Assessment Citizenship Assessment

Find out if you qualify for Canadian Citizenship

   Surname / Last Name as it appears on your birth certificate          
   First Name / Given name's as it appears on your birth certificate:   
   First Name you most commonly use at this time:                       
 Maiden Name:                                                                         
  List all other names you have used in the past or are currently using:
  Home address:
Mailing address:
  Telephone:   Email: (required)
  Date of Birth( DD/MM/YYYY):   Place of Birth:  
  Have you been adopted?   My eye color is:  
  My current citizenship is:   Are now living in Canada?  
  Are you a landed immigrant?      
  What is your date of landing? (DD/MM/YYYY)  
  Have you physically lived in Canada for 1095 days (3yrs) in a four year period?  
  Did you reside in Canada prior to obtaining landed immigrant status?
  if yes, for how long? (Months, Days)  
  if yes, why were you in Canada?
  Have you been convicted of a crime during the above period?   if yes, give details:
  if yes, are you currently on Parole?
  Are you currently on a deportation order?
  Were you born in wedlock to a Canadian Citizen parent?   Was one of your parents born in Canada?
  Additional Comments:      
By submitting the above answers, I declare that I have answered all the required questions in this application fully, truthfully, and to the best of my ability. I waive all present and future liability on evaluations provided by Samintel Technologies Inc. as I understand that my case assessment will be based on the above answers that I have provided.
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