Immigrate to Canada

EXPRESS ENTRY APPLICATION FORM

SUMEDH NENE
CAN-EDUCATION CONSORTUM
 Bringing you Closer to Canada
Contents

Express Entry Assessment Form............................................................................. 2

Section A Principal Applicant’s Information .......................................................................... 2
Section B Principal Applicant’s Spouse Information ............................................................. 6
Section C Other Information ................................................................................................. 8
Appendix A .......................................................................................................... 10

Sumedh Nene Page |1 India / WApp: +91.914.618.6996

Settle Me In Canada Canada: +1.416.317.6597
SettleMeInCanada@gmail.com Skype: sumedhnene
 Bringing you Closer to Canada
Express Entry Assessment Form
Section A Principal Applicant’s Information
Applicant Last Name: Click here to enter text. Referred by:Click here to enter text.
Name First Name:Click here to enter text. (if applicable)

Date of
Click here to enter a date. Sex
Birth

Address Click here to enter text.

E-mail Click here to enter text.

Home : Click here to enter text.

Phone
Mobile : Click here to enter text.

Marital
Status
Family Name Relation Date of Birth Highest Current
Members Education Occupation
Click here to Click here to enter Click here to Click here to Click here to
enter text. text. enter a date. enter text. enter text.
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enter text. text. enter a date. enter text. enter text.
Click here to Click here to enter Click here to Click here to Click here to
enter text. text. enter a date. enter text. enter text.

Language English:
Profiency
French:

Sumedh Nene Page |2 India / WApp: +91.914.618.6996

Settle Me In Canada Canada: +1.416.317.6597
SettleMeInCanada@gmail.com Skype: sumedhnene
 Bringing you Closer to Canada
Have you or your spouse been to any countries in the past 10 years for more than 6 months?

If yes, please refer to Appendix A

Have you ever been refused a visa for any countries, including Canada?

If yes, please attach a copy of the refusal letter(s)

2. Principal Applicant Education History

From To
Name of the Institution Program of Study Degree /Certificate
(Y / M) Y/M
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to enter text. text. text. enter text.
text.
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text.
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text.
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Have you
taken the Date you plan on taking it Click here to enter text.
IELTS Date Taken: Click here to enter a date. Overall Score: Click here to enter text.
Listening:Click here to enter text. Speaking: Click here to enter text.
Reading: Click here to enter text. Writing: Click here to enter text.
☐ Please tick this checkbox if the IELTS Results Copy is attached.

Sumedh Nene Page |3 India / WApp: +91.914.618.6996

Settle Me In Canada Canada: +1.416.317.6597
SettleMeInCanada@gmail.com Skype: sumedhnene
 Bringing you Closer to Canada
2a. Principal Applicant Education History in CANADA (if applicable)

Have you earned any Canadian degree, diploma or certificate?

Note that you must have:
● Studied in Canada (foreign campus doesn’t count)
● Been enrolled full time in a Canadian school for at least eight months and physically present in Canada
for at least eight months.
Start End Degree
Name of the School Program of Study
Y/M Y/M /Certificate
Please provide these details on a separate sheet of paper and attach it. Please clearly give the
sheet this title: 2a. Principal Applicant Education History In Canada
If appicable, attach copies of each Canadian degree, diploma or certificate

3. Principal Applicant Employment History

From To
Name of Employer Occupation Duty Salary
Y/M Y/ M
Please provide these details on a separate sheet of paper and attach it. Please clearly give the
sheet this title: 3. Principal Applicant Employment History

3a. Principal Applicant Employment History in CANADA (if applicable)?

In last ten years, how many years of skilled work experience do you have in Canada?
Click here to enter text. year(s).
Do you have a certificate of qualifications from a Canadian Province or Federal body?

Note: this requires experience and training from an employer in Canada, and to be assessed by the
province or federal body.
☐ Please tick this checkbox if copies of any certificate of qualification (Provincial or Federal)
are attached.

Sumedh Nene Page |4 India / WApp: +91.914.618.6996

Settle Me In Canada Canada: +1.416.317.6597
SettleMeInCanada@gmail.com Skype: sumedhnene
 Bringing you Closer to Canada
4. Principal Applicant Business Ownership (if applicable)
Company 1 Company 2
Company Name Click here to enter text. Click here to enter text.

Address Click here to enter text. Click here to enter text.

Established Click here to enter a date. Click here to enter a date.

Dissolved Click here to enter a date. Click here to enter a date.

(if applicable)
% of shares Click here to enter text. Click here to enter text.

Annual Revenue Click here to enter text. Click here to enter text.

Net Assets Click here to enter text. Click here to enter text.

Current Market Click here to enter text. Click here to enter text.
Value of Business
Nature of Business Click here to enter text. Click here to enter text.

Sumedh Nene Page |5 India / WApp: +91.914.618.6996

Settle Me In Canada Canada: +1.416.317.6597
SettleMeInCanada@gmail.com Skype: sumedhnene
 Bringing you Closer to Canada
Section B Principal Applicant’s Spouse Information
5. Spouse Education History
From To
Name of the Institution Program of Study Degree /Certificate
(Y / M) Y/M
Click
Click here Click here to enter Click here to enter Click here to
here to enter
to enter text. text. text. enter text.
text.
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here to enter
to enter text. text. text. enter text.
text.
Click
Click here Click here to enter Click here to enter Click here to
here to enter
to enter text. text. text. enter text.
text.
Click
Click here Click here to enter Click here to enter Click here to
here to enter
to enter text. text. text. enter text.
text.
Have you
taken the Date you plan on taking it Click here to enter text.
IELTS Date Taken: Click here to enter a date. Overall Score: Click here to enter text.
Listening:Click here to enter text. Speaking: Click here to enter text.
Reading: Click here to enter text. Writing: Click here to enter text.
☐ Please tick this checkbox if the IELTS Results Copy is attached.

6. Spouse Employment History

From To
Name of Employer Occupation Duty Salary
Y/M Y/ M
Please provide these details on a separate sheet of paper and attach it. Please clearly give the
sheet this title: 6. Spouse Employment History

7. Spouse’s Employment History in CANADA (if applicable)?

In last ten years, how many years of skilled work experience do you have in Canada?
Click here to enter text. year(s)

Note: Must have been paid, full-time (or an equal amount in part-time) work, and in one or more
NOC O, A or B jobs.

8. Spouse Business Ownership (if applicable)

Sumedh Nene Page |6 India / WApp: +91.914.618.6996

Settle Me In Canada Canada: +1.416.317.6597
SettleMeInCanada@gmail.com Skype: sumedhnene
 Bringing you Closer to Canada
Company 1 Company 2
Company Name Click here to enter text. Click here to enter text.

Address Click here to enter text. Click here to enter text.

Established Click here to enter a date. Click here to enter a date.

Dissolved Click here to enter a date. Click here to enter a date.

(if applicable)
% of shares Click here to enter text. Click here to enter text.

Annual Revenue Click here to enter text. Click here to enter text.

Net Assets Click here to enter text. Click here to enter text.

Current Market Click here to enter text. Click here to enter text.
Value of Business
Nature of Business Click here to enter text. Click here to enter text.

Sumedh Nene Page |7 India / WApp: +91.914.618.6996

Settle Me In Canada Canada: +1.416.317.6597
SettleMeInCanada@gmail.com Skype: sumedhnene
 Bringing you Closer to Canada
Section C Other Information
9. Applicant add Spouse Combined Value of Asset
Bank Deposit Savings account Chequing account:
1.
Bonds
2.
1.
Stock
2.
Real Estate City of the Date Purchased Mortgaged Market Ownership
Properties Property Purchased Price Amount Price (yes/no)
1.
2.
3.

Sumedh Nene Page |8 India / WApp: +91.914.618.6996

Settle Me In Canada Canada: +1.416.317.6597
SettleMeInCanada@gmail.com Skype: sumedhnene
 Bringing you Closer to Canada
10. Applicant and Spouse Family Members in Canada
Do you or your spouse or common law partner (if they will come with you to Canada) have at least
one brother or sister living in Canada who is a citizen or permanent resident?

Note that in order to answer Yes, your brother or sister must meet all the criteria below. Please
tick all that apply. They must be be:
18 years old or older
related to you or your partner by blood, marriage, common-law partnership or adoption
have a parent in common with you or your partner
A brother or sister is related to you by:

11. Information of Relative(s) Living in Canada

Name Relationship Current Residence Employment
(Province, City)
Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.

Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.

Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.

Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.

☐ Please tick this checkbox if copies of any supporting document(s) indicating affiliation for each
family member in Canada are attached.

Sumedh Nene Page |9 India / WApp: +91.914.618.6996

Settle Me In Canada Canada: +1.416.317.6597
SettleMeInCanada@gmail.com Skype: sumedhnene
 Bringing you Closer to Canada
Appendix A
Please include details of any countries you have been to in the past 10 years.

Main Applicant Spouse Child 1 Child 2

Name of Click here to enter Click here to Click here Click here to
Country 1 text. enter text. to enter text. enter text.
Click here to enter Click here to Click here Click here to
Type of Visa text. enter text. to enter text. enter text.
Name of Click here to enter Click here to Click here Click here to
Country 2 text. enter text. to enter text. enter text.
Click here to enter Click here to Click here Click here to
Type of Visa text. enter text. to enter text. enter text.
Name of Click here to enter Click here to Click here Click here to
Country 3 text. enter text. to enter text. enter text.

Click here to enter Click here to Click here Click here to

Type of Visa text. enter text. to enter text. enter text.

Name of Click here to enter Click here to Click here Click here to
Country 4 text. enter text. to enter text. enter text.
Click here to enter Click here to Click here Click here to
Type of Visa text. enter text. to enter text. enter text.
Name of Click here to enter Click here to Click here Click here to
Country 5 text. enter text. to enter text. enter text.
Click here to enter Click here to Click here Click here to
Type of Visa text. enter text. to enter text. enter text.
Name of Click here to enter Click here to Click here Click here to
Country 6 text. enter text. to enter text. enter text.
Click here to
Type of Visa enter text.

Sumedh Nene P a g e | 10 India / WApp: +91.914.618.6996

Settle Me In Canada Canada: +1.416.317.6597
SettleMeInCanada@gmail.com Skype: sumedhnene
 Bringing you Closer to Canada

Have you or your spouse been to CANADA in the past 10 years?

Main Applicant Spouse Child 1 Child 2

Journey 1: Click here to enter Click here to Click here Click here to
Type of Visa text. enter text. to enter text. enter text.
Click here to enter a Click here to Click here Click here to
Entry Date date. enter a date. to enter a date. enter a date.
Click here to enter a Click here to Click here Click here to
Exit Date date. enter a date. to enter a date. enter a date.
Journey 2: Click here to enter Click here to Click here Click here to
Type of Visa text. enter text. to enter text. enter text.
Click here to enter a Click here to Click here Click here to
Entry Date date. enter a date. to enter a date. enter a date.
Click here to enter a Click here to Click here Click here to
Exit Date date. enter a date. to enter a date. enter a date.
Journey 3: Click here to enter Click here to Click here Click here to
Type of Visa text. enter text. to enter text. enter text.
Click here to enter a Click here to Click here Click here to
Entry Date date. enter a date. to enter a date. enter a date.
Click here to enter a Click here to Click here Click here to
Exit Date date. enter a date. to enter a date. enter a date.
Journey 4: Click here to enter Click here to Click here Click here to
Type of Visa text. enter text. to enter text. enter text.
Click here to enter a Click here to Click here Click here to
Entry Date date. enter a date. to enter a date. enter a date.
Click here to enter a Click here to Click here Click here to
Exit Date date. enter a date. to enter a date. enter a date.

Sumedh Nene P a g e | 11 India / WApp: +91.914.618.6996

Settle Me In Canada Canada: +1.416.317.6597
SettleMeInCanada@gmail.com Skype: sumedhnene