Form view – Canadian Provincial Nominee & Immigration Services

PLEASE SPECIFY CATEGORY FOR WHICH YOU ARE APPLYING	Family Class
PERSONAL INFORMATION	PERSONAL INFORMATION
Title	Mr.
First Name	Edwin
Last Name	Tejasukmana
Place of Birth	Cimahi
Country of Citizenship	Indonesia
EDUCATION	Secondary/High School
Current Occupation	Warehouse & Inventory Control
Occupation in Years	5
LANGUAGE PROFICIENCY	LANGUAGE PROFICIENCY PRINCIPAL APPLICANT
English	Very Good
French	Fair
Specify Other Language	Bahasa
MARITAL STATUS	Married
LANGUAGE PROFICIENCY SPOUSE	LANGUAGE PROFICIENCY SPOUSE
English	Very Good
French	Fair
SPOUSE DETAIL	SPOUSE DETAIL
Title	Mrs.
First Name	Lisda
Last Name	Dewi
Birth Date (m/d/y)	28/06/1984
Place of Birth	Bandung
Country of Citizenship	Indonesia
CHILDREN'S DETAIL (IF ANY)	CHILDREN'S DETAIL (IF ANY)
1. Name	Mikaila Maryam
Date of Birth (mm/dd/yyyy)	29/12/2014
Place of Birth	Bandung
2. Name	Maryam Malik
Date of Birth (mm/dd/yyyy)	18/03/2021
Place of Birth	Bandung
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	Ciparay
Province	Jawa Barat
UPLOAD RESUME	CV-Edwin-Tejasukmana-2022.pdf
CONTACT DETAILS	CONTACT DETAILS
Address	Permata Regency Ciparay Blok D no 7 RT 001/018 Desa Bumiwangi
Contact Number	(083) 829-1323
Email Address	Email hidden; Javascript is required.