Please complete the following questionnaire to help us determine is you qualify for the US Green Card and/or permanent residency via a Investor EB-5 visa as a Business applicant.

** PLEASE ANSWER QUESTIONS IN ENGLISH **

Personal Information
 
Name:
Email Address:
In order to receive a reply, kindly ensure that you have sufficient space in your e-mail account. In addition, for Hotmail and Yahoo users our reply may be filtered as "Junk Mail".
Nationality:
Current Place of Residence: (City,Country)
Daytime Telephone number preceded by the area code: (areacode , phone number)
Home, Office, or Mobile
Date of Birth:  
 Day        Month             Year
Sex: Male Female
Marital Status : Single
Married
Divorced/Separated
   
If Married, please provide Spouse's Characteristics in the fields below
   
Spouse's Date of Birth:  
 Day        Month             Year
Spouse's Level of Education and duration:                                       (If other please specify)
Spouse's total years of education:
(Starting from primary school)

Spouse's field of study:


Spouse's Number of Years and Months of Working Experience:

Number of Dependant Children:
   
Ability in English
 
ENGLISH
 
Read
Write
Speak
Listen
   
Educational Profile
 
Total Years of education:
(Including Primary, Secondary, and Post Secondary)
1. Certificate:

(If other please specify)
Field of Study:
Date Started: (Month, Year)
Date of Graduation: (Month, Year)
Name of Institution:
City:
Country:
 
2. Certificate:

(If other please specify)
Field of Study:
Date Started: (Month, Year)
Date of Graduation: (Month, Year)
Name of Institution:
City:
Country:
 
3. Certificate:

(If other please specify)
Field of Study:
Date Started: (Month, Year)
Date of Graduation: (Month, Year)
Name of Institution:
City:
Country:
   
Managerial Experience (Planning, Supervision and Control of Human & Financial Resources)
 
1. Name of Company/Organization:
Job Title:
From: (Month, Year)
To: (Month, Year)
Employment Status: Part Time
Full Time
Number of Hours Worked per Week: Hours Per Week
Do You Presently Still Work at this Company? (Yes/No):
Employment Duties:
 (please provide details)
City:
Country:
   
2. Name of Company/Organization:
Job Title:
From: (Month, Year)
To: (Month, Year)
Employment Status: Part Time
Full Time
Number of Hours Worked per Week: Hours per Week
Do You Presently Still Work at this Company? (Yes/No):
Employment Duties:
(please provide details)
City:
Country:
   
3. Name of Company/Organization:
Job Title:
From: (Month, Year)
To: (Month, Year)
Employment Status: Part Time
Full Time
Number of Hours Worked per Week: Hours per Week
Do You Presently Still Work at this Company? (Yes/No):
Employment Duties: (please provide details)
City:
Country:
   
Business Ownership in the Past 5 Years
(If Applicable)
 
1. Most recent operating year:
a. Name of Business (Complete in Full):
b. Type of Business Activity:
c. Type of Ownership: Proprietorship
Partnership
Corporation
d. Percentage (%) of Ownership:
e. From: (Month, Year)
f. To: (Month, Year)
g. Annual Sales (US$):
h. Net Income (US$):
i. Net Assets (US$):
j. Number of Full Time Employees:
 
2. Previous year:
a. Name of Business (Complete in Full):
b. Type of Business Activity:
c. Type of Ownership: Proprietorship
Partnership
Corporation
d. Percentage (%) of Ownership:
e. From: (Month, Year)
f. To: (Month, Year)
g. Annual Sales (US$):
h. Net Income (US$):
i. Net Assets (US$):
j. Number of Full Time Employees:
 
3. Previous year:
a. Name of Business (Complete in Full):
b. Type of Business Activity:
c. Type of Ownership: Proprietorship
Partnership
Corporation
d. Percentage (%) of Ownership:
e. From: (Month, Year)
f. To: (Month, Year)
g. Annual Sales (US$):
h. Net Income (US$):
i. Net Assets (US$):
j. Number of Full Time Employees:
 
4. Previous year:
a. Name of Business (Complete in Full):
b. Type of Business Activity:
c. Type of Ownership: Proprietorship
Partnership
Corporation
d. Percentage (%) of Ownership:
e. From: (Month, Year)
f. To: (Month, Year)
g. Annual Sales (US$):
h. Net Income (US$):
i. Net Assets (US$):
j. Number of Full Time Employees:
 
5. Previous year:
a. Name of Business (Complete in Full):
b. Type of Business Activity:
c. Type of Ownership: Proprietorship
Partnership
Corporation
d. Percentage (%) of Ownership:
e. From: (Month, Year)
f. To: (Month, Year)
g. Annual Sales (US$):
h. Net Income (US$):
i. Net Assets (US$):
j. Number of Full Time Employees:
 
If you have additional experience, please include in the Additional Comments below.
Other
 
Relationship to Closest Blood Relative in the US (American Citizen or Green Card Holder):
Blood Parent Blood Aunt/Uncle Blood Brother or Sister Blood Son/Daughter
Blood Niece/Nephew (22 years or older) Blood Grand Parent Blood Cousin
Relative State of Residence :
Personal Net worth (US$):
Do you currently have an offer of employment from an American employer?
Yes No  
If your answer to the above question is "Yes" provide details here:
Have you or your spouse or common-law partner ever:
  • Had any serious disease
Yes No  
  • Been convicted of or currently charged with any crime or offence in any country
Yes No  
  • Applied previously for an immigrant visa to the US
Yes No  
  • Visited the US (visit,study,work)
Yes No  
  • Are you able to obtain a visitors visa to the US
Yes No  
If answer to any of above is "Yes" provide details here:
   
PLEASE INFORM US HOW YOU WERE INTRODUCED TO THIS SITE:
 
Search Engine (please specify name or the keywords used for the search)
Newspaper or Magazine (please specify)
Newsgroup (please specify)
General Recommendation
 
Additional Comments if Any:
 
      
 
 
 
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