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HELPING HANDS IMMIGRATION CONSULTANCY INC.

Client Intake Form

Please complete ALL fields. Write "N/A" if a question does not apply to you. Incomplete forms delay your application.

Privacy note: The information you provide is collected strictly for preparing your immigration application and is kept confidential. It will be shared only with the consultant handling your file and, where required, with Immigration, Refugees and Citizenship Canada (IRCC).

1. Service(s) Requested

Tick everything that applies. Sections for your selected services appear below automatically.

Other / details of what you need help with

2. Personal Details (exactly as shown in your passport)

Family name (surname)

Given name(s)

Full name on passport (if different)

Date of birth

City / town of birth

Country of birth

Citizenship / nationality

Gender

Marital status

Eye colour

Height (cm / ft-in)

Native language(s)

Preferred language of communication

If married/common-law: date of marriage

Place of marriage (city, country)

3. Contact Information (CURRENT - this is how we reach you)

Current email address (check it daily)

Phone / WhatsApp number

Current full address (street, unit, city, province/state, country, postal code)

Date you moved to this address

Who do you live with at this address?

Emergency contact (name + phone)

4. Address History (last 10 years)

Use the + button to add more rows. List every address for the last 10 years.

From (MM/YYYY)	To (MM/YYYY)	Street, unit, city, province/state, country

5. Passport & Travel Documents

Passport number

Issue date

Expiry date

Issuing country

National ID number (if any)

Do you hold any OTHER passport (second nationality)?

6. Immigration History

Current country of residence

Current status in Canada (if applicable)

Status valid until

First entry to Canada (date + city)

Most recent entry to Canada (date + city)

UCI / application number (if any)

List EVERY visa/permit application you have ever made (Canada or any other country), including refusals. Use the + button to add rows.

Type of application	Year	Country	Result	Details / refusal reason (if refused)

Have you ever been ordered to leave any country, or denied entry at a border? (Yes/No + details)

Any criminal charges or convictions in ANY country? (Yes/No + details)

Have you ever overstayed, worked or studied without authorization in Canada or elsewhere? (Yes/No + details)

Any serious medical condition or ongoing treatment? (Yes/No + details)

7. Family Members

List ALL: spouse/partner, children, parents, siblings. Use the + button to add more members.

Name	Relationship	Date of birth	Country	Status / where they live now	Accompanying you to Canada?

Have you ever been married before (to anyone other than your current spouse)?

8. Education

List all education after high school. Use the + button to add more rows.

From	To	Institution, city, country	Program / field of study	Credential earned

Highest credential

Do you have an ECA (Educational Credential Assessment - WES, IQAS, etc.)?

9. Work History (last 10 years - no gaps)

List every job for the last 10 years. Use the + button to add more rows. Detailed duties matter - your consultant will confirm them with you.

From	To	Employer name, city, country	Job title	Hrs/week	Main duties (3-5 lines)

Explain any gap of 6+ months (unemployed, studying, travelling)

10. Language Tests

Add a row for each test taken or planned - yours and your spouse's.

Whose test	Test (IELTS/CELPIP/TEF/PTE)	Date (or planned date)	Results (L / S / R / W)

11. Funds

Available settlement funds (CAD)

Whose account(s)? (mine / joint / family)

Source of funds (salary, sale, gift...)

13. Documents You Already Have

Tick what you can provide NOW. For anything unticked, note when you can get it. Your consultant will send you a full numbered checklist for your case type.

For anything unticked: when can you provide it?

14. Declaration & Consent

I declare that the information provided in this form is true, complete and correct to the best of my knowledge. I understand that:

providing false or misleading information can result in my application being refused and a ban from applying to Canada;
my consultant relies on this information to prepare my application, and I must report any changes (address, marital status, new refusal, criminal matter, etc.) immediately;
my documents and personal information will be stored securely and used only to prepare and submit my immigration application;
I will submit all requested documents in the requested format by the deadlines given to me.

Full name (signature equivalent)

Date signed

Client signature (if printed, sign here)

Consultant name

Submit your form online

Please do not attach documents here. We will send you a secure way to share passports, bank statements and other documents.