General Information Full Name Date Of Birth City & Country of Birth Home Address City/State Postal Code Email Address Home Phone Work Phone Fax Number What method would prefer we use to contact you?PhoneEmailFax What time of day would you like us to call?MorningAfternoonEvening What is your current country of residence? What is your resident status? How long have you been in that country? Education Secondary School attended: Year of graduation: Post-Secondary School attended: Year of graduation: Grade: Work Your Employer (If Self-Employed, what business do you do): Address: Phone: Marital Status: MarriedSingleSeparated Spouse Information: Full Name Date Of Birth Email Spouse Address: (If different from yours): Employer: If Self-Employed, what business do your spouse do? Employer's Address: Employer's Phone: Children Information Enter the Name(s) and Date of Birth of your Child(ren): (Incase of multiple children, separate each one with a ; ) Is this your first experience engaging the services of a lawyer in Canada? YesNo Why do you want to go to Canada? VisitStudyWorkImmigrationBusinessOther Are you here regarding Citizenship? ApplyProofResume/Renounce How did you come to know about our law firm? ReferralFriendSeminarNewspaperInternetOther Why do you want to go to Canada? VisitStudyWorkImmigrationBusinessOther What do you want us to do for you? (Please be explicit with this) What countries have you been to within the past 5years? (If none, write NA) Have you been denied visas to Canada or any other country? State the country, dates and reasons for refusal Any other information that is relevant to this assessment? (If none, write NA) I agree that my submitted data is being collected and stored.
