All members of your immediate family are to be listed (including married brothers and sisters even though they may no longer live with you; half and step-brothers and sisters are also to be included). All names are to be written in English and Chinese characters. Attach an additional sheet if more space is required.

©Ò¦³®a®x¤¤ªº¦¨­û³£­n¦C¥X¨Ó(¥]¬A¤w±B¤§¥S§Ì©n©f¡A¬Æ¦Ü¤w¤£¦A©M§A¦í¦b ¤@°_ªº®a¤H¡A»â¾i¤§¥S§Ì©n©f¥ç¥]¬A¦b¤º)¡C©Ò¦³ªº©m¦W¥²¶·¥H¤¤­^¤å¼g¥X ¨Ó¡A¦pªG¦ì¸m¤£°÷¡A¥i¼g¦b¨ä¥Lªº¯È±i¤Wªþ¤W¨Ó¡C

NOTE:If you are married, please list the name, date and place of birth, address and occupation of spouse/children on a separate sheet and indicate whether they will accompany you to Canada.

ª`·N:¦pªG§A¤w±B¡A½Ð±N°t°¸»P¤p«Ä¤§©m¦W¡B¥X¥Í¤é´Á©M¦aÂI¡B¦a§}»P¾·~ ¼g¦b¥t¥~¤@±i¯È¤W¨Ã»¡©ú¥L­Ì¬O§_·|©M§A¤@°_¥h¥[®³¤j¡C

8. City/Country of birth Taipei, Taiwan «°¥«/¥X¥Í°ê®a		9. Telephone number 02-1234567 ¹q¸Ü¸¹½X	10. Sex ©Ê§O ¡¼ ¡½ Male ¨k Female ¤k
11. Mailing address 13f., #365, Fu Hsin N. Rd., Taipei, Taiwan ³q°T¦a§}
12. Permanent address: or ¡½ Same as number 11 (¦P11) ¥Ã¤[¦a§}
13.Marital status ±B«Ãª¬ªp Never married¡½ Engaged¡¼ Married¡¼ Widowed¡¼ Separated¡¼ Divorced¡¼ ¥¼±B ­q±B ¤w±B Å`/¹è ¤À©~ Â÷±B
14. ¡¼Passport# M1234567 Å@·Ó¸¹½X	15. Country of issue Taiwan µo·Ó°ê®a	16. Date of issue Dec. 12, 1995 µo·Ó¤é´Á	17. Date of expiry Dec, 12, 2001 ºI¤î¤é´Á
18. Citizenship °êÂÇ Taiwan, R.O.C.
19. Grade or course of study µ¥¯Å©Î¾Ç²ß¤§½Òµ{ ESL Program		20. Total length of this course ½Òµ{ªøµu One Year
21. Exact starting date of this course ½Òµ{¶}½Ò¤§½T¤Á¤é´Á Sept. 4, 1995		22. Exact completion date of this course ½Òµ{§¹¦¨¤§½T¤Á¤é´Á Sept. 4, 1996

Date ¤é´Á		Name and address of school/company during the last 10 years ¹L¥h¤Q¦~¶¡¤§¾Ç®Õ/¤½¥q¦WºÙ©M¦a§}	Level/position µ{«×/¾¦ì	Type of course/business ½Òµ{/¤u§@©Ê½è
From ©l	to ¦Ü
month/year ¤ë/¦~	month/year ¤ë/¦~
10/1992	05/1995	Top Trading Company 5F., #18 Chung Shan N. Rd., Taipei, Taiwan	Assistant	Business
09/1988	06/1992	Chinese Culture University 55 Hwakang Rd., Yangmingshan, Taipei, Taiwan	University	Business
09/1992	06/1985	Tan-Kang High School 26, Chen-Li St., Tamsui, Taipei, Taiwan	Gr. 10-12	High-School

I understand that the issuance of a student authorization/visa to me is dependent upon the outcome of a personal interview and the production of the required documents on my part. In order to speed up the processing of my application, I am prepared to undergo the required medical examination at my own expense before a decision is made. I understand that completing this examination does not commit the Government of Canada to issuing me a student authorization or reimbursing my expenses. I also hereby certify that all information listed on this form is TRUE and COMPLETE. I understand that if this information is found to be untrue or incomplete, my application whil be refused.

¥»¤Hª¾±x¡A¥»¤H¥Ó½Ð¾Ç¥Í­ãÃÒ/ñÃÒ¬O§_Àò±o§å­ã¡Aµø¥G­±¸Õ¤§µ²ªG¤Î¥»¤H¬O§_´£¥æ ¥þ³¡¥²»Ý¤å¥ó¦Ó©w¡C¬°¤F¥[³t¥»¤H¥Ó½Ð¤§¼f²z¡A¥»¤HÄ@·N©|¥¼Àò±o¥¿¦¡µªÂФ§®É¡A ¦Û¶O¶i¦æ©Ò»Ý¤§¨­ÅéÀËÅç¡C¥»¤H¾é¸Ñ¡A¥»¤H¶i¦æ¦¹¶µ¨­ÅéÀËÅ秹²¦¡A¨Ã¤£ªí¥Ü¥[®³ ¤j¬F©²¤w¸g©Ó¿Õ¦V¥»¤Hµo¥X¾Ç¥ÍñÃҩΰhÁÙ¥»¤H¤§¶O¥Î¡C ¥»¤H¯÷ÃÒ¹ê¡A¥»ªí®æ¤º©Ò¦C¥þ³¡¸ê®Æ§¡Äݯu¹ê¤Î§¹³Æ¡C¥»¤Hª¾±x¡A­Õµo²{¤W­z¸ê®Æ ¤£¯u¹ê©Î¤£§¹³Æ¡A«h¥»¤H¤§¥Ó½Ð±N·|³Q©Úµ´¡C

ShenYunBai signature of student applicant ¾Ç¥Í¥Ó½Ð¤Hñ¦W

Nov. 6, 1995 date ¤é´Á

STUDENT AUTHORIZATION/VISA SUPPLEMENTARY INFORMATION Please carefully answer the following questions. Details about any question answered "YES" are to be given below.			¥Ó½Ð¾Ç¥Í­ãÃÒ/ñÃÒ ¸É¥R¸ê®Æ ½ÐÂÔ·V¦^µª¤U¦C°ÝÃD¦³Ãö¦^µª ¡u¬O¡vªº¥ô¦ó°ÝÃDªº¸Ô±¡¡AÀ³ ¦b¥»­¶¤U­±¼g©ú¡C
1. I have previously applied for a Canadian visa (student, employment, tourist, immigrant).	§_ NO¡Ô	¬O YES___	1. §Ú¥H«e´¿¸g¥Ó½Ð¥[®³¤jñÃÒ (¾Ç¥Í¡B´N·~¡B®È¹C¡B²¾¥Áñ ÃÒ)
2. I have previously applied for a visa to visit, study, work, or live in another country.	§_ NO¡Ô	¬O YES___	2.§Ú¥H«e´¿¸g¥Ó½Ð¥t¤@­Ó°ê®a ªº®È¹C¡AŪ®Ñ¡A¤u§@©Î¥Í¬¡Ã± ÃÒ¡C
3. I have visited Canada before.	§_ NO¡Ô	¬O YES___	3.§Ú¥H«e´¿¸g®È¹C¥[®³¤j¡C
4. I have been refused entry to Canada, been refused any extension for my stay in Canada, or have been ordered to appear at a Canadian Immigration Inquiry.	§_ NO¡Ô	¬O YES___	4.¦³Ãö·í§½´¿¸g©Úµ´§Ú¶i¤J¥[ ®³¤j¹Ò¤º , ´¿¸g©Úµ´©µªø§Ú¦b ¥[®³¤jªº©~¯d´Á­­¡A©Î´¿¸g©R ¥O§Ú¥X®u¡u¥[®³¤j²¾¥Á½Õ¬d¡v¡C
5. Members of my immediate family are now in Canada as students, visitors, or residents.	§_ NO¡Ô	¬O YES___	5.§Úªºª½ÄÝ®a®x¦¨­û¥Ø«e¦b¥[ ®³¤j¡A¨­¥÷¬O¾Ç¥Í¡A³X«È©Î ©~¥Á¡C
6. Members of my immediate family are now applying or have previously applied for a Canadian visa of any type.	§_ NO¡Ô	¬O YES___	6.§Úªºª½ÄÝ®a®x¦¨­û¥Ø«e¥¿¦b ¥Ó½Ð©Î¥H«e´¿¸g¥Ó½Ð¥ô¦óºØÃþ ªº¥[®³¤jñÃÒ¡C
7. I have been charged with a criminal offence or have been required to appear in a court of law in any country.	§_ NO¡Ô	¬O YES___	7.§Ú´¿³Q«ü±±¥Ç¸o©Î´¿³Q­n¨D ¥X®u¥ô¦ó°ê®aªºªk®x²â°T¡C
8. a) Are you an official or an employee of a government or of a government agency? If the answer is Yes, give the name of the organization and your exact position on a separate page;	§_ NO¡Ô	¬O YES___	8. a) ¥xºÝ²{¦b¬O§_¬F©²¾÷ºc¤§ ©x­û©Î¹µ­û©Î¬F©²ºÞÁҩΤä«ù ¤U¤§²Õ´»P¤½¥q¤§¦¨­û?
b) Do you intend while in Canada to undertake any activities on behalf of a government or of a government agency?	§_ NO¡Ô	¬O YES___	b) ¬O§_¹w³Æ¨ì¥[®³¤j§@¥ô¦ó ¥Nªí¬F©²©Î¬F©²ºÞÁÒ¤ä«ù¤U¤§ ²Õ´»P¤½¥q¤§¬¡°Ê?
Explain any "yes" answers in detail on a separate sheet. µª®×¦pªG¬O"yes"½Ð¦b¥t¤@±i¯È¤W¸Ô¥[»¡©ú
DECLARATION			Án©ú
I declare that all the above information is true and complete.			§ÚÁn©ú¤W¦C¥þ³¡¸ê®Æ¬O½T¹ê©M §¹¾ãªº¡C
ShenYunBai signature of student applicant ¾Ç¥Í¥Ó½Ð¤Hñ¦W			Nov. 6, 1995 date ¤é´Á