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Immigration – New Client Intake Form
To assist us in preparing your file, please complete the following information, which will be kept completely private and confidential.
Name
*
First
Last
Date of Birth
MM slash DD slash YYYY
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Phone
*
Email
*
City/ Province/ Country of Birth
Citizenship(s)
Passport Number
Prior Canadian Visas/ Status Changes (if any)
Date Issued | Place Used | Visa/Status | Expiration Date
Have you been refused a Visa to a country?
Yes
No
Applied for any type of Visa to Canada and been refused?
Yes
No
Entries Into Canada
Date of Entry | Place of Entry | Type of Visa | Length of Stay
Made a claim for refugee in any country?
Yes
No
If yes, whom and where?
Please indicate your level of assets (minus debt):
Family Information
Martial Status
Single
Married
Divorced
Widowed
Spouse's Name
First
Last
Spouse's Date of Birth
MM slash DD slash YYYY
Place of Birth
Date of Marriage
MM slash DD slash YYYY
Immigration Status
Is this your first marriage?
Yes
No
Has your spouse been previously married?
Yes
No
Spouse's Entries into Canada
Date of Entry | Place of Entry | Type of Visa | Length of Stay
Family Information (Children):
Name | Date of Birth | Married? | Residence
Family Information (Parents)
Father's Name
First
Last
Mother's Name
First
Last
Immigration Questions
Have you ever applied for permanent residence?
Yes
No
Are you, your spouse, child, mother, father, brother, or sister a permanent resident or citizen?
Yes
No
Have you been represented by or consulted with another immigration attorney or consultant?
Yes
No
Criminal History
Have you ever had an issue with the Canada Border Services Agency (CBSA)?
Yes
No
Have you ever been denied entry into Canada?
Yes
No
Have you ever had issues with law enforcement anywhere in the world?
Yes
No
Has an immediate family member ever had issues with law enforcement?
Yes
No
Have you ever been arrested, detained, or convicted for a crime?
Yes
No
Have you ever been charged with a crime, but the case was not prosecuted or the case was dismissed?
Yes
No
Please provide additional details about your criminal history in the space below
Language Proficiency
What is your language proficiency?
What is your spouse's language proficiency?
Education
Provide your education history (include all of your degrees)
Provide your spouse's education history (include all degrees)
Employment
What is your employment history?
Please upload a copy of your resume
Max. file size: 128 MB.
What is your spouse's employment history?
Please upload a copy of your spouse's resume
Max. file size: 128 MB.
For business class entrepreneur immigrants, please briefly describe your proposal for establishing business in Canada
Additional Information
Additional Comments
Declaration
Do you confirm that the information provided above is true?
Yes
No
New Client Signature
Consent
*
I agree to the privacy policy.
Date
MM slash DD slash YYYY