Assessment Form

1. Your Contact Information:

First Name: Middle Name:

Last Name:

Email Address:

Residence Address:

Telephone: (Include Country and City code)

Nationality:

2. Your Personal Profile:

Date of Birth:

Age:

Marital Status:

Have you previously been married or in a common law relationship? No

3. Spouse Profile Details:

Name:

Date of Birth:

Qualification:

Will Your Spouse be Accompany With You No

 4. What is your Country of Residence:

5. The country where you are currently located?

6. What is your preferred destination in Abroad?

7. Do you have any Dependent Children?

8. Have you previously submitted a visa application? Yes

9. Your Personal Net Worth:

(Your Personal Net Worth is the current value of all the assets (e.g. properties,
investments, stocks, bonds, bank accounts) that you (and your spouse/common-law
partner, if applicable) personally own, MINUS the current value of all your combined
personal liabilities (e.g. mortgages, loans, credit card balances).
Please be sure to include your share of the value of any businesses that you own.

Net worth (INR):

10. Your Language Skills:

Speak Read Write Listen

English:
French:

11. Education:

Course Detail Course name Part time/Full time Start /End Date

PHD (Regular/Correspondence):

Master Degree (Regular/Correspondence):

Bachelor Degree (Regular/Correspondence):

Other Diploma/Certificate
(Regular/Correspondence):
10th& 12th (Regular/Correspondence):
 12. Your Work History:

Have you ever worked in any other country in a skilled occupation for at least one year? Other
Have you done any paid work anywhere in the world during the last 10 years?
Yes

Total Years of Work Experience:

DETAILS OF WORK EXPERIENCE:

Company Name Designation Start End Duration Country

Date Date (Years)
Employment 1

Employment 2

Employment 3

Employment 4

Employment 5

Additional Information:-

13. Annual Income (INR):

14. Do you have an abroad Job Offer? Other

15. Family and Friends in Any other country: Yes

a) Do you have any family members, relatives, or close friends living in abroad? No

b) Which country do they reside?

16. Do you have any criminal records? If Yes, Explain:

17. Have you ever refused any visa? If Yes, Explain:

18. Are you able to obtain a clean Police Clearance Record with no criminal record? No

19. Do you have any medical problem? If Yes, Explain:

Thank you For Your Response