| PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING | Self Employed |
|---|---|
| PERSONAL INFORMATION | PERSONAL INFORMATION |
| Title | Mr. |
| First Name | Iketut |
| Middle Name | Iketut Suastika |
| Last Name | Suastika |
| Place of Birth | Badung |
| Country of Citizenship | Indonesia |
| EDUCATION |
|
| LANGUAGE PROFICIENCY | LANGUAGE PROFICIENCY PRINCIPAL APPLICANT |
| English |
|
| French |
|
| MARITAL STATUS | Single |
| LANGUAGE PROFICIENCY SPOUSE | LANGUAGE PROFICIENCY SPOUSE |
| SPOUSE DETAIL | SPOUSE DETAIL |
| CHILDREN'S DETAIL (IF ANY) | CHILDREN'S DETAIL (IF ANY) |
| 2. Name | Iketut Suastika |
| 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 | Antapan -baturiti-Bali-Indonesia |
| Contact Number | (036) 172-7284 |
| Email Address | Email hidden; Javascript is required. |
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