Form view – Canadian Provincial Nominee & Immigration Services

PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING	Skilled Worker
PERSONAL INFORMATION	PERSONAL INFORMATION
Title	Mr.
First Name	Dedy
Middle Name	Eko
Last Name	Sutrisno
Birth Date (m/d/y)	24/12/1991
Place of Birth	Banyumas
Country of Citizenship	Indonesia
EDUCATION	Secondary/High School
Other Eduction	SMA N WANGON
Current Occupation	Driver / Supir
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	Mrs.
First Name	Wulan
Last Name	Sari
Birth Date (m/d/y)	26/01/1994
Place of Birth	Cirebon
Country of Citizenship	Indonesia
CHILDREN'S DETAIL (IF ANY)	CHILDREN'S DETAIL (IF ANY)
1. Name	Queensha Dinar Salsabila
Date of Birth (mm/dd/yyyy)	17/10/2014
Place of Birth	Banyumas
2. Name	Muhammad Alby Al Khalifi
Date of Birth (mm/dd/yyyy)	20/09/2019
Place of Birth	Banyumas
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	Cawston
Province	British Columbia
CONTACT DETAILS	CONTACT DETAILS
Address	Ajibarang Kulon Rt 05/08 Kec. Ajibarang Kab. Banyumas Jawa Tengah Indonesia
Contact Number	+6285747038032
Email Address	Email hidden; Javascript is required.