PROTECTED WHEN COMPLETED - B PAGE 1 OF 1 SCHEDULE 17 BUSINESS IMMIGRATION PROGRAMS – IMMIGRANT INVESTOR VENTURE CAPITAL CLASS The principal applicant must complete this form. If there is not enough space to provide all the necessary information, attach to this form a separate sheet of paper with further details. Print your name at the top of each additional sheet and indicate the form's title and the number of the question you are answering. 1. Your full name (as shown on your passport) Family Name Given Name(s) YYYY 2. Your date of birth 3. Language proficiency MM DD a) Which will be your first official language in Canada? English French b) Have you taken a CIC designated language test to assess your proficiency? Yes Provide original language test results for all your language abilities: speaking, listening, reading and writing. No 4. Personal net worth Indicate your legally obtained net worth derived from business or investment activities. At least CDN $10 million CDN $50 million or more Note: if your application is randomly selected, you will be instructed to obtain a due diligence report from a designated service provider to verify the amount you claim. Do not provide any documentation related to your net worth unless requested by CIC. 5. At-risk investment Are you willing and able to make an at-risk investment of CDN $2 million? Yes No 6. Canadian Educational Credential OR Educational Credential Assessment (ECA) Report Do you have a Canadian post-secondary degree, diploma or certificate of at least one year? Yes Provide a copy. No Have you obtained an ECA report from an organization designated by CIC indicating that your completed foreign educational credential is equivalent to a completed Canadian post-secondary educational credential of at least one year? Yes Provide an original ECA report from the designated organization and proof of your completed foreign educational credential. No Note: you must provide an original ECA report if you are applying with a completed foreign educational credential. The ECA report will be used to determine whether you meet the education requirement unless you can demonstrate a legally obtained personal net worth of CDN $50 million or more derived from business or investment activities. Signature YYYY This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants. IMM 0008 (01-2015) E SCHEDULE 17 (DISPONIBLE EN FRANÇAIS - IMM 0008 F ANNEXE 17) MM DD