| Assessment
for Refugee Status Seekers |
This
form will provide us essential information to assist you with
your refugee application
If you have any technical problems
with this form, you may contact us directly at: info@zeeinfotech.com
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| 1)
Contact Information
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| Ms.
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Mr.
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| Family
Name: |
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| First
Name: |
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| Email
Address: |
We
will send response to this e-mail. Make sure it is correct!
|
Day
time Telephone Number:
Please include country code, city
code, etc. |
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| |
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| 2)
Refugee Applicant
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Name
of principal applicant:
(if different from contact person) |
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| address: |
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| Marital
Status: |
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| Age: |
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| Number
of children and/or dependants: |
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| Country(ies)
of Citizenship: |
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City
and country where you
are currently residing: |
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| 3)
Language Abilities
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Please
indicate your abilities in both the English and French languages,
as follows:
FLUENT:
Very good command of the language in a range of
social and work situations, and no difficulty
communicating in a professional capacity.
WELL:
Can communicate reasonably well about personal
and familiar things.
WITH DIFFICULTY:
Command of just a few basic words.
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Reading |
Writing |
Speaking |
Listening |
| English:* |
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| French:* |
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| 4)
Questionnaire
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| 1)
Have you previously sought refugee status in Canada
or applied for an immigrant or visitor visa?
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Yes
No
If yes, please explain:
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| 2)
Have you been refused refuge status in, or immigrant
or visitor visa to Canada or any other country?
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Yes
No
If yes, please explain:
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| 3) Are
you in your country of citizenship or habitual residence?
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Yes
No
If no, please explain:
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| 4) Have
you ever applied for convention refugee status with the United
Nation high commissioner for refugees.(UNHCR)?
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Yes
No
If yes, please explain:
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| 5) Have
you been refused refugee status by the country in which you
are currently living in or in any other country?
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Yes
No
If yes, please explain:
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| 6) Can
you build a life in the country in which you are now located?
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Yes
No
Please explain:
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| 7) Are
you in danger in the country where you are now living?
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Yes
No
Please explain:
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| 8)
Will you be able to return to the community you are fleeing?
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Yes
No
Please explain:
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| 9) Have
ever been detained or put in Jail?
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Yes
No
If yes, please explain:
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| 10) Have
you ever been associated with any organizations, such as political,
social or any other organizations.
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Yes
No
If yes, please explain:
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| 11) Why
do you consider your-self as a refugee?
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Please explain:
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| 5)
Comments
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| An
automated response acknowledging receipt of your form will
be emailed to you immediately. If you do not receive the acknowledgment,
it could mean that the email address provided by you is invalid
and we will be unable to respond to your assessment request. |
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B213 - 2099 Lougheed Hwy, Shaughnessy Square, Port Coquitlam, BC. V3B 1A8 Canada 
