Dependents Class Assessment Form

Please complete the following questionnaire and send it to us. Please contact us if there is anything you need clarified.

Name of Canadian citizen or Canadian Permanent Resident (Sponsor)
Date of birth (day/month/year)

Name(s) of dependant child being sponsored
Age of child being sponsored
Relationship to sponsor

Telephone Number
Fax Number
E-mail address

What is your marital status?
If you are not sure please describe your situation

	* Common-law Definition: have a partner of either sex who you are living with and have lived with for at least one year in an physically intimate relationship. ** Conjugal Partner Definition: in a conjugal relationship of at least a year with a Canadian or Canadian Permanent Resident partner of either sex, but have not lived together for a total of twelve months.


Are you a Canadian citizen or a Canadian Permanent Resident?

Where are you living?
If you chose "Other country" when do you expect to return permanently to Canada?	On or With my partner, when s/he is granted Canadian Permanent Residence

Are you receiving social assistance or welfare?
Have you currently, or in the past, declared bankruptcy?
Have you paid all required support payments to your former spouse or children?

*If neither of you are a Canadian or a Canadian Permanent Resident you do not qualify under this class. Please refer to the information on the Economic Class applications.
Have you previously sponsored anyone? Or co-signed a sponsorship with a spouse or partner?
If Yes, did they or their family members receive welfare or social assistance during the time you were legally responsible for their support?

Do you owe the Immigration Department any money?
Is the Canadian government attempting to revoke your citizenship?
Are you the subject of an immigration report on inadmissibility?
Has the Canadian government ordered you to leave Canada?
Are you currently detained in a jail, prison, penitentiary or reformatory?
In the past five years, have you been convicted of a crime against one of your family members?
Have you been charged with anything under Canadian Federal law?

Sponsor's annual income
If there is anything you think may affect your qualifications to sponsor that we have not asked about or you have concerns about, please note them here	your notes
How did you hear of us?

Please review your details prior to submission.