North American Immigration Network (NAIN)

Canadian Immigration Specialists

Korean

Assessment Form

This form will be used to provide an initial free assessment of your request. A separate form will be needed for each applicant. If spouse is employed a separate form will be needed.

Personal Information

Name
Address
Address (cont.)
Home Phone
Work Phone
Facsimile
E-Mail
Date of Birth	Place of Birth SexMale Female
Nationality
Do you have a valid passport?	Yes No Number Expiry
Country of primary residence?	(last 10 years)
Marital Status
Spouse's Name
Spouse's Education
Spouse's Occupation
Will spouse be residing with you?	Yes No Will spouse be working in Canada? Yes No
Number of Children	Ages
Will children be residing with you?	Yes No
Relatives in Canada

Immigration History

Do you or any of your family members have any past Canadian immigration history?Yes No

If yes, please explain...

Which consulate/embassy did you or they apply?

Have you or any of your immediate family members ever been denied a Canadian/US Visa? Yes No

If yes, please explain...

Language Ability

	English	French
Speak
Write
Read

Education

Secondary/High School	From	Name & Country of Institution
	To	Certificate Received
College/University	From	Name & Country of Institution
	To	Certificate Received
Technical/Vocational Apprenticeship	From	Name & Country of Institution
	To	Certificate Received
Other	From	Name & Country of Institution
	To	Certificate Received

Business & Occupational History

Present	From	Employer
	To	Title
		Description
Previous	From	Employer
	To	Title
		Description
Previous	From	Employer
	To	Title
		Description

Assets & Liabilities

Please estimate the total value of your assets (including fixed assets and liquid assets) and of your current liabilities:
Assets: US$
Liabilities: US$
Transferable Money: US$

Additional Information

Do you or any other family member have any of the following:

Any past or present medical conditions? Yes No

If yes, please explain...

Past criminal history in Canada or any other country? Yes No

If yes, please explain...

Please provide any additional information that you feel may assist with our assessment:

The above information is provided in confidentiality to North American Immigration Network, and will not be disclosed without prior authorization by the applicant.

Note: If this application is completed and transmitted back via e-mail, its confidentiality cannot be guaranteed.

Korean