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Contact Information
First Name: *
Last Name: *
Nationality: *
Current Country of Residence: *
Current City of Residence: *
Email address: *
Confirm Email address: *
Phone number: *
Marital Status: *	Single Married
Number of Children: *
Ages of Children:	1. 2. 3. 4.

Canada Questions
Have you visited Canada before: *	Yes No
If yes, please specify when and where:
Do you have friend and family in Canada? *	Yes No
If yes, please specify name and city :
Have applied previously for permanent resident status in Canada? *	Yes No
Does the following apply to you or any family member (wife or children)
a) Medical problem	Medical Problem Yes No
b) Convicted or charged for criminal activity	Criminal Activity Yes No
c) Refused entry into Canada or any other country	Refused Entry Yes No
If yes, please provide details here

Financial & Employment
Net assets you have : *
Net assets are determined by adding up all your assets (property, business interests, stocks, bonds, cash etc.) and subtracting all your liabilities (mortgages, loans, etc.).
If you are the owner or co-owner of a business, what percentage do you own?*	<10% 10-50% 51-99% 100%
Your position within the business*
During the past five years, have you managed employees, either as a business owner or as a manager? *	Yes No
What is the largest number of full-time employees you have managed within the past 5 years (whether as a business owner or employee)?*	<5 5-15 15-50 50 Not Applicable

Comments

Please provide us with any questions or comments (max. 300 characters):

Terms & Conditions: I am providing my personal information to allow Optimum Investments to determine initial eligibility for Business Immigration and I acknowledge that my personal information will not be used for any other purpose without my consent. *

Please indicate the best time of day (local time) to contact you:*

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