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
Divorsed/
Seperated
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 &
keywords used for the search)
