1294E Study Permit

1294E Study Permit dummy form

PLEASE USE UPPER CASE LETTERS
Your REF:*
Check your invoice right top corner
I want service in *
Personal details
Family name/Surname/ Last name*
As per your passport
Given names*
As per your passport or travel document
Have you ever use any other names?*

YesNo
Family name/Last names/Surnames/names (alias)
As per your passport or travel document
Given names (alias)
As per your passport or travel document
Sex*
Date of birth*

YearMonthDay
Place of birth*
City/Town as per your passport
Country*
Citizenship*
Current country of residence*
Status*
8.Previous country of residence (If you have resided in any country other than your country of citizenship for duration of more than 6 months select yes otherwise select no)

YesNo
Country 1 where you live for more than 6 months in past five years
In past five years have you lived in any country other than your country of citizen for the period of more than 6 months then provide details
What was your status in that country 1
Country 2 where you live for more than 6 months in past five years
In past five years have you lived in any country other than your country of citizen for the period of more than 6 months then provide details
What was your status in that country 2
Country where applying: is the same as current country of residence? If you are in India and applying within India select "yes"*

YesNo
Choose the Country from this list if you are not applying from your country of citizenship
In past five years have you lived in any country other than your country of citizen for the period of more than 6 months then provide details
Choose your status of your residence if you are not applying from your country of citizenship
Your maritial status?*
If you are married or have common-law partner

Fill the following two fields 10 b) and 10 c-1) only if you are married or have common-law partner other wise leave blank
if you are married or in common-law relationship provide the date since when you are in this relationship.

YearMonthDay
Provide the details name of spouse or common law partner
Surname/Lastname/Family name
Given names
Given names
Have you previously been married or have common law partner?*

YesNo
Give details of previous spouse/common law partner
Surname/Lastname/Family name
Given names
Given names
Date of birth of spouse/common law partner

YearMonthDay
Type of relationship
From which date you are in relationship?

YearMonthDay
To which date you are in relationship?

YearMonthDay
Language(s)
Mother tongue*
Are you able communicate in English/French?*
In which language are you at most ease?
Have you taken test from designated test agency?*

YesNo
Passport

Your passport expiry date must not be less than six months at the time of application of the visa.
Passport number*
Country of issue*
Issue date*

YearMonthDay
Expiry date*

YearMonthDay
Contact information
1. Current mailing address (Give your current address where you can be contacted by post it could be different from your passport address if you have change your home)
P O Box
Apt/Unit
Street no.
Street name*
City/Town*
District
Country*
Post code
2. Residential Address
Is your residential same as mailing address?*

YesNo
2 a) P O Box
2 b) Apt/Unit
2 c)Street no.
2 d)Street name
2 e) City/Town
2 f)District
2 g)Country
2 h)Post code
3. Telephone number:
Choose all that are applicable*

Canda/UsOther
Type of phone #*
Phone Number*
4. Alternative telephone number:
choose one

Canda/UsOther
Alt Type of phone #
Alt Phone Number
6. Email address:
E-mail*
example@example.com
Details of intended study in Canada
1. I have been accepted at following educational institute (Attach the original letter of Acceptance)
a)Name of school*
b)My level of study will be:*
c)My field of study will be:*
d) Complete address of school in Canada
Province*
City/Town*
Address*
2 a)Designated Learning institute # (O#)*
2 b)My student id # *
3. Duration of Expected study
From*

YearMonthDay
To*

YearMonthDay
4. The cost of my study will be:
Tuition*
room and board*
other*
5. Fund available for my stay*
CAD
6 a) My expense in Canada will be paid by*
b) Other
Education (Section E)

Give your highest degree here
Have you had any post secondary education? (E.g. University, College or apprenticeship training? )*

YesNo
From when

YearMonthday
Field and level of study
School Name/College/University name
To when

YearMonthday
City/Town of institute
State of institute
Country of institute
Employment

Give details of 10 years of employment details. In case of student leave the fields blank details.
Do you have work experience?

YesNo
Detail of Job1

Your most recent work
Year of joining job 1
YYYY
Month of joining job 1
MM
Current activity/Occupation job 1
Designation
Company/Employer/Facility Name job 1
Year of leaving job 1
YYYY
Month of leaving job 1
MM
City/Town job 1
Country job 1
Detail of Job2

Your previous work if any and if yo do not have any other job please leave fields blank
Year of joining job 2
YYYY
Month of joining job 2
MM
Current activity/Occupation job 2
Designation
Company/Employer/Facility Name job 2
Year of leaving job 2
YYYY
Month of leaving job 2
MM
City/Town job 2
Country job 2
Please give details of your previous education of last 10 years apart from your most recent education which you have mentioned in Section E above.

Leave the fields blank which are not applicable to you.
Year of entering 12 (HSC)
YYYY
Month of entering 12 (HSC)
MM
School name 12 (HSC)
Year of leaving 12 (HSC)
YYYY
Month of leaving 12 (HSC)
MM
City/Town 12 (HSC)
Country 12 (HSC)
Year of entering 10 (SSC)
YYYY
Month of entering 10 (SSC)
MM
School name 10 (SSC)
Year of leaving 10 (SSC)
YYYY
Month of leaving 10 (SSC)
MM
Name of City/Town School 10 (SSC)
Country of School 10 (SSC)
Year of entering diploma
YYYY
Month of entering diploma
MM
Institute name diploma
Year of leaving diploma
YYYY
Month of leaving diploma
MM
Name of City/Town of college of diploma
Country college diploma
Year of entering bachelors
YYYY
Month of entering bachelor
MM
School/College Name Bachelor Degree
Year of leaving bachelor
YYYY
Month of leaving bachelor
MM
Town/City where you have done Bachelor Degree
Country where you have done Bachelor Degree
Year of entering master
YYYY
Month of entering master
MM
School/College Name Master Degree
Year of leaving master
YYYY
Month of leaving master
MM
Name of City/Town Master Degree
Country where you have done Master Degree
Back ground Information
1. A) Within the past two years, have yo or a family member ever had tuberculosis of the lungs or been in close contact with a person with tuberculosis?*

YesNo
1 B) Do you have any physical or mental disorder that would require social and /or health services, other than medication , during a stay in Canada?*

YesNo
1 c) If any of your answer is yes give details
2. A) Have you ever remained beyond the validity of your status, attended school without authorization or worked without authorization in Canada?*

YesNo
2. B) Have you evern been refulsed a visa or permit, denied entry or ordered to leave Canada or any other country?*

YesNo
2. C) Have you previously applied to enter or remain in Canada?*

YesNo
2 d) If any of your answer is yes give details
3 A) Have you ever committed, been arrested for, been charged with or convicted of any criminal offence in any country?*

YesNo
3 b) If any of your answer is yes give details
4 A) 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 unit)*

YesNo
4 b) If any of your answer is yes give details
5 Are you or have you been a member of associated with any political party, or other group of organization which has engaged in or advocated violence as a means to achieving a political or religious objective, or which has been associated with criminal activity at any time?*

YesNo
5 a) If any of your answer is yes give details
6. Have you ever witnessed or participated in the ill treatment of prisoners or civilians, looting or descration of religious buildings?*

YesNo
If you answered "yes" to any of questions 3 to 6 above, or upon request of a visa officer, you MAY BE REQUIRED to fill out IMM 5257 Schedule-1
6 a) If any of your answer is yes give details
Declaration*

I have declare that all the information provided in the form are correct and there is no misleading or false information provided
Click below*
Should be Empty:

1294E Study Permit dummy form

Personal details

If you are married or have common-law partner

Language(s)

Passport

Contact information

Details of intended study in Canada

Education (Section E)

Employment

Detail of Job1

Detail of Job2

Please give details of your previous education of last 10 years apart from your most recent education which you have mentioned in Section E above.