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	Ida bagus
Middle Name	Gina madriana
Last Name	Putra
Place of Birth	Singaraja
Country of Citizenship	81114
EDUCATION	Secondary/High School
Other Eduction	Diploma
Current Occupation	Bartender
Occupation in Years	5 years
LANGUAGE PROFICIENCY	LANGUAGE PROFICIENCY PRINCIPAL APPLICANT
English	Very Good
French	Good
MARITAL STATUS	Married
LANGUAGE PROFICIENCY SPOUSE	LANGUAGE PROFICIENCY SPOUSE
English	Very Good
French	Good
SPOUSE DETAIL	SPOUSE DETAIL
Title	Ms.
First Name	Komang
Last Name	Suharyani
Birth Date (m/d/y)	08 04 1991
Place of Birth	Balikpapan
Country of Citizenship	81114
CHILDREN'S DETAIL (IF ANY)	CHILDREN'S DETAIL (IF ANY)
1. Name	Ida bagus gina raditya
Date of Birth (mm/dd/yyyy)	23 02 2011
Place of Birth	Singaraja
2. Name	Ida bagus gina asvathama
Date of Birth (mm/dd/yyyy)	14 11 2014
Place of Birth	Singaraja
DO YOU HAVE ANY RELATIVES IN CANADA?	No
WHERE DO YOU INTEND TO LIVE IN CANADA?	WHERE DO YOU INTEND TO LIVE IN CANADA?
CONTACT DETAILS	CONTACT DETAILS
Address	Jalan pulau riau gang 1 no 1 singaraja - balu
Contact Number	(812) 370-3955
Email Address	Email hidden; Javascript is required.