Family & Background Information - Belong Immigration Services

Family & Background Information Form

- Step 1 of 8

Name of Principal Applicant *

First

Last

Date of birth

Country of Birth

Marital Status *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Name of Spouse, common-law partner or conjugal partner *

First

Last

Date of birth

Country of Birth

Marital Status

Provide address below. If deceased, give city or town, country or territory and date

Parents

Name - Parent 1 (mother of father) *

First

Last

Date of birth *

Town/city of birth

Country of birth

Marital Status

Provide address below. If deceased, give city or town, country or territory and date

Name - Parent 2 (mother of father) *

First

Last

Date of birth

Town/city of birth

Country of birth

Marital Status

Provide address below. If deceased, give city or town, country or territory and date

Children

The principal applicant must fill out this form for yourself and on behalf of any of your family members 18 years of age or older who are not already Canadian citizens or permanent residents. Enter all names in English and in your native language (for example, Arabic, Cyrillic, Chinese, Korean or Japanese script or Chinese commercial/telegraphic code). If a section does not apply, write “Not Applicable."

Relationship

Name - Child 1

First

Last

Date of birth

Country of birth

Marital Status

Provide address below. If deceased, give city or town, country or territory and date

Got more children? Relationship

Name - Child 2

First

Last

Date of birth

Country of birth

Marital Status

Provide address below. If deceased, give city or town, country or territory and date

Relationship

Name - Child 3

First

Last

Date of birth

Country of birth

Marital Status

Provide address below. If deceased, give city or town, country or territory and date

Have more children?

Enter the following for each additional children: Full name, Date of birth, Country of birth, Marital Status, Email Address, Address

Siblings

Relationship

Name - Sibling 1

First

Last

Date of birth

Country of birth

Marital Status

Provide address below. If deceased, give city or town, country or territory and date

Relationship - Sibling 2

Name - Sibling 2

First

Last

Date of birth

Country of birth

Marital Status

Provide address below. If deceased, give city or town, country or territory and date

Relationship - Sibling 3

Name - Sibling 3

First

Last

Date of birth

Country of birth

Marital Status

Provide address below. If deceased, give city or town, country or territory and date

Relationship - Sibling 4

Name - Sibling 4

First

Last

Date of birth

Country of birth

Marital Status

Provide address below. If deceased, give city or town, country or territory and date (copy)

Have more siblings?

Enter the following for each additional siblings: Full name, Date of birth, Country of birth, Marital Status, Email Address, Address

Educational Background

Give the number of years of school you successfully completed for each of the following levels of education

Elementary/primary school *

Secondary/high school *

University/college *

Trade school or other post-secondary school *

Give full details of all the secondary and post-secondary education(including university, college and apprenticeship training) you have had.

Education 1 - From

Name of Institution - 1

City and country/territory

Type of certificate and diploma issued

Field of study

Education 2 - From

Name of Institution - 2

City and country/territory

Type of certificate and diploma issued

Field of study

Education 3 - From

Name of Institution - 3

City and country/territory

Type of certificate and diploma issued

Field of study

Education 4 - From

Name of Institution - 4

City and country/territory

Type of certificate and diploma issued

Field of study

Addresses

List all addresses where you have lived in the past 10 years or since your 18th birthday if it was less than 10 years ago. Do not use P.O. box addresses.

1. Date From - To (YYYY-MM) *

Address 1 *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

2. Date From - To (YYYY-MM) *

Address 2 *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

3. Date From - To (YYYY-MM)

Address 3

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

4. Date From - To (YYYY-MM)

Address 4

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

5. Date From - To (YYYY-MM)

Address 5

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Personal History

Provide the details of your personal history for the past 10 years, or since your 18th birthday if it was less than 10 years ago. Start with the most recent information. Under “Activity,” write your occupation or job title if you were working. If you were not working, provide information on what you were doing (for example, unemployed, studying, travelling, retired, in detention). If you were outside your country or territory of nationality, indicate your status in the country or territory you were in. Note: Please ensure that you do not leave any gaps in time. Failure to account for all time periods will result in a delay in the processing of your application.

Personal History 1 *

Personal History 2 *

Personal History 3 *

Personal History 4

Personal History 5

Personal History 6

Personal History 7

Personal History 8

Personal History 9

Personal History 10

Background Information

What organizations have you supported, been a member of or been associated with? Include any political, social, youth or student organization, trade unions and professional associations. Do not use abbreviations. Indicate the city and country or territory where you were a member. Write “NONE” in the first input field if you have not been a member of any association/organization. *

Date From - Date To (YYYY-MM) | Name of organization | Type of organization | Activities and/or positions held within organization | City and country

List any government positions (such as civil servant, judge, police officer, employee in a security organization) you have held. Include positions you have held before or after your retirement. Do not use abbreviations. Write “NONE” in the first input field if you have not held any government positions. *

Date From - Date To (YYYY-MM) | Country/territory and level of jurisdiction (national, regional, municipal) | Department/branch | Activity and/or positions held

Provide complete details of military and paramilitary service for each of the countries in whose armed forces you served. Write “NONE” in the first input field if you have not undertaken military and/or paramilitary service. Note: Please ensure that you do not leave any gaps in time. *

I declare that the information I have given is truthful, complete and correct. *

Family & Background Information Form

Parents

Children

Siblings

Educational Background

Give full details of all the secondary and post-secondary education(including university, college and apprenticeship training) you have had.

Addresses

Personal History

Background Information

Contact Info

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