| PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING | Skilled Worker |
|---|---|
| PERSONAL INFORMATION | PERSONAL INFORMATION |
| Title | Mr. |
| First Name | Andi |
| Last Name | Juarna |
| Place of Birth | Bandung |
| Country of Citizenship | Indonesia |
| EDUCATION |
|
| LANGUAGE PROFICIENCY | LANGUAGE PROFICIENCY PRINCIPAL APPLICANT |
| English |
|
| French |
|
| MARITAL STATUS | Married |
| LANGUAGE PROFICIENCY SPOUSE | LANGUAGE PROFICIENCY SPOUSE |
| English |
|
| French |
|
| SPOUSE DETAIL | SPOUSE DETAIL |
| Title | Mrs. |
| First Name | Fitri |
| Last Name | Sulastri |
| Birth Date (m/d/y) | 31-03-1990 |
| Place of Birth | Bandung |
| Country of Citizenship | Indonesia |
| CHILDREN'S DETAIL (IF ANY) | CHILDREN'S DETAIL (IF ANY) |
| 1. Name | Jasmine |
| Date of Birth (mm/dd/yyyy) | 08-12-2014 |
| Place of Birth | Bandung |
| 2. Name | Abiyyu |
| Date of Birth (mm/dd/yyyy) | 28-10-2016 |
| Place of Birth | Bandunh |
| 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 | Jl baladewa Utara no 12.rt 01/0( |
| Contact Number | (122) 482-2090 |
| Email Address | Email hidden; Javascript is required. |
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