Nominee & Immigration Services

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PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING	Skilled Worker
PERSONAL INFORMATION	PERSONAL INFORMATION
Title	Mr.
First Name	anaduita
Middle Name	bagus
Last Name	I gusti agung
Place of Birth	Pohsanten, Bali
Country of Citizenship	Indonesia
EDUCATION	College
Other Eduction	Hospitality Training Center
Current Occupation	Farmer
Occupation in Years	8 Years working with Holland America Cruise Line
Occupation in Months	6 years working as a freelance surfing instructor
LANGUAGE PROFICIENCY	LANGUAGE PROFICIENCY PRINCIPAL APPLICANT
English	Very Good
French	Fair
Specify Other Language	No french
MARITAL STATUS	Married
LANGUAGE PROFICIENCY SPOUSE	LANGUAGE PROFICIENCY SPOUSE
English	Fair
French	Fair
Specify Other Language	no french
SPOUSE DETAIL	SPOUSE DETAIL
Title	Mrs.
First Name	Krisna Dewi
Middle Name	Ari
Last Name	Ni Kadek
Birth Date (m/d/y)	19/08/1988
Place of Birth	Pekutatan, Bali
Country of Citizenship	Indonesia
CHILDREN'S DETAIL (IF ANY)	CHILDREN'S DETAIL (IF ANY)
1. Name	Agung Bagus Arron Ariana Putra
Date of Birth (mm/dd/yyyy)	13/04/2013
Place of Birth	Mendoyo, Jembrana, Bali, Indonesia
2. Name	Agung Ayu Aurellia Ariana Putri
Date of Birth (mm/dd/yyyy)	12/06/2015
Place of Birth	Mendoyo, Jembrana, Bali, Indonesia
3. Name	anaduita I gusti agung bagus
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	Vancouver
Province	BC
CONTACT DETAILS	CONTACT DETAILS
Address	Cilinaya st. 182. Banjar Rangdu, Pohsanten, Mendoyo, Jembrana, Balu, Indonesia 82261
Contact Number	(628) 133-9475
Email Address	Email hidden; Javascript is required.