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Assessment Form

Personal Details

Family Name after Married (If Applicable)
Sex

Passport Details

Have you previously been married or in a common-law partnership?
From
To

Family Member who may or may not be accompanying you. It is imperative that the principal applicant declare all the members of his family. (for the definition of family member, Spouse, de facto spouse and dependent child, see definition on the detachable page)

List every place where you have lived in the past 10 years.

Education, excluding elementary school (Start with your most recent degree/ diploma)

Degree / Certificate Awarded
Name of the University / Institute
Name of the Course Completed ( Please mention the Stream)
Course Duration
From
To
City or Town and Country
Full Time /Part Time

Employment during the past 10 Years, Including military services (Start with your most recent job)

Designation
From Date
To date
Name of Company including you own and country where it is located ( Enter full Name – no Abbreviations )

Stayed in Any other country other than India over the last 10 Years

For full time studies
To work fulltime including a youth exchange program EX: (Working holiday program)
For business
Other reasons ( Specify)
If your answer to any of these questions is YES, provide details.

Did you Give IELTS Exam for English Proficiency

If Yes Please provide the IELTS score results.
Listening
Reading
Writing
Speaking

Any Family members residing in any other country with the Status as (Permanent Residents or citizens)

Have you received an offer of employment from other countries

Personal Details of Parents and Siblings

I CONFIRM AND DECLARE THAT ALL THE INFORMATION FURNISHED IN THIS WORK SHEET IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AND I SHALL BE FULLY RESPONSIBLE IF THE ABOVE INFORMATION IS FOUND TO BE FALSE AT ANY POINT OF TIME.