Self-Assessment Form - Manitoba Provincial Nominee Program ... · Manitoba Provincial Nominee Program Business Investor Stream - Entrepreneur Pathway Self-Assessment Form Effective

Manitoba Provincial Nominee Program

Business Investor Stream - Entrepreneur Pathway Self-Assessment Form Effective May 2018

Candidate Identification & Contact Information Candidate Full Name:

Last First Middle Initial Date of Birth : yyyy / mm / dd

IMPORTANT: Please provide your contact information below. Do not include the contact information of your representative, if you have one.

Residential Address: Street Number, Street Name Apartment/Unit #

City/ Town Province/State Country Postal Code

Home Phone: country code + area code + number Cell Phone: country code + area code + number Fax: country code + area code + number

Email: Personal Web Page:

Do you have a representative who helped you to fill this form? Yes No

If yes, please provide contact information of your representative.

Representative’s Full Name: Last

First

Representative’s Address: Street Number, Street Name Apartment/Unit #

City/ Town Province/State Country Postal Code

Representative’s Phone: country code + area code + number

Representative’s Email:

Please check one of the following (if applicable):

Canadian provincial or territorial Lawyer

Member of the Immigration Consultants of Canada Regulatory Council (ICCRC)

Unpaid immigration representative such as relative/friend.

Exploratory Visit to Canada / Manitoba Have you visited Canada? Yes No From:

yyyy / mm / dd To:

yyyy / mm / dd

Have you visited Manitoba? Yes No From: yyyy / mm / dd

To: yyyy / mm / dd

Have you conducted in-depth business research and completed the Business Concept form? If yes, please attach it to this form.

Yes No

Have you attended a Business Information Seminar offered by the Immigration and Economic Opportunities Division?

Yes No Date: yyyy / mm / dd

IMPORTANT: You must complete this Self-Assessment Form to be considered as a Business Investor candidate.

Note: The Manitoba Provincial Nominee Program is referred to in this document as “the MPNP” or “the Program”.

Manitoba Provincial Nominee Program BIS-ENP-SA062018

This document is available for free and is not to be sold. www.immigratemanitoba.com

Page 1 of 7 Revised 2018-06-28

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Business Investor - Entrepreneur Self-Assessment Form

Instructions: Enter a response for each factor. Enter details about your assets and liabilities. A score will be calculated based on the

information you enter. Save your self-assessment form. Submit the form by email to [email protected].

All values are in Canadian dollars (CAD), unless otherwise stated.

Section 1: Human Capital Factors

Factor 1: Age Maximum Points: 10 Your age is calculated according to the date this form is received by the MPNP.

Your Age: Possible points: Your score:

Under 25 0

25 to 30 4

31 to 35 6

36 to 45 10

46 8

47 6

48 4

49 2

Over 50 0

Factor 2: Education Maximum Points: 10 You must demonstrate education equivalent to at least a Canadian high school diploma to qualify.

Your Education: Possible points: Your score:

Post-secondary degree or diploma - two year program 4

Post-secondary degree or diploma - three year program or longer 6

Master’s degree or equivalent 8

University degree at a Doctoral (PhD) level 10

None of the above 0

Factor 3: Business Experience Maximum Points: 30 Enter the number of years you have worked as a senior manager and/or a business owner. Review the Program’s definition of business

ownership experience and senior management experience. No points are awarded for other experience. For example, middle- or entry-level

management experience or self-employed business ownership experience will not score any points under this criterion.

• You must have a minimum 3 years of business ownership and/or senior manager experience in the past 5 years to be eligible to apply

to the MPNP.

• To qualify as a business owner you must have a minimum 3 years of business ownership experience in the past five years. To be

considered as a business owner, your share ownership must be at least 33.33%.

• Add your non-concurrent business ownership experience and senior manager experience to count your total years of experience.

• Enter only full years of experience. Do not round up your years of experience.

Scoring Reference – Business Owner Possible Points Scoring Reference – Senior Manager Possible Points

11 years or more as a business owner 30 7 years or more as a senior manager 10

7 to 10 years as a business owner 25 3 to 6 years as a senior manager 5

3 to 6 years as a business owner 20

Your Business Experience: Your score:

Within the 5 years before completing this form, how many years have you worked as:

A business owner years

A senior manager years

In total, how many years have you worked as:

A business owner years

A senior manager years




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Factor 4: Official Languages Proficiency Maximum Points: 25 To receive points for your English and/or French language ability you must provide results from recognized tests that are less than 2 years old

at the time this form is received by the MPNP.

English

• You must provide the MPNP with results from a recognized testing agency proving that your language level is equal to a minimum of

• Canadian Language Benchmark (CLB) 5 to be eligible to apply to the MPNP.

• The MPNP will accept test results from two English testing agencies – International English language Testing System (IELTS) General and

Canadian English Language Proficiency Index Program (CELPIP)-General (available in Canada only). These are the same agencies and tests

used by Immigration, Refugees and Citizenship Canada.

• The MPNP will assess your language points based on your test results in terms of how they compare to Canadian Language Benchmark

• (CLB) levels. You can calculate your own language points based on your recognized test results by using our CLB calculator at:

https://www.immigratemanitoba.com/calculators/ielts_calculator.php

French

• You must provide the MPNP with results from the Test d’Evaluation de Francaise (TEF) as proof of your French language proficiency:

• compréhension écrite; compréhension orale; expression écrite; expression orale.

• The MPNP will assess your language points based on your test results in terms of how they compare to niveaux de compétence

linguistique canadiens (NCLC) levels. You can calculate your own language points based on your recognized test results by using our NCLC

calculator at: https://www.immigratemanitoba.com/calculators/tef_calculator.php

Your Official Languages Proficiency: Possible points: Your score:

CLB/NCLC 5 10

CLB/NCLC 6 15

CLB/NCLC 7 20

CLB/NCLC 8 or higher 25

Continue to Section 2: Investment Factors




https://www.immigratemanitoba.com/calculators/ielts_calculator.php

https://www.immigratemanitoba.com/calculators/tef_calculator.php

Section 2: Investment Factors

Factor 1: Net Worth Maximum Points: 10 You must demonstrate a minimum net worth of at least CAD $500,000 to qualify under the MPNP.

Please enter details of all assets and liabilities owned by you, your spouse or common-law partner, and your dependent children.

A complete and current statement of your total net worth is required (in CAD). All assets and liabilities must be identified. However,

do not include personal items such as jewelry, furniture, and personal vehicles. Personal financial information will remain confidential.

If you have jointly shared assets and liabilities with others, include only your shares and your family members’ shares.

A. Your Assets:

Description Number of Assets Estimated current market value

(Specify principal candidate, spouse and children’s share only)

Chequing and Savings Accounts Number of all Chequing and Savings Accounts Total Current Balance in CAD

Term/Fixed Deposits Accounts Number of Term/Fixed Deposits Accounts Total Current Balance in CAD

Properties Number of Properties Total Appraised Market Value in CAD

Publically Traded Stocks Number of Depository Accounts Total Current Market Value in CAD

Insurance Policies Number of Insurance Policies Total Surrender Value in CAD

Pension Number of Pension Accounts Total Accumulated Value of Pension Fund(s) in CAD

Other Investments/Assets Number of Other Investments/Assets Total Current Market Value in CAD

Businesses Number of Businesses Current Book Value in CAD

Total Assets

B. Your Liabilities:

Description Number of Liabilities Amount

(Specify principal candidate/spouse’s share only)

Mortgages Number of Mortgages Total Current balance in CAD

Other Personal Debts Number of Other Personal Debts Total Current balance in CAD

Total Liabilities

C. Your Total Net Worth:

Total Assets -

Total Liabilities =

Total Net Worth

Your Total Net Worth: Possible points: Your score:

$500,000 to $1 Million 5

Above $1Million to $1.5 Million 6

Above $1.5 Million to $2 Million 7

Above $2 Million to $2.5 Million 8

Above $2.5 Million to $3 Million 9

Above $3 Million 10




Factor 2: Business Investment Maximum Points: 15 You must propose a minimum investment of at least CAD $250,000 in the Manitoba Capital Region or $150,000 in rural Manitoba to be eligible.

If your application is approved, you will be required to invest at least the amount claimed in your Business Plan.

For example, if your total investment is $600,000 in the Manitoba Capital Region, the amount of investment exceeding $250,000 will be

$350,000. Your score for this section will be 10.

Your Investment Amount Exceeding Minimum Required Investment: Possible points: Your score:

$200,000 - $499,999 10

$500,000 - $899,000 12

$900,000 or above 15

None of the above 0

Factor 3: Economic Priorities Maximum Points: 5 • Value-added – if the business adds value to a product or service by utilizing Manitoba resources such as materials, plant and

machinery, labour and expertise.

• Recurring – if the business performs repeated acts of commerce in accordance with the business cycle for each particular industry

sector.

• Active business – if the activities of the business are being conducted for the purpose of generating profits.

Economic Priorities: Possible points: Your score:

Export oriented value-added active business with recurring activities in Manitoba

5

or

Business location or succession outside Manitoba Capital Region 5

None of the above 0

Factor 4: Business Research Visit to Manitoba Maximum Points: 20 The Business Research Visit must be conducted no more than one year before your Business Concept is received by the MPNP.

Business Research Visit to Manitoba: Possible points: Your score:

You have visited Manitoba for at least five consecutive days and conducted relevant business

10

or

You have completed an extended Business Research Visit to Manitoba (You visited Manitoba for at least for 10 consecutive days and conducted extensive relevant business and lifestyle-related research during this visit).

20

None of the above 0

Continue to Section 3: Adaptability Factors




Section 3: Adaptability Factors

Factor 1: Adaptability Maximum Points: 25 You can score additional points for factors that indicate a stronger probability of successful social and economic integration in Manitoba,

including any close relatives in Manitoba, your spouse/common-law partner’s language ability, and if your children are studying in Manitoba.

The MPNP defines a close relative as a sister/brother, aunt/uncle, niece/nephew, parent, grandparent or first cousin who is also a Citizen or a

Permanent Resident of Canada and has resided in Manitoba for more than one year at the time this form is received by the MPNP.

Your Adaptability Factors: Possible points: Your score:

Your spouse/common-law partner has CLB/NCLC 5 or above. 10

You or your spouse/common-law partner has CLB/NCLC 5 or above in Canada’s Second Official Language.

10

You have a close relative currently residing in Manitoba for more than one year.

5

Your child is enrolled in an accredited Manitoba educational institution at least six months prior to the date of submission of EOI and is actively pursuing academic, professional or vocational training on a full-time basis.

5

You or your accompanying spouse/common-law partner have completed a program of full-time study for at least one year at a post-secondary institution in Manitoba. You or your accompanying spouse or common-law partner must have done this after you turned 18 years old and with a valid study permit;

and/or You or your accompanying spouse/common-law partner have completed at least six months of continuous full time employment in Manitoba.

5

Continue to Self-Assessment Overview




Self-Assessment Overview

Disclaimer and Signature

I declare that the information I have given in this form is truthful, complete and correct. I understand that material misrepresentation of a

relevant fact may be grounds for refusal or revocation of a nomination certificate. If the Program becomes aware of or discovers discrepancies,

such as false submissions, omissions, etc. of a relevant and material nature in a form, an application, or other candidate/applicant-provided

information, the submission or application may be declined, even when such misrepresentations are made by a representative of the

candidate/applicant rather than the candidate/applicant themselves.

I certify that I reviewed all the answers provided in this form to the Manitoba Provincial Nominee Program (MPNP). I understand that I am

responsible for the accuracy and veracity of the documents and information submitted with my application, if I am invited to apply to the

MPNP. This is also true for any information or documents provided by my representative on my behalf.

I understand all the foregoing statements. I have asked for and obtained an explanation on every point that was not clear to me.

Name of Candidate:

Signature of Candidate:

Date:

Your Points Maximum Points Office Use Only

Human Capital Factors /75

1. Age 10

2. Education 10

3. Business Experience 30

4. Language Ability 25

Investment Factors /50

1. Net Worth 10

2. Business Investment above minimum 15

3. Economic Priorities 5

4. Business Research Visit 20

Adaptability Factors /25

Spouse language ability 10

Ability in second official language 10

Close Relative in MB 5

Child in MB 5

Previous Study and/or work experience in MB 5

Total /150




Self-Assessment Form - Manitoba Provincial Nominee Program ... · Manitoba Provincial Nominee Program Business Investor Stream - Entrepreneur Pathway Self-Assessment Form Effective

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