PERSONAL INFO

First Name and Surname:
Age:
Citizenship:
Sex:	Please Select Male Female
Marital Status:	Please Select Married Never married Separated Divorced Widowed

BUSINESS MANAGEMENT DETAILS

Paste or type in details of your business management or occupational history for the past five years. Please, include:

Type of business; Your role in the business; Your duties and responsibilities within the business;

	Yes	No
Can you provide documentary proof that, over any two of the last five years, you managed at least five full-time employees (in any business)?

ASSETS

Is your net worth including the assets of your spouse/common-law partner, if applicable,

less than 300,000 Canadian Dollars?
equal to or greater than 300,000 but less than 1,600,000 Canadian Dollars?
equal to or greater than 1,600,000 Canadian Dollars?

Total liabilities (CDN):

To convert over 40 currencies to Canadian Dollars use Foreign Exchange Converter

BUSINESS DEATAILS

Please provide the following data for each of the last five years. Indicate all amounts in Canadian Dollars.

	2006	2007	2008	2009	2010
Percentage ownership of business	%	%	%	%	%
Number of full-time employees (37.5 hours per week)
Sales in thousands
Net income in thousands
Equity in thousands

SPECIAL COMMENTS

Please indicate visa refusals, serious medical problems, criminal issues, previous immigration applications:

REFERENCE TO ARIADNE COUNSELLING

Please indicate where did you find out about Ariadne Counselling:

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