| PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING | Self Employed |
|---|---|
| PERSONAL INFORMATION | PERSONAL INFORMATION |
| Title | Mr. |
| First Name | Jevon |
| Last Name | Hautomo |
| Birth Date (m/d/y) | 10021996 |
| Place of Birth | Surabaya |
| Country of Citizenship | Indonesia |
| EDUCATION |
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| LANGUAGE PROFICIENCY | LANGUAGE PROFICIENCY PRINCIPAL APPLICANT |
| English |
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| French |
|
| Specify Other Language | Mandarin |
| MARITAL STATUS | Married |
| LANGUAGE PROFICIENCY SPOUSE | LANGUAGE PROFICIENCY SPOUSE |
| English |
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| French |
|
| SPOUSE DETAIL | SPOUSE DETAIL |
| Title | Mrs. |
| First Name | Grace |
| Last Name | Vincentia |
| Birth Date (m/d/y) | 23121991 |
| Place of Birth | Surabaya |
| 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 | She was an excellent make up artist, can cook very delicious food and can take care of dog |
| CHILDREN'S DETAIL (IF ANY) | CHILDREN'S DETAIL (IF ANY) |
| 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 |
| CONTACT DETAILS | CONTACT DETAILS |
| Address | Pakis tirtosari 16/29 |
| Contact Number | +6283857822201 |
| Email Address | Email hidden; Javascript is required. |
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- Address: Madison Centre Tower | 4950 Yonge Street | Suite 1000 | Toronto | Ontario | M2N 6K1
- Email Address: inquiry@cpnis.com
