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East Wind Immigration and Investment Services
(A Division of East Wind International Limited)

Preliminary Questionnaire Form

Thanks for your recent quarry for Immigration. In order to properly assess your qualifications for Immigration, you are asked to complete a preliminary questionnaire form. There is no fees or obligation for this service and all information is held in strictest confidence.

Category under which you are applying
	Independent	Business	Self Employed

Principal Applicant

Spouse

Name (as in passport)

Sex

Male

Female

Date of Birth

(DD-MM-YYYY)

Place of Birth

Town / City
Country

Marital Status

	Never married		Married
	Widowed		Divorced
	Engaged		Legally Separated

Total Years of Education

Highest Level of Education

	S.S.C		H.S.C
	Bachelor Degree		Master’s
	Ph. D		Other’s

Knowledge in English & French

English

French

	Fluent
	Good
	Weak

	Fluent
	Good
	Weak
	Nil

Current Occupation

Years of Job Experience

Name (as in passport)

Sex

Male

Female

Date of Birth

(DD-MM-YYYY)

Place of Birth

Town / City
Country

Marital Status

	Never married		Married
	Widowed		Divorced
	Engaged		Legally Separated

Total Years of Education

Highest Level of Education

	S.S.C		H.S.C
	Bachelor Degree		Master’s
	Ph. D		Other’s

Knowledge in English & French

English

French

	Fluent
	Good
	Weak

	Fluent
	Good
	Weak
	Nil

Current Occupation

Job Experience / Business
From	To	Name Of Employer / Business	Location	Position

Applicant Monthly Gross Income Tk.

Applicant Relatives In Canada

Relationship

Immigration Status

Spouse Monthly Gross Income Tk.

Spouse Relatives In Canada

Relationship

Immigration Status

Business Experience : (If any)


% Ownership of a business	%
% Ownership of a business	%

Personal Net Worth (Assets minus liabilities)

	Under US $ 20,000.00		Under US $20,000.00 - 1,00,000.00
	Under US $1,00,000.00 - 2,50,000.00		Under US $2,50,000.00 - 5,00,000.00
	Under US $5,00,000.00 - 10,00,000.00		Over US $ - 10,00,000.00

Do you have a business which plans to make a substantial investment in Canada or the USA?

Yes

If yes, approximate amount of investment

US $

Do you have a business which does a substantial amount of trade with the USA?

Yes

If yes, approximate Annual amount

US $

Does your business or employer wish to transfer you to a related company in the USA or Canada?

Yes

If yes, in what position?

Have you ever applied for Immigration to Canada or the USA before?

Yes

Thank you for completing this questionnaire.

Your Mailing Address

Name:
Address:

Telephone
Residence:		Office:		Mobile:

Fax:

E-mail: