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	Hans
Last Name	Ferdiansah
Birth Date (m/d/y)	02/08/1980
Place of Birth	Jakarta
Country of Citizenship	Indonesia
EDUCATION	Bachelor's Degree
LANGUAGE PROFICIENCY	LANGUAGE PROFICIENCY PRINCIPAL APPLICANT
English	Good
French	Fair
Specify Other Language	Hans Ferdiansah
MARITAL STATUS	Married
LANGUAGE PROFICIENCY SPOUSE	LANGUAGE PROFICIENCY SPOUSE
English	Good
French	Fair
Specify Other Language	Gg. Cemp. Baru Timur V No.40 6, RT.6/RW.5
SPOUSE DETAIL	SPOUSE DETAIL
Title	Mrs.
First Name	Rahmayeni
Last Name	Ferdiansah
Birth Date (m/d/y)	03/17/1981
Place of Birth	Lampung
Country of Citizenship	Indonesia
CHILDREN'S DETAIL (IF ANY)	CHILDREN'S DETAIL (IF ANY)
1. Name	Chika Putri Azahra
Date of Birth (mm/dd/yyyy)	10/28/2006
Place of Birth	Jakarta
2. Name	Mizu Ryu Putra Hafizan
Date of Birth (mm/dd/yyyy)	01/13/2013
Place of Birth	Jakarta
3. Name	Aiko Izzati Azalia
Date of Birth (mm/dd/yyyy)	11/18/2014
Place of Birth	Jakarta
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	10640
Province	Daerah Khusus Ibukota Jakarta
CONTACT DETAILS	CONTACT DETAILS
Address	Gg. Cemp. Baru Timur V No.40 6, RT.6/RW.5
Contact Number	+62817175527
Email Address	Email hidden; Javascript is required.