CANADIAN SPONSOR'S PERSONAL INFORMATION

First name and surname:
Date of birth:	Month: - 01 02 03 04 05 06 07 08 09 10 11 12 Year:
Sex:	Please Select Male Female
Your status in Canada:	Please Select Citizen Permanent Resident
What country are you residing in at present time?
Relative you'd like to sponsor:	Please Select Spouse Common-Law Partner Conjugal Partner Dependent Child Parent Grandparent Orphaned Brother/Sister Orphaned Niece/Nephew
Your total income amount for the last 12 months in CND$:
Have you sponsored anyone before:	Please Select Yes No
If positive, indicate relative you have sponsored:	Please Select Spouse Common-Law Partner Conjugal Partner Dependent Child Parent Grandparent Orphaned Brother/Sister Orphaned Niece/Nephew
How many years ago did you sponsor the relative:
If you applied for social assistance, bankruptcy, support payment during the sponsorship, please provide details:
Have you been convicted of, or are currently charged with, on trial for, or party to a crime or offense, or subject of any criminal proceedings in any country:	Please Select Yes No
If you answered positive to the previous question, please provide details:

SPONSORED FOREIGNER'S PERSONAL INFORMATION

First name and surname:
Age of the applicant:
Sex of the applicant:	Please Select Male Female
Country of nationality of the applicant:
Country of residence of the applicant:
Has your relative criminal record:	Please Select Yes No
If your relative has criminal record, please provide details:
If you sponsor a spouse or common-law or conjugal partner, provide details about the relationship: when and how you met; how the relationship progressed; whether you have been living together:

DECLARATION

	Yes	No
I certify that I understand all the questions and the information provided by me for the assessment are true, accurate and complete. I realize that if the submitted information is not true, accurate and/or complete the assessment result is nul and void.