Self-Assessment Form - Manitoba Provincial Nominee Program ... · PDF fileManitoba 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.

Representatives Full Name: Last

First

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

City/ Town Province/State Country Postal Code

Representatives Phone: country code + area code + number

Representatives 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

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

Masters 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 Programs 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

Manitoba Provincial Nominee Program BIS-ENP-SA062018

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

Page 2 of 7 Revised 2018-06-28

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 dEvaluation de Francaise (TEF) as proof of your French language proficiency:

comprhension crite; comprhension orale; expression crite; expression orale.

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

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

Manitoba Provincial Nominee Program BIS-ENP-SA062018

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

Page 3 of 7 Revised 2018-06-28

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 childrens 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

Pens