Citizenship Application Assessment Form All information submitted is kept strictly confidential. View Privacy Policy A. PERSONAL DETAILSFull Name*Email Address*Phone Number*Gender*MaleFemaleAddress*City*State/Province*Zip/Postal Code*Place of Birth*Date of Birth*(If the calendar icon does not work, please manually enter the date using YYYY-MM-DD format)Citizenship*Country of Residence*Number of Children*Marital Status*Please selectSingle / Never MarriedMarriedDivorced / WidowedCommon LawConjugal Relationship Are you a permanent resident of Canada?*YesNoWhen did you obtain permanent residence?*(If the calendar icon does not work, please manually enter the date using YYYY-MM-DD format)Prior to obtaining permanent residence, were you a temporary resident in Canada?*YesNoDuring what period were you a temporary resident?*Have you physically resided in Canada for at least 3 years in the past 5 years?*YesNoHow many days have you been in Canada in the last 5 years?*How often have you travelled out of Canada in the past five years*Please selectDid not travelOccasionallyFrequentlyWhat countries have you travelled to in the past 5 years?*Are you able to speak English or French*YesNoWhat language do you speak?*What level is your English or French at? *Please selectFluentModerateBasicNoneHave you been filing income tax returns in Canada for at least 3 of the past 5 years?*YesNoB. APPLICANT ADMISSIBILITYHave you been convicted of or are currently charged with a criminal offence in any country?*YesNoAre you currently under a removal order?*YesNoAre you imprisoned, on parole, or on probation?*YesNoHas your Canadian citizenship previously been revoked?*YesNoHave you been convicted of human rights violations, war crimes or crimes against humanity, acts of subversion, espionage, or terrorism? *YesNoIf you have replied “yes” to any of the above questions, please provide details:C. FINAL DETAILSIf there is anything else that you believe is important in relation to your case please note it here:DECLARATIONUpload Identification*Please include a photo ID, (driver's license or passport etc.), to ensure the authenticity of your inquiry. All information provided are kept confidential as outlined in our Privacy Policy.I certify that the above information provided by me in the Free Assessment is true and I agree to Matthew Jeffery's Privacy Policy & Use of Terms.*Yes, TrueFurthermore, I consent to the law office of Matthew Jeffery, Barrister & Solicitor, contacting me in relation to the above Free Assessment.*YesSendThis field should be left blank