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	Husny
Middle Name	Aditya
Last Name	Rafsanjani
Birth Date (m/d/y)	03/08/1988
Place of Birth	Wonosobo
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	Good
French	Fair
SPOUSE DETAIL	SPOUSE DETAIL
Title	Mrs.
First Name	Dea
Middle Name	Resista
Last Name	Prastiwi
Birth Date (m/d/y)	12/12/1987
Place of Birth	Wonosobo
Country of Citizenship	Indonesia
N.B. Additional information on your spouse (if applicable), i.e. education, work experience could be provided on extra Space below	Couple graduated with a bachelor:s degree in english education, initially worked as an english teacher, now work as village assistants under the auspices of the ministry of social affairs
CHILDREN'S DETAIL (IF ANY)	CHILDREN'S DETAIL (IF ANY)
1. Name	Lingga dananta rafsanjani
Date of Birth (mm/dd/yyyy)	09/08/2017
Place of Birth	Wonosobo
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	Victoria
Province	Ontario
UPLOAD RESUME	Husny-aditya-Rafsanjani.pdf
CONTACT DETAILS	CONTACT DETAILS
Address	Wonosari indah A23 003/004 wonosari, wonosobo, jawa tengah, indonesia
Contact Number	085228874710
Email Address	Email hidden; Javascript is required.