Questionnaire for Applicant

To expedite processing, please provide the following information in English and send it to
us via email.

Personal Information – Principal Applicant

Last Name AHAMED First Name THAIYUB HUSSAIN

Used Name THAIYUB HUSSAIN Gender MALE
AHAMED
Date of birth 22ND SEPTEMBER 1982 Place of CHENNAI,
birth(City/Province) TAMILNADU, INDIA
Height (ft or cm) 174 CMS Eye Color BROWN
Marital status MARRIED Date of marriage, if 26TH DECEMBER 2008
married
（Marriage status: Single/Married/Common-law/Divorced/Widowed, etc.）
Passport Z3383150 Place of issue CHENNAI
number
Date of issue 19TH AUGUST 2016 Date of expiry 18TH AUGUST 2026
National ID number: Place of issue CHENNAI
(if applicable) 3147 4421 7912
Date of issue N/A Date of expiry N/A
Current address 19/36 MAYOR SHIVASHANMUGAM STREET, NUNGAMBAKKAM,
CHENNAI
PIN: 600034, TAMILNADU, INDIA
Current email [email protected] Current home +91-44-28218516
address m number
Current cell +91-9600007853 #of years of formal 17
phone number education in total
TAMIL Able to YES
Native language communicate in
English?
Current GENERAM MANAGER – Intended BUSINESS
occupation NEW BUSINESS occupation in
Canada
Fill out the following if you have more than one country of residence permit (other than
your citizenship)
Country of N/A Date of issue and N/A
residence&Statu expiry (m-day-year)
s
Fill out the following if you had more than one marriage：
Name of ex- N/A Date of birth N/A
wife/husband
Date of marriage N/A Date of separation N/A
Family Information – Principal Applicant

Note: please fill in information about Principal Applicant’s parents, brothers/sisters; if

deceased, please provide date; indicate deceased in the Marriage Status column; for
Marriage Status, indicate: single, married, common-law, divorced, widowed, etc.
Name Relationshi Date of Place of Marital Present address
p birth birth(specif status (with postal code)
(and Death y city/town And
If and Current
applicable) country) occupation

AHAMED Father 04TH JULY KILAKARAI, WIDOWED, 19/36 MAYOR

MUSTAFA 1946 TAMILNADU MANAGIN SHIVASHANMUGA
KATHER , INDIA G M STREET,
MOHAME DIRECTOR NUNGAMBAKKAM,
D HUSSAIN CHENNAI
PIN: 600034,
TAMILNADU, INDIA
KAMILA Mother 14TH APRIL KILAKARAI, DECEASED 19/36 MAYOR
MUSTAFA 1950 TAMILNADU SHIVASHANMUGA
, INDIA M STREET,
NUNGAMBAKKAM,
CHENNAI
PIN: 600034,
TAMILNADU, INDIA
SAFEERA Sister 25TH CHENNAI, MARRIED 08, SUBBARAO
ASHRAF OCTOBER TAMILNADU AVENUE, 3RD
BUHARY 1973 , INDIA STREET,
NUNGAMBAKKAM,
CHENNAI - 600006
SARAH Sister 29TH CHENNAI, DIVORSED 19/36 MAYOR
FAKIHA SEPTEMBE TAMILNADU SHIVASHANMUGA
MUSTAFA R 1978 M STREET,
NUNGAMBAKKAM,
CHENNAI
PIN: 600034,
TAMILNADU, INDIA

Education Background
Note: please provide year and month.

From To Full name of City, Degree

(yyyy- (yyyy school Province
mm- -mm-
 dd) dd)
Primary school 1988- 1998- PADMA CHENNAI, MATRICULATION
03 06 SESHADRI BALA TAMILNAD EXAMINATION
BHAVAN U CERTIFICATE
SENIOR
SECONDARY
SCHOOL
High 1998- 2000- DON BOSCO CHENNAI, HIGHER
school/Vocational 07 03 MATRICULATIO TAMILNAD SECONDARY
school or N HIGHER U COURSE
equivalent SECONDARY CERTIFICATE
SCHOOL
University/ 2000- 2004- UNIVERSITY OF CHENNAI, BACHELOR OF
Technical college or 09 04 MADRAS TAMILNAD ENGINEERING
equivalent U

University/ 2005- 2006- UNIVERSITY OF SWANSEA, MASTER OF

Technical college or 09 10 WALES UNITED BUSINESS
equivalent SWANSEA KINGDOM ADMINISTRATIO
N
University/
Technical college or
equivalent

Additional Information:

Personal History after the age of 18

Note：1. Please provide year and month; 2. Under “Activity”, write your job title if you
were working. If you were not working, provide information on what you were doing (e.g.
unemployed, studying, travelling, retired, indetention etc.)

From(yyyy- To(yyyy- Activity City or Town, and Name of company,

mm-dd) mm-dd) Country employer, school, Job
title, as applicable
2005-09 2006-12 POST SWANSEA, UNIVERSITY OF WALES
GRADUATION WALES, U.K. SWANSEA
EDUCATION
2006-12 2010-08 EMPLOYMENT DUBAI, UNITED ETA M&E LLC
–MANAGER – ARAB EMIRATES
PROCUREMEN
T & COST
CONTROL
2010-08 2015-11 EMPLOYMENT RIYADH, ASSOCIATED
– ASSISTANT KINGDOM OF CONSTRUCTION &
GENERAL SAUDI ARABIA INVESTMENT
MANAGER –
 SUPPLY CHAIN COMPANY LIMITED
& PRODUCT (ASCON)
DEVELOPMENT
2015-11 2016-06 UNEMPLOYED CHENNAI, N/A
TAMILNADU,
INDIA
2016-06 TILL DATE EMPLOYMENT CHENNAI, ETA ENGINEERING
– GENERAL TAMILNADU, PRIVATE LIMITED
MANAGER – INDIA
NEW BUSINESS

Addresses since your age of 18

Note: please provide year and month.

From To Street and City or Town Province, State Country

number or District
(yyyy- (yyyy-
mm) mm)

2000-09 2005-09 19 MAYOR CHENNAI TAMILNADU INDIA

SIVASHANMUGAM
STREET
2005-09 2006-12 NO. 045, NICHOLL SWANSEA WALES U.K.
STREET
2006-12 2008-09 SALAHUDDIN DUBAI DUBAI UNITED
ROAD, AL ARAB
MURAQABBAT EMIRATE
S
2008-09 2010-08 KHALIDIYA ABU DHABI ABU DHABI UNITED
CORNICHE STREET ARAB
EMIRATE
S
2010-08 2015-11 ABI MOADH AL AR-RIYADH CENTRAL KINGDO
ANSARI STREET PROVINCE M OF
SAUDI
ARABIA
2015-11 TILL 19 MAYOR CHENNAI TAMILNADU INDIA
DATE SIVASHANMUGAM
STREET

Travel
List all the trips you (if applicable) have taken outside your country of origin or of
residence in the last 10 years, or since your 18th birthday if this was less than 10 years ago.
Include all trips: tourism, business, training, etc.
For example:
04-2004 04-2004 6 days Madrid, Spain Business

Destination (City, Purpose of

Month-Year Month-Year Length (Days)
Country) Travel

September-05 December-06 461 Swansea, United Kingdom Student

Dubai, United Arab

December-06 August-10 1328 Resident
Emirates

January-10 January-10 5 Doha, Qatar Business

January-10 January-10 1 Doha, Qatar Business

January-10 February-10 14 Doha, Qatar Business

March-10 April-10 38 Doha, Qatar Business

August-10 November-15 1917 Riyadh, Saudi Arabia Resident

Dubai, United Arab

September-10 September-10 3 Business
Emirates

Dubai, United Arab

April-12 April-12 3 Business
Emirates

Dubai, United Arab

August-12 August-12 6 Holiday
Emirates

December-12 December-12 9 Kuala Lumpur, Malaysia Holiday

December-12 December-12 4 Singapore Holiday

Dubai, United Arab

June-13 June-13 2 Business
Emirates

Dubai, United Arab

August-13 August-13 2 Business
Emirates

Dubai, United Arab

September-13 October-13 44 Business
Emirates
 Dubai, United Arab
October-13 October-13 6 Business
Emirates

Dubai, United Arab

December-13 December-13 1 Business
Emirates

October-14 October-14 2 Manama, Bahrain Holiday

Dubai, United Arab

March-15 March-15 1 Business
Emirates

November-15 November-15 2 Kuala Lumpur, Malaysia Holiday

November-15 November-15 6 Colombo, Sri Lanka Business

December-15 December-15 22 Colombo, Sri Lanka Business

January-16 March-16 53 Colombo, Sri Lanka Business

May-16 May-16 23 Colombo, Sri Lanka Holiday

March-17 March-17 4 Colombo, Sri Lanka Business

April-17 May-17 30 Toronto, Canada Holiday

During the past 5 years have you live in any country other than your country of citizenship
or your current country of residence for more than 6 months? If so, list the country, status,
and date (from-to).
1. KINGDOM OF SAUDIA ARABIA, RESIDENT, FROM 13TH AUGUST 2010 TO 12TH
NOVEMBER 2015

Have you been to Canada before? If so, list the (1) province; (2) date (from-to); (3) status
(visitor, student, worker...) and (4) address you stayed.
YES, 1. ONTARIO, 2. FROM 25TH APRIL 2017 TO 25TH MAY 2017, 3. VISITOR, 4. 406 STEPHANIE
BLVD, WOODBRIDGE, ON L4L 1A6

Have you submitted immigration applications to Canada previously? If so, indicate the type
of program or visa, file number, result, date of result, and destination in Canada.
NO
Do you have relatives living in Canada? If so, please provide the name, city & province, and
relationship to you.
FAIZA HAMEED, 406 STEPHANIE BLVD, WOODBRIDGE, ON L4L 1A6, COUSIN

Have you ever served in the military? If yes, please describe in detail: service time, rank,
country of service, whether you have engaged in battle.
NO

Have you ever worked in government? If yes, please describe in detail: beginning and
ending time of your job, position，department, and city.
NO

Have you joined any organization? If yes, please describe in detail: time of joining/quitting,
name of organization, city.
Name: N/A
Date of Joining: City: N/A

Personal Wealth
Bank saving balance as indicated in your
application documents

Property, if applicable – please indicate the

purchasing price

Spouse Information
Name NALEEFA HASAN Gender FEMALE
Date of birth 19TH SEPTEMBER 1987 Place of CHENNAI,
birth(City/Province) TAMILNADU,
INDIA
Height (ft or cm) 158 Eye Color BROWN
Marital status MARRIED Date of marriage, if 26TH DECEMBER
married 2008

（Marriage status: Single/Married/Common-law/Divorced/Widowed, etc.）

Passport number H0274070 Place of issue CHENNAI

Date of issue 02ND SEPTEMBER 2008 Date of expiry 01ST

SEPTEMBER
2018
National ID number: Place of issue CHENNAI
(if applicable) 6005 2106 4566

Date of issue N/A Date of expiry N/A

Current address OLD NO. 06, NEW NO. 09, 1ST STREET, SUBBARAO AVENUE, COLLEGE
ROAD, CHENNAI 600006, TAMILNADU, INDIA
Current email [email protected] Current home number +91-44-
address m 28218585

Current cell phone +91-9940356733 #of years of formal 15 YEARS

number education in total

Native language TAMIL Able to communicate in YES

English?

Current UNEMPLYED Intended occupation in PRIMARY

occupation (HOUSEWIFE) Canada SCHOOL
TEACHER
Fill out the following if you have more than one country of residence permit (other than
your citizenship)

Country of N/A Date of issue and expiry N/A

residence&Status (m-day-year)

Fill out the following if you had more than one marriage：
Name of N/A Date of birth N/A
ex-wife/husband

Date of marriage N/A Date of separation N/A

Family Information – Spouse

Note: please fill in information about spouse’s parents, brothers/sisters; if deceased,

please provide date; indicate deceased in the Marriage Status column; for Marriage
Status, indicate: single, married, common-law, divorced, widowed, etc.

Name Relationship Date of Place of Marital Present

birth birth(specify status address(with
city/town) postal code)

AHAMED Father 28TH KILAKARAI, MARRIED NO. 09, 1ST

HASAN APRIL TAMILNADU, STREET,
SADAK 1955 INDIA SUBBARAO
ABDUL AVENUE, COLLEGE
CADER ROAD,
NUNGAMBAKKAM
, CHENNAI 600006
NADHIRA Mother 11TH CHENNAI, MARRIED NO. 09, 1ST
HASAN OCTOBE TAMILNADU, STREET,
(NADHIRA) R 1962 INDIA SUBBARAO
AVENUE, COLLEGE
ROAD,
NUNGAMBAKKAM
, CHENNAI 600006

AHMED Brother 21ST CHENNAI, MARRIED NO. 09, 1ST

IJAS AUGUST TAMILNADU, STREET,
AHMED 1982 INDIA SUBBARAO
HASAN AVENUE, COLLEGE
ROAD,
NUNGAMBAKKAM
, CHENNAI 600006
N/A Sister N/A N/A N/A N/A

Education Background
Note: please provide year and month.

From To Full name of City, Degree

(yyyy (yyyy school Province
-mm) -mm)
Junior School 1993- 2003- GOODSHEPERD CHENNAI, MATRICULATION
03 03 MATRICULATIO TAMILNADU EXAMINATION
N HIGHER , INDIA CERTIFICATE
SECONDARY
SCHOOL,
CHENNAI, INDIA
High 2003- 2005- GOODSHEPERD CHENNAI, HIGHER
school/Vocational 05 03 MATRICULATIO TAMIL SECONDARY
school or N HIGHER NADU, COURSE
equivalent SECONDARY INDIA CERTIFICATE
SCHOOL,
CHENNAI, INDIA
University/ 2005- 2008- THE WOMEN’S CHENNAI, DEGREE OF
Technical college or 06 04 CHRISTIAN TAMILNADU BACHELOR OF
equivalent COLLEGE , INDIA ADMINISTRATIO
N
Additional Information:

Personal History after the age of 18

Note：1. Please provide year and month; 2. Under “Activity”, write your job title if you
were working. If you were not working, provide information on what you were doing (e.g.
unemployed, studying, travelling, retired, indetention etc.)

From(yyyy- To(yyyy- Activity City or Town, and Name of company,

mm) mm) Country employer, school, as
applicable
2009-04 2009-10 UNEMPLOYE ABU DHABI, N/A
D UNITED ARAB
(HOUSEWIFE) EMIRATES
2011-01 2015-11 UNEMPLOYE RIYADH, SAUDI N/A
D ARABIA
(HOUSEWIFE)

Addresses since your age of 18

Note: please provide year and month.

From(yyyy To(yyyy Street and number City or Town Province, Country

-mm) -mm) State or
District

2009-04 2009-10 KHALIDIYA, ABU DHABI ABU DHABI UNITED

CORNICHE STREET ARAB
EMIRATE
S
2011-01 2015-11 ABI MOADH AL RIYADH CENTRAL KINGDO
ANSARI STREET PROVINCE M OF
 SAUDI
ARABIA

Travel
List all the trips you (if applicable) have taken outside your country of origin or of
residence in the last 10 years, or since your 18th birthday if this was less than 10 years ago.
Include all trips: tourism, business, training, etc.
For example:
04-2004 04-2004 6 days Madrid, Spain Business

Length Destination (City,

Month-Year Month-Year Purpose of Travel
(Days) Country)

April-05 June-05 56 Bangkok, Thailand Holiday

June-05 June-05 7 Kuala Lumpur, Malaysia Holiday

Dubai, United Arab

October-08 November-08 30 Holiday
Emirates
Dubai, United Arab
January-09 February-09 18 Holiday
Emirates
Dubai, United Arab
April-09 October-09 182 Resident
Emirates

January-11 November-15 1772 Riyadh, Saudi Arabia Resident

Dubai, United Arab

August-11 September-11 20 Holiday
Emirates
December-
December-12 9 Kuala Lumpur, Malaysia Holiday
12
December-
December-12 4 Singapore Holiday
12
Dubai, United Arab
October-13 October-13 6 Holiday
Emirates

October-14 October-14 2 Manama, Bahrain Holiday

May-16 May-16 23 Colombo, Sri Lanka Holiday

April-17 May-17 30 Toronto, Canada Holiday

During the past 5 years have you live in any country other than your country of citizenship
or your current country of residence for more than 6 months? If so, list the country, status,
and date (from-to).

1. KINGDOM OF SAUDIA ARABIA, RESIDENT, FROM 13TH AUGUST 2010 TO

12TH NOVEMBER 2015

Have you been to Canada before? If so, list the (1) province; (2) date (from-to); (3) status
(visitor, student, worker...) and (4) address you stayed.

YES, 1. ONTARIO, 2. FROM 25TH APRIL 2017 TO 25TH MAY 2017, 3. VISITOR, 4. 406 STEPHANIE
BLVD, WOODBRIDGE, ON L4L 1A6

Have you submitted immigration applications to Canada previously? If so, indicate the type
of program or visa, file number, result, date of result, and destination in Canada.

NO

Do you have relatives living in Canada? If so, please provide the name, city&province, and
relationship to you.

FAIZA HAMEED, 406 STEPHANIE BLVD, WOODBRIDGE, ON L4L 1A6, COUSIN

Have you ever served in the military? If yes, please describe in detail: service time, rank,
country of service, whether you have engaged in battle.

NO

Have you ever worked in government? If yes, please describe in detail: beginning and
ending time of your job, position，department, and city.

NO

Have you joined any organization? If yes, please describe in detail: time of joining/quitting,
name of organization, city.

NO

Personal Wealth
Bank saving balance as indicated in your
application documents
Property, if applicable – please indicate the
purchasing price

Note: Children aged over 18 must also fill out the above information forms.

Children Information

Name AFRAAZ ABDUL Name

MAJID HUSSAIN
Gender MALE Gender
Date of birth 15TH JANUARY 2010 Date of birth
Place of birth CHENNAI, Place of birth
(city/town) TAMILNADU, INDIA (city/town)

Marital status SINGLE Marital status

Eye color BROWN Eye color
Height 130 CMS Height
#of years of 2 #of years of
education in total education in total

Native language TAMIL Native language

Able to YES Able to
communicate in communicate in
English? (Y/N) English? (Y/N)

Passport No. M5266534 Passport No.

Date of issue 06TH JANUARY 2015 Date of issue
Date of expiry 05TH JANUARY 2020 Date of expiry
National ID no. 5643 9661 7970 National ID no.
(if applicable) (if applicable)

Date of issue N/a Date of issue

Date of expiry N/a Date of expiry
Travel
List all the trips you (if applicable) have taken outside your country of origin or of
residence in the last 10 years, or since your 18th birthday if this was less than 10 years ago.
Include all trips: tourism, business, training, etc.
For example:
Sarah Chen 04-2004 04-2004 6 days Madrid, Spain Business

CHILD Month- Length Destination (City,

Month-Year Purpose of Travel
NAME Year (Days) Country)
January-
November-15 1772 Riyadh, Saudi Arabia Resident
11
September- Dubai, United Arab
August-11 20 Holiday
11 Emirates
December
December-12 9 Kuala Lumpur, Malaysia Holiday
-12
AFRAAZ December
ABDUL December-12 4 Singapore Holiday
-12
MAJID
HUSSAI October- Dubai, United Arab
October-13 6 Holiday
N 13 Emirates
October-
October-14 2 Manama, Bahrain Holiday
14

May-16 May-16 23 Colombo, Sri Lanka Holiday

April-17 May-17 30 Toronto, Canada Holiday

During the past 5 years have you live in any country other than your country of citizenship
or your current country of residence for more than 6 months? If so, list the country, status,
and date (from-to).
KINGDOM OF SAUDIA ARABIA, RESIDENT, FROM 13TH AUGUST 2010 TO
12TH NOVEMBER 2015

Have you been to Canada before? If so, list the (1) province; (2) date (from-to); (3) status
(visitor, student, worker...) and (4) address you stayed.

YES, 1. ONTARIO, 2. FROM 25TH APRIL 2017 TO 25TH MAY 2017, 3. VISITOR, 4. 406 STEPHANIE
BLVD, WOODBRIDGE, ON L4L 1A6