Form view – Canadian Provincial Nominee & Immigration Services

PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING	Family Class
PERSONAL INFORMATION	PERSONAL INFORMATION
Title	Mr.
First Name	Madika
Middle Name	Tara
Last Name	Sandy
Birth Date (m/d/y)	04/01/1987
Place of Birth	Indonesia
Country of Citizenship	Indonesia
EDUCATION	Secondary/High School
LANGUAGE PROFICIENCY	LANGUAGE PROFICIENCY PRINCIPAL APPLICANT
English	Good
French	Fair
MARITAL STATUS	Married
LANGUAGE PROFICIENCY SPOUSE	LANGUAGE PROFICIENCY SPOUSE
English	Good
French	Fair
SPOUSE DETAIL	SPOUSE DETAIL
Title	Ms.
First Name	Fransisca
Last Name	Kuswantini
Birth Date (m/d/y)	30/03/1988
Place of Birth	Indonesia
Country of Citizenship	Indonesia
CHILDREN'S DETAIL (IF ANY)	CHILDREN'S DETAIL (IF ANY)
1. Name	Gwen Eleanor
Date of Birth (mm/dd/yyyy)	03/02/2022
Place of Birth	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?
City/Town	Toronto
Province	Ontario
CONTACT DETAILS	CONTACT DETAILS
Address	Jl Cimanuk 2 No 63
Contact Number	6282122337723
Email Address	Email hidden; Javascript is required.