Canada Visa Questionnaire

CANADA VISA QUESTIONNAIRE
PLEASE ANSWER IN CAPITAL LETTER AND IN BOLD FONT. PUT N/A IF NOT APPLICABLE
LAST NAME: FIRST NAME:
PASSPORT NUMBER: COUNTRY OF ISSUANCE OF PASSPORT:
DATE OF BIRTH: MARITAL STATUS:
SOURCE OF INCOME:
WHO WILL PAY FOR YOUR TRAVEL?
IF SPONSORED, HOW ARE YOU RELATED WITH THE SPONSOR?
HOW MUCH IS YOUR CURRENT BALANCE ON YOUR BANK?
DETAILS OF VISIT
PLESE SPECIFY THE MAIN PURPOSE OF VISIT TO CANADA:
FROM TO Funds available for my

Indicate how long you plan stay (CAD)
to stay:
(YYYY-MM-DD) (YYYY-MM-DD)
Name, Address and relationship of any person(s) or institution(s) I will visit:
1. NAME:
Relationship to me:
Address in Canada:
EDUCATION
Have you had any post-secondary education (including university, college or apprenticeship training?)
[YES or NO]
If you answered YES, give full details of your highest level of post-secondary education.
FROM Field of Study School/Facility Name
YYYY-MM
TO City/Town Country of Territory and
State/Region
YYYY-MM
EMPLOYMENT
Give details of your employment for the past 10 years, including if you have held any government position (such as
civil servant, judge, police officer, mayor, Member of Parliament, hospital, administrator, employee of a security
organization). Do not leave gaps. If retired, not working or studying, please indicate. If you are retired, please
provide the 10 years before your retirement.
FROM Current Activity/Occupation Company/Employer/Facility Name
YYYY-DD
1
TO City/Town Country and Region
YYYY-DD
FROM Current Activity/Occupation Company/Employer/Facility Name
2 YYYY-MM
TO City/Town Country and Region
YYYY-MM
BACKGROUND INFORMATION
You must complete this section if you are 18 years old and older.
1A Within the past two years, have you or your family member ever had tuberculosis of the lungs or been in
contact with a person with tuberculosis? [YES or NO]
1B Do you have any physical or mental disorder that would require social and/or health services, other than
medication, during stay in Canada? [YES or NO]
If you answered YES to the question 1A and 1B, please provide details and the name of the family member (if
applicable).
2A Have you ever remained beyond the validity of your status, attended school without authorization in
Canada? [YES or NO]
2B Have you ever been refused a visa or permit, denied entry or ordered to leave Canada or any other country
or territory? [YES or NO]
2C Have you previously applied to enter or remain in Canada? [YES or NO]
If you answered YES to the question 2A, 2B and 2C, please provide details.
3A Have you ever committed, been arrested for, been charged with or convicted of any criminal offense in any
country or territory? [YES or NO]
If you answered YES to the question 3A, please provide details.
4A Did you serve in any military, militia, or civil defense unit or serve in a security organization or police force
(including non obligatory national service, reserve or volunteer units)? [YES or NO]
If you answered YES to question 4A, please provide dates of service and countries or territories where you served.
5 Are you, or have you ever been a member or associated with any political party, or other group or
organization which has engaged in or advocate violence as a means to achieving a political or religious
objective, or which has been associated with criminal activity at any time? [YES or NO]
6 Have you ever witnessed or participated in the ill treatment of prisoners or civilian, looting or desecration of
religious building? [YES or NO]
If you answered YES to any of the questions 3 to 6, or upon request of a visa officer, you MAY BE REQUIRED to fill
out IMM 5257 Schedule 1.
Have you lived in Canada as a permanent resident or landed immigrant?
Are you a resident of U.S.A with a valid US Citizenship and Immigration Services?
Have you travelled to other countries in the past 10 years? If YES, kindly indicate the countries.
Are you accompanying a family member that has a status in Canada or recently been approved to come to
Canada?
Have you ever committed, been arrested for, been charged with or convicted of any criminal offense in any
country?
Have you had a medical exam performed by an IRCC authorized panel physician within the last 12 months?
Have you given your fingerprints (biometrics) and photo for an application to come to Canada?
Have you applied before for a Canada visa and got a denied decision?
Can you provide soft copy [scanned or clear photo] of all the required documents if we will proceed with the
application?

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CANADA VISA QUESTIONNAIRE

LAST NAME: FIRST NAME:

PASSPORT NUMBER: COUNTRY OF ISSUANCE OF PASSPORT:

DATE OF BIRTH: MARITAL STATUS:

WHO WILL PAY FOR YOUR TRAVEL?

IF SPONSORED, HOW ARE YOU RELATED WITH THE SPONSOR?

HOW MUCH IS YOUR CURRENT BALANCE ON YOUR BANK?

FROM TO Funds available for my

Name, Address and relationship of any person(s) or institution(s) I will visit:

2C Have you previously applied to enter or remain in Canada? [YES or NO]

If you answered YES to the question 3A, please provide details.

Have you lived in Canada as a permanent resident or landed immigrant?

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