Contact | Bluenose Residence

Apply to Bluenose Residence

Fill out the application below and a member of our team will be in touch. No pressure, no obligation, just answers.

Application

Full Name* Please enter your full name.

Spouse Name (if applicable)

Address* Please enter your address.

Email Address* Please enter a valid email address.

Contact Number* Please enter your contact number.

Age* Please enter your age.

Sex*

Male Female

Please select an option.

Nationality

Monthly Income* Please enter your monthly income.

Source of Income

Health

How is your health?

Will you be purchasing health insurance in Canada or Cambodia, or not at all?

Canada Cambodia Not at all

Do you have food allergies?

Yes No

If yes, please list your allergies

Are you able to climb 2 flights of stairs?

Yes No

Anything else you'd like us to know?

Head Office
Halifax, Nova Scotia

Residence
Siem Reap, Cambodia