Immigration – Prospective Client Intake Form

Name(Required)

First Last

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

How can we help? (Please list the reasons for contacting our firm.)

Citizenship(s)

Passport Number

Please provide a copy of the biographical page of your current passport.

Max. file size: 50 MB.

Have you been refused a Visa to Canada or any other country?

Please provide details about your criminal history in the space below.

What is your language proficiency?

If you have taken a language test, please provide a copy.

Max. file size: 50 MB.

Please provide a copy of your resume outlining your education and work experience.

Max. file size: 50 MB.

If you are contacting our office, because you are in receipt of IRCC (Immigration) correspondence, please provide a copy of the letter.

Max. file size: 50 MB.

Do you confirm that the information provided above is true?

Prospective Client Signature

Consent

I agree to the privacy policy.

Date