Supplementary Form - Canada International

Embassy of Canada Ambassade Du Canada PROTECTED WHEN COMPLETED - B
Riyadh, Saudi Arabia Riyad, Arabie Saoudite PAGE 1 OF 2
Visa Section Service des Visas
SUPPLEMENTARY FORM
* Please, use TYPE/PRINT & Gregorian calendar format (Day/Month/Year)
*Please write N/A if a question does not apply to you.
TYPE OF APPLICATION: Visitor Worker Student Other
A. APPLICANT SUPPLEMENTARY INFORMATION
1.FULL NAME (Family Name, First Name and Middle Name) as in passport.
_____________________________________________________________________________________________________________
2. CURRENT NATIONALITY: ___________________________Nationality at birth:______________________________________
Do you have any other nationalities? If yes, please provide details: _______________________________________________________
3. PASSPORT DETAILS: Passport Type: Regular Special Diplomatic Other
Place of issue (City &Country): _________________________________________________
Date of your last entry into the Kingdom of Saudi Arabia: _________/_________/_________
4. LENGTH OF TRAVEL: (DD/MM/YYYY)
- Date you will leave Saudi Arabia: ______/______/______ - Estimate date of arrival to Canada: ______/______/______
- Estimate date of departure from Canada: ______/______/______
- Are you travelling to any other country during this trip: YES _______NO ______
- Please indicate the countries you will be visiting:____________________________________________________________________
B. FAMILY & FRIENDS SUPPLEMENTARY INFORMATION
Relatives/friends in Canada? YES NO If YES, please provide the requested information with a copy of the document proving
the validity of their status in Canada: Valid Study Permit – Work Permit, Permanent Resident Card…..etc
Relationship Family Name First Name
Date of Birth
(dd/mm/yyyy)
Citizenship Occupation in Canada
Please provide the requested information for other individuals (not family) travelling with you.
Relationship Family Name First Name
Date of Birth
(dd/mm/yyyy)
Citizenship Occupation
October 2010 Visa Section, P.O. Box 94321, Riyadh 11693, KSA. Fax: +966-1- 488-9657 Internet: www.saudiarabia.gc.ca
E-mail : riyadh.visa@international.gc.ca
Current country
of residence

C. TRAVEL INFORMATION
Please list all countries visited in the past ten years and year of visit. * Use separate sheet if necessary.
October 2010 Visa Section, P.O. Box 94321, Riyadh 11693, KSA. Fax: +966-1- 488-9657 Internet: www.saudiarabia.gc.ca
E-mail : riyadh.visa@international.gc.ca
PAGE 2 OF 2
Country Year Country Year Country Year
1 4 7
2 5 8
3 6 9
- Have you ever travelled to Canada during the past 10 years?
- If YES, please provide details of your last two visits to Canada (beginning with the most recent one).
Date of Entry
(dd/mm/yyyy)
Purpose Duration
D. TO BE COMPLETED BY NON-SAUDI NATIONALS
Date of Departure
(dd/mm/yyyy)
Visa File Number
(If applicable)
1. How long have you resided in Saudi Arabia? _________________________________________________________________________
2. What is the expiry date of your residence permit? _____________________________________________________________________
3. What is the name of your sponsor for your residence permit? ____________________________________________________________
4. What are the dates of your authorized leave from your sponsor? __________________________________________________________
E. FOR STUDENT PERMIT APPLICANTS ONLY ***
Please give the request information in reference to the agent or representative who assisted you with your admission to the Educational
Institution in Canada and/or with your study permit in application:
Agent’s name: ___________________________________________Phone number:___________________________________
Business address:_________________________________________________________________________________________
- Please detail your education/work experience since the age of 18. Start with the most recent information. Under Field Activity, write
your course of study or details of employment. In the case where you were not working or studying, please indicate what you were doing.
As an example: unemployed, travelling, etc...
* Use separate sheet if necessary.
From To
Month&Year Month&Year
- Who will pay for your tuition and fees in Canada?
School / Employer-Company Field of Study / Activity
Diploma or Certificate/
Position at work
Complete name:_________________________________________Relationship:_________________________________________
Phone number(s) where the person can be contacted:________________________________________________________________
I declare that I have answered all questions in this form fully and truthfully. I understand that if the information is found to be untruth or
incomplete, my application may be refused.
Name ______________________________________Signature_____________________________
Date: ____________________ dd/mm/yyyy