PLEASE ATTACH TO THIS QUESTIONNAIRE
A COPY OF YOUR PASSPORT AND COPIES OF ALL DOCUMENTS
RELEVANT TO YOUR CASE SUCH AS YOUR RESUME/CV, CURRENT AND
PRIOR VISA/WORK PERMITS, JOB OFFER, REFUSAL LETTER, ETC.
CLIENT INFORMATION (CANADA)
THE APPLICANT’S PERSONAL INFORMATION
Applicant's full legal name:
Date of birth:
Residential address:
Home phone #: Cell phone #:
Work phone #: Email:
Country where you last lived:
Current status in Canada (if applicable):
Have you been approved in principle for Canadian permanent residence?
Have you had an Immigration Medical Examination?
Country of citizenship: Date citizenship acquired (if not by
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birth):
Second country of citizenship (if Date citizenship acquired:
applicable):
Legally allowed to live in other country(ies):
Have any other valid passport?
Is this your first time in Canada?
Please provide a summary of your immigration matter (Please mention if you
have a job offer and/or assignment as part of your current employment. Provide
details.):
APPLICANT'S ADMISSIBILITY
Applicant's full legal name:
Have you ever:
Stayed in Canada longer than you were permitted?
Attended school in Canada without authorization?
Worked in Canada without authorization?
Violated any of the conditions of your stay?
Been refused admission to Canada?
Please provide details if your answer is "YES" to any of the above questions:
_________________________________________________________________
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_________________________________________________________________
_________________________________________________________________
Have you ever been convicted of, or charged with a crime or offence in any
country?
If your answer is "YES", please provide details:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Have you suffered from any serious mental or physical illness?
Have you ever been ordered to leave Canada?
Have you ever had a social insurance number?
Have you ever been issued a Canadian Permanent Residency (PR) Card?
APPLICANT'S FAMILY MEMBERS & DEPENDENTS
Applicant's full legal name:
Do you have any dependent family members (i.e., spouse or children)?
If “YES”, will they be accompanying you to Canada?
For each accompanying family member please provide:
Last name:
First name:
Sex:
Relationship to you:
Marital status:
Passport #:
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Date of birth:
For additional family members use the addendum (See Reverse)
Have any of your family members:
Stayed in Canada longer than they were allowed to stay?
Attended school without authorization?
Worked without authorization?
Violated any of the conditions of their stay?
Have any of your family members ever been convicted of or charged with a crime
or offence in any country?
Have any of your family members suffered from any serious mental or physical
illness?
Have any of your family members ever been ordered to leave Canada?
Have any of your family members ever applied for a Canadian social insurance
number?
Do you have any pets accompanying you? YES ___ NO ___
What is the expiry date of your current passport? If you have more than one passport, please
include all expiry dates of respective passports or travel documents:
1. ____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
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ADDENDUM
CLIENT INFORMATION (CANADA)
LIST OF APPLICANT'S FAMILY MEMBERS & DEPENDENTS
Applicant's full legal name:
Family Member (2) Family Member (3)
Last name: Last name:
First name: First name:
Sex: Sex:
Relationship to you: Relationship to you:
Marital status: Marital status:
Passport #: Passport #:
Date of birth: Date of birth:
Family Member (4) Family Member (5)
Last name: Last name:
First name: First name:
Sex: Sex:
Relationship to you: Relationship to you:
Marital status: Marital status:
Passport #: Passport #:
Date of birth: Date of birth:
Family Member (6) Family Member (7)
Last name: Last name:
First name: First name:
Sex: Sex:
Relationship to you: Relationship to you:
Marital status: Marital status:
Passport #: Passport #:
Date of birth: Date of birth:
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CLIENT INFORMATION (CANADA)
SOURCE OF REFERRAL
Please indicate how you heard about our law firm:
Person:
Web site:
Online Search:
Other:
I declare that the information I have given herein, as well as any information provided in my
curriculum vitae (“C.V.”) and other supporting documents, is true and complete to the best of my
knowledge.
________________________ ________________________
Declarant’s Signature Date
Make sure you included your resume/CV and
other documents to this questionnaire!
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