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Family Sponsorship Free Assessment Form
FAMILY SPONSORSHIP FREE ASSESSMENT FORM
QUESTIONS ABOUT THE SPONSOR (CANADIAN CITIZEN OR PERMANENT RESIDENT)
A. SPONSOR PERSONAL DETAILS
Family Name
*
Given Name
Gender
Male
Female
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Home Phone Number
Business Phone Number
Mobile Phone Number
*
Fax Number
E-mail Address
*
E-mail Address*
Confirm E-mail Address*
Alternate E-mail Address
Place of Birth
Citizenship
Date of Birth
Are you a Canadian citizen?
Yes
No
Are you a Canadian permanent resident?
Yes
No
When did you become a permanent resident?
Country of Residence
B. WHO DO YOU WANT TO SPONSOR? (CHECK ONE OR MORE)
Spouse (husband or wife)
Common-law partner
Conjugal Partner
Child
Parent
Grandparent
Orphan
Adopted child
Please provide details about who you want to sponsor including the number of people you want to sponsor and their relationship to you and to each other
If you need more information about the types of relatives you can sponsor, please refer to the
Family Class
page.
C. SPONSOR ANNUAL INCOME
Are You Employed?
Yes
No
What was your total income for the last year in Canadian dollars?
Are you married, or do you have a common-law partner?
Yes
No
Is your spouse or common-law living with you in Canada?
Yes
No
Is your spouse or common-law partner employed?
Yes
No
How many children under the age of 19 do you have?
How many people do you intend to sponsor?
What will be your total family size, including yourself, when the person(s) you want to sponsor arrive in Canada?
Please provide any important details about your family size and income here
D. SPONSOR ELIGIBILITY DETAILS
Have you yourself been sponsored within the past 5 years?
Yes
No
Have you sponsored anyone else within the past 3 years?
Yes
No
Are you subject to a removal order?
Yes
No
Are you detained in any penitentiary, jail, reformatory, or prison?
Yes
No
Have you been convicted of a sexual offence within the past 5 years?
Yes
No
Have you been convicted of a violent crime or a crime that resulted in bodily harm within the past 5 years?
Yes
No
Are you in default of any previous undertaking or any support payments ordered by a court?
Yes
No
Are you an undischarged bankrupt?
Yes
No
Are you in receipt of social assistance for any reason other than a disability?
Yes
No
If you answered yes to any of the above questions, please provide details here
2. QUESTIONS FOR THE APPLICANT (PERSON TO BE SPONSORED)
A. APPLICANT PERSONAL DETAILS
Family Name
Given Name
Gender
Male
Female
Date of Birth
Address
Street
Apartment
City
State
Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Home Phone Number
Business phone number
Mobile Phone Number
Fax Number
E-mail Address
E-mail Address
Confirm E-mail address
Alternate E-mail address
Place of Birth
Citizenship
Are you married or do you have a common-law partner?
Yes
No
Do you have any children?
Yes
No
If yes, how many children do you have and what are their ages?
B. APPLICANT ADMISSIBILITY
HAVE YOU, YOUR SPOUSE, OR ANY OF YOUR CHILDREN
Had any serious disease or physical or psychological disorder?
Yes
No
Been convicted of or are currently charged with a criminal offence in any country?
Yes
No
Applied previously for a temporary visa to Canada?
Yes
No
Applied previously for permanent residence in Canada?
Yes
No
Been refused a visa to Canada or any other country?
Yes
No
Been refused admission to or order removed from Canada or any other country?
Yes
No
Been involved in the commission of human rights violations, acts of subversion, espionage, terrorism, or organized criminality?
Yes
No
If you have replied “yes” to any of the above questions, please provide details
C. FINAL DETAILS
If there is anything else that you believe is important in relation to your case please note it here.
DECLARATION
*
I certify that the above information provided by me in the Free Assessment is true.*
*
Furthermore, I consent to the law office of Matthew Jeffery, Barrister & Solicitor, contacting me in relation to the above Free Assessment.*
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