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Canadian Immigration Client Intake Form

 

Please fill out and submit this intake form - the information you submit will be kept in complete confidence. We will contact you and answer any questions you have. If you wish to proceed we will assist you each step of the way. See our Privacy Policy

* indicates required information in order to process form
* First Name:
* Last Name:
Other Names:
Maiden Name:
Gender:	Male: Female:
* Date of Birth:	dd/mm/yyyy
* Country of Birth:
* Current Citizenship:
Street Address:
Street Address 2:
City/Town/Village:
Province/State/Other:
Postal/Zip Code:
Country:
Telephone:
Fax:
* Email Address:
Dependent Children:	Yes No
How Many:
Ages:
* Assets: (include entire family assets, in US dollars)
* What is your estimated total net worth (assets minus debts):
* What amount of your net worth can be in cash within six months?:
* Have you or your spouse or common law partner worked legally in Canada for a minimum of one year? (Full time authorized work.)	Yes No
* Have you or your spouse or common law partner studied a minimum two years in Canada? ( Full-time authorized post-secondary study)	Yes No
If you checked the above box and were the applicant, and your spouse has met the same requirements of study in Canada, complete the check boxes at the right.	Yes No

* MARITAL STATUS (Choose one from below: )
Married:		Widowed:
Never Married:		Divorced:
Engaged:		Separated:
Annulled Marriage:

*My First Language is:   English       French     ( If you speak both languages, check the one you speak the best and complete the boxes below that apply to you. Otherwise, just complete the boxes that apply to you. )
* ENGLISH LANGUAGE
	Fluently	Well	With Difficulty	Not At All
I speak English
I read English
I write English
Listening Skills
* FRENCH LANGUAGE
	Fluently	Well	With Difficulty	Not At All
I speak French
I read French
I write French
Listening Skills

* EDUCATION
I have successfully completed (insert appropriate number of years and name of degree/diploma) NOTE: Failure to include the Number of School Years may result in your application not being considered
No of Years		Name of Degree/Diploma
a) elementary/primary school:
b) Secondary/High School Educational Credential :
University Degrees
No of Years		Name of Degree/Diploma
c) university/collegePhD, or Master's, AND at least 17 years of full-time or full-time equivalent study
Two or more university degrees at the Bachelor's level AND at least 15 years of full-time or full-time equivalent study
A two-year university degree at the Bachelor's level AND at least 14 years of full-time or full-time equivalent study
A one-year university degree at the Bachelor's level AND at least 13 years of full-time or full-time equivalent study
Trade or Non-university Certificate or Diploma
No of Years		Name of Degree/Diploma
d) A three-year diploma, trade certificate or apprenticeship AND at least 15 years of full-time or full-time equivalent study
A two-year diploma, trade certificate or apprenticeship AND at least 14 years of full-time or full-time equivalent study
A one-year diploma, trade certificate or apprenticeship AND at least 13 years of full-time or full-time equivalent study
A one-year diploma, trade certificate or apprenticeship AND at least 12 years of full-time or full-time equivalent study

*WORK HISTORY (since 18th birthday) Please fill in the experience in an occupation that you plan to apply for in Canada
From	mm/yyyy	To	mm/yyyy
Full name of employer
City		Country
Occupation/Title
Gross Monthly Salary	US$
Full Time	Yes	Part Time	Yes
From	mm/yyyy	To	mm/yyyy
Full name of employer
City		Country
Occupation/Title
Gross Monthly Salary	US$
Full Time	Yes	Part Time	Yes
From	mm/yyyy	To	mm/yyyy
Full name of employer
City		Country
Occupation/Title
Gross Monthly Salary	US$
Full Time	Yes	Part Time	Yes
From	mm/yyyy	To	mm/yyyy
Full name of employer
City		Country
Occupation/Title
Gross Monthly Salary	US$
Full Time	Yes	Part Time	Yes

Personal Details of All Dependents (whether accompanying you or not)
Spouse
Family Name		Date of Birth	mm/yyyy
Given Name(s)		Gender	Male Female
Maiden Name		Current Citizenship
City/Town of Birth		Country of Birth
Will Accompany You Overseas		Yes   No
*If your spouse will accompany you, complete the boxes to the right		Spouse has a Degree Yes No	Name of Degree

Dependent I
Family Name		Date of Birth	mm/yyyy
Given Name(s)		Gender	Male Female
Other Names		Current Citizenship
City/Town of Birth		Relationship to Applicant
Country of Birth		Will Accompany You Overseas	Yes No
Marital Status
	Never Married	Divorced
	Engaged	Widowed
	Married	Separated
	Annulled Marriage

Dependent 2
Family Name		Date of Birth	mm/yyyy
Given Name(s)		Gender	Male Female
Other Names		Current Citizenship
City/Town of Birth		Relationship to Applicant
Country of Birth		Will Accompany You Overseas	Yes No
Marital Status
	Never Married	Divorced
	Engaged	Widowed
	Married	Separated
	Annulled Marriage
Dependent 3
Family Name		Date of Birth	mm/yyyy
Given Name(s)		Gender	Male Female
Other Names		Current Citizenship
City/Town of Birth		Relationship to Applicant
Country of Birth		Will Accompany You Overseas	Yes No
Marital Status
	Never Married	Divorced
	Engaged	Widowed
	Married	Separated
	Annulled Marriage

* Family in Canada Canadian Citizen or Permanent Resident (Yes/No)
Uncle	Yes	Sister	Yes
Aunt	Yes	Niece	Yes
Brother	Yes	Nephew	Yes
	None

* Before submitting form, please check to see all required entries have been made. This is necessary in order to make a valid assessment of your status for potential immigration. Thank you.
Additional Comments & Questions: