| PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING | Other |
|---|---|
| PERSONAL INFORMATION | PERSONAL INFORMATION |
| Title | Mrs. |
| First Name | Maryam |
| Last Name | Farzaneh |
| Place of Birth | Iran/Tehran |
| Country of Citizenship | Tehran |
| EDUCATION |
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| Current Occupation | Lecturer in University of Applied Science and Technology |
| Occupation in Years | R&D Researcher in pharmaceutical companies for 6 years(full time) and since 2008 part time |
| LANGUAGE PROFICIENCY | LANGUAGE PROFICIENCY PRINCIPAL APPLICANT |
| English |
|
| French |
|
| MARITAL STATUS | Married |
| LANGUAGE PROFICIENCY SPOUSE | LANGUAGE PROFICIENCY SPOUSE |
| English |
|
| French |
|
| SPOUSE DETAIL | SPOUSE DETAIL |
| Title | Mr. |
| First Name | Shahin |
| Last Name | Habibi |
| Birth Date (m/d/y) | 03/09/1976 |
| Place of Birth | Iran/Tehran |
| Country of Citizenship | Iran |
| N.B. Additional information on your spouse (if applicable), i.e. education, work experience could be provided on extra Space below | Civil Engineer |
| CHILDREN'S DETAIL (IF ANY) | CHILDREN'S DETAIL (IF ANY) |
| 1. Name | Arman |
| Date of Birth (mm/dd/yyyy) | 25/03/2008 |
| Place of Birth | Iran |
| 2. Name | Hoomun |
| Date of Birth (mm/dd/yyyy) | 11/09/2013 |
| Place of Birth | Iran |
| DO YOU HAVE ANY RELATIVES IN CANADA? | Yes |
| WHERE DO YOU INTEND TO LIVE IN CANADA? | WHERE DO YOU INTEND TO LIVE IN CANADA? |
| City/Town | Toronto or Corner Brook |
| Province | Ontorio |
| CONTACT DETAILS | CONTACT DETAILS |
| Address | No. 34, 11th Ave., North Golnaz, 1st Sq. of Sadeghieh, Tehran, Iran |
| Contact Number | (912) 439-7694 |
| Email Address | Email hidden; Javascript is required. |
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- Email Address: inquiry@cpnis.com
