CONFIDENTIAL

YAXIS Immigration & Visa Services Application Form

YAXIS Immigration & Visa Services Application Form

Personal Information
First Name: __Shinoj _________________________Middle Name___K________ Last
Name___________________________

Address: _NIrmalyam , Tirurkkad PO, Malappuram DT________________________

City:_____________________________________ Sate: ____Kerala___________________

Contact Number (Res): 9946555669 Mobile 9539004336

Email ID:
_______shinooz@rediffmail.com_________________________________________________________

Date of Birth: 29-12-1979_______ Age: __30_____________

Marital Status: Single Engaged Married Divorced

Select your category

Visa Type Country Applicant/s

Permanent Residence USA Individual

Business Visa Canada Family
Student Visa UK Company
Tourist Visa Australia Other________________
Investor Visas New Zealand
Working Holiday Maker Visa Singapore
Other________________ Germany
UAE
Other________________

Purpose of the Visa/Migration

Work Study Invest Visit Friends Visit Family Holiday Medical
Explore new markets Set up office Business Meeting consult with business associates
Negotiate a contract Buy goods Participate in conference Other _____________________

Date OR Period you need to be overseas? Specific Date (if any) No later
than__________________________________ OR
Period within 1 week 2 weeks 1 month 2 months 3 months 6 months 1 year 2 years

Education
Year of Part time / Full Time
Qualification Name of the University Pass
ing
MBA Cochin University of Science 2005 Fulltime
and Technology
Bsc Maths Calicut University 2001 Fulltime
Pgdca IHRD 2003 Fulltime

© YAXIS Overseas Careers LLC. California, USA

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YAXIS Immigration & Visa Services Application Form
Certifications/Memberships
Name of the Issuing Authority Year of Valid until
Name of the Pass
Certificate/Membership ing

Work Experience
Are you Salaried Self Employed ?

If Self Employed:
Is your company incorporated? Yes No
Can you provide the Articles & Memorandum of Association? Yes No
Can you provide the last 3 months company bank statements? Yes No
What is the primary business of your company? _________________________________
Will you be able to provide the company tax documentation? Yes No

If Salaried:
What is your designation / title ? ________Branch Manager_______________________________________________
How many years have you been with this present job? _5__________
Do you receive your salary directly in your bank account? Yes No
Can you provide the last 3 months bank statements? Yes No
Total number of years of full time work experience _5_______

Please list your work experience:

Name of the Position Period of Employment
Organization

If married, please give the following details for your spouse:

Date of Marriage _______________________
First Name: ___________________________Middle Name___________ Last Name_____________
Age: ___________________ Qualification: ________________________
Total number of years of full time work experience: ____________
Salaried Self-Employed

Do you have children: Yes No

If yes, where do your spouse & children live? Inside India Outside India

Relationship
Do you have a close blood relative (Brother, Sister, Uncle, Aunt, Niece, Nephew, Father, Mother) in
Australia /Canada/New Zealand? Yes No
If yes:

COUNTRY RELATIONSHIP VISA STATUS LOCATION

Australia
Canada
New Zealand
USA
UK

Overseas Travel History

Have you ever traveled overseas before? Yes No

Name of the Purpose Year Duration of stay

country

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YAXIS Immigration & Visa Services Application Form

Do you currently hold a visa for any country? Yes No

Have you been rejected by any consulate? Yes No
If yes, please provide details about which consulate and the date you were rejected.

Name of the consulate When rejected?

This Month Last month less than 6
months 1 year more than 1 year
This Month Last month less than 6
months 1 year more than 1 year

English Language Proficiency

Have you taken the IELTS/TOEFL exam? Yes No Date Taken
_____________________________________
If yes, which module have you taken? General Academic Band______
Do you have knowledge of French? Yes No . If yes, please tick appropriate level of Proficiency
Beginners Medium High Level

Finances
What has been your gross annual income during the previous 12 months?___6 lakhs___________________
What is the total value of the assets you sponsor hold?
Fixed Assets ____________________ Liquid Assets ____________________________
Do you file IT Returns? Yes No

For Business Visa Applicants only

Have you transacted any business with any company in the country you are applying to? Yes No

What is the nature of the transaction? ___________________________________________

What is the value of the transaction? ________________________________

For how long have you had transactions? 1-month 3 months 6 months Over 1 year

Do you have any invitation from overseas contacts? Yes No

How long do you want to go on your first visit? 1 wk 2 wks 1 month 2 months 3 months
More than 3 months

Will your visits be frequent? Yes No If yes, number of times in a year you are likely to visit overseas?
1 2-3 5-6 More than 6 times per year

How will this business affect your business?

Increase in sales Technology Transfer Establish presence in new market

Have any of your company employees been abroad on company business? Yes No

If so, how many? 1 2 3 4 5 5-10 More than 10

Have they been to any of these countries? Check those that apply.
USA Canada UK New Zealand Australia Germany France Scandinavia
Japan Singapore Other _________________________________________

__________________________________ ______________________________
Signature Date

© YAXIS Overseas Careers LLC. California, USA

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 CONFIDENTIAL
YAXIS Immigration & Visa Services Application Form
FOR OFFICE USE ONLY
Migration/Visa Eligibility Worksheet

USA Canada UK Australi New Singapor Germany UAE Other

a Zealand e
Age
Diploma
Bachelors
Masters
Salary
Business
Wife
Children
Occupation
Experience
English
Relations
MODL
Acheivement
s
Certifications
Total

VISAS

Business Student Tourist WHMV

Counseled By: ______________________ Date: ___________________

Referred by: ___________________________ YRN _________________________________________
Suitable for:
YRN: _______________________________________________________________________________

Eligible for _________________ Ineligible

Immigration Visit Visa
Canada Australia New Zealand United Kingdom
USA UK Canada Australia New Zealand Other__________

Comments: _________________________________________________________________________

Next Action Items ___________________________________________________________________

Follow-up Details
_______________________________ __________________________ ______________________

© YAXIS Overseas Careers LLC. California, USA

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