Intake Form – Kanu Immigration

Your name:

Referred By:

Phone Number starting with country code:

Your email:

Home Address:

Country of Birth:

Date of Birth:

Citizenship(s):

Passport Number:

Other Names Used: (if any)

Prior Canadian Visas/Status Changes (if any) DATE ISSUED | PLACE USED | VISA STATUS | EXPIRATION

Entries Into Canada: DATE OF ENTRY | PLACE OF ENTRY | TYPE OF VISA | LENGTH OF STAY

Marital Status:

FAMILY INFORMATION

Spouse’s Name:

Spouse’s Date of Birth:

Spouse’s Place of Birth:

Date of Marriage:

Immigration Status:

Is this your first marriage?:

Has your spouse been previously married?

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?

Family Information (Parents):
FATHER’S INFORMATION:
First Name:

Last Name:

MOTHER’S INFORMATION:
First Name:
Last Name:

Have you ever applied for permanent residence?

Are you, your spouse, child, mother, father, brother, or sister a permanent resident or citizen of Canada?

Have you been represented by or consulted with another immigration consultant/attorney?

CRIMINAL HISTORY:

Have you ever had an issue with the Canada Border Services Agency (CBSA)?

Have you ever been denied entry into Canada?

Has an immediate family member ever had issues with law enforcement?

Have you ever been arrested, detained, or convicted for a crime?

Have you ever been charged with a crime, but the case was not prosecuted or the case was dismissed?

Please provide additional details about your Criminal History section 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 email your resume)

What is your spouse’s employment history? (Please email his/her resume)

ADDITIONAL INFORMATION

Additional Comments:

Do you confirm that the information provided above is true?

Prospective Client Signature:
First and Last Name:

DATE:

Additional Information (optional):