Confidential Client Questionnaire Please fill in the form below. Step 1 of 8 12% Section One - Client InformationThis client questionnaire is for family law clients. Please note that not all fields are mandatory.Full Legal Name First Middle Last Also known as? First Last Date of Birth Month Day Year Place of BirthCurrent Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Date you became a Resident of BC Month Day Year Is BC your permanent Home? If not, do you intend to make BC your permanent Home?Home PhoneCell PhoneEmail Marital Status at time of marriageEducation and vocational trainingWork HistoryCurrent EmploymentDate of commencement Month Day Year Address of Employer Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Work Phone NumberDescription of JobSalaryMonthly Gross IncomeMonthly Net IncomeOther Income from any sourceDividends, pension, child tax benefits, support.Significant Medical HistoryName of PhysicianPhysician's Phone NumberPhysician's Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Section Two - Information About the Other PartyFull Legal Name First Middle Last Also known as? First Last Date of Birth Month Day Year Place of BirthCurrent Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Date you became a Residient of BC Month Day Year Is BC our permanent Home? If not do you intend to make BC your permanent Home?Home PhoneCell PhoneEmail Marital Status at time of marriageEducation and vocational trainingWork HistoryCurrent EmploymentDate of commencement Month Day Year Address of Employer Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Work Phone NumberDescription of JobSalaryMonthly Gross IncomeMonthly Net IncomeOther Income from any sourceDividends, pension, child tax benefits, support.Significant Medical HistoryName of PhysicianPhysician's Phone NumberPhysician's Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Photo of other partyAccepted file types: jpg, png, Max. file size: 2 MB.Should it be necessary to serve documents please provide a recent photo of the other party. Section Three - Information about the RelationshipIf married please provide your government issued marriage certificate. If you do not have one you will need to order one from vital statistics.Date of cohabitation Month Day Year Date of marriage Month Day Year Place of marriageIf married, is marriage certificate available Yes No Date of separation Month Day Year Reason for SeparationAny previous Court ProceedingsAny separation agreements in place? If yes, please provide.Any marriage /cohabitation agreements in place? If yes, please provide.Wife’s surname at birthWife’s marital status at the time of marriageHusband’s surname at birthHusband’s marital status at the time of marriageParticulars of previous marriage of either partyParticulars of divorce(s) or death(s) of previous spouse(s) including date and location Section Four - Family ViolenceIf you believe that any of the following apply to you or your children, please indicate by marking yes or no. The lawyer will discuss the detail and implications at your meeting.Physical, sexual, psychological and emotional abuse, including attempted abuse Yes No Forced confinement and/or being deprived of the necessities of life Yes No Restrictions on your financial and/or personal freedom Yes No Intimidation, harassment, coercion or threats, including to other people, property and pets Yes No Being stalked or followed Yes No Intentional damage to property Yes No Exposure of children to family violence, either directly or indirectly Yes No Section Five - Information about the ChildrenAre there children of the relationship? Yes No Child 1 First Last Child 1 Date of Birth Month Day Year Child 1 Resides with Mom Dad Both Child 2 First Last Child 2 Date of Birth Month Day Year Child 2 Resides with Mom Dad Both Child 3 First Last Child 3 Date of Birth Month Day Year Child 3 Resides with Mom Dad Both Child 4 First Last Child 4 Date of Birth Month Day Year Child 4 Resides with Mom Dad Both Child 5 First Last Child 5 Date of Birth Month Day Year Child 5 Resides with Mom Dad Both Is there medical/dental coverage for the children? Yes No Medical Coverage provided byWho is covered under this plan Mom Dad Both Dental Coverage provided byWho is covered under this plan Mom Dad Both Significant medical history of children.Name address telephone number of physician and counselors.Do children have any assets, trust property, bank accounts etc? Please describe.Please describe the parenting arrangementContact with parents and when?Any court orders in place or Separation Agreements dealing with Parenting?Other relevant information?Child support monthly amount?When did payments start? Month Day Year Is there a Court Order for support?Other relevant information Section Six - AssestsHouseAddress Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Legal DescriptionMarket ValueAnnual TaxesWater RatesDate Acquired Month Day Year Title HolderRecreational PropertyAddress Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Legal DescriptionMarket ValueAnnual TaxesWater RatesDate Acquired Month Day Year Title HolderRRSPsDetails of RRSPsDate Acquired Month Day Year Title HolderPensionsDetails of pensionsDate Acquired Month Day Year Title HolderHospital and Medicial CoverageDetails of coverageDate Acquired Month Day Year Title HolderBusinesses and CompaniesName of BusinessBusiness Location Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Address of registered and records office Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Shareholders namesApproximate value of business if knownCorporate solicitorPhoneEmail AccountantPhoneEmail Are income tax returns available? Yes No Bank InformationName of BankBranch NumberType of AccountAccount NumberApproximate balanceName of BankBranch NumberType of AccountAccount NumberApproximate balanceName of BankBranch NumberType of AccountAccount NumberApproximate balanceSafety Deposit BoxLocation Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province ContentsWho has keys?InvestmentsPlease select all that apply Stocks Bonds Receivables Select AllName of BrokerVehiclesMakeModelYearMakeModelYearMakeModelYearMakeModelYearRental PropertyName of Tenant First Last Name of Tenant First Last Name of Tenant First Last Rental income per month, if anySubstantial Personal PropertyPlease list any that apply, such as house contents, jewellery, antiques, etc.Other AssetsPlease list any additional assests Section Six Continued - LiabilitiesMortgageMortgage CompanyAccount NumberAmount OwingMortgage PaymentLoansNameAccount NumberAmount OwingInterest RatesNameAccount NumberAmount OwingInterest RatesLine of CreditNameAccount NumberNameAccount NumberCredit CardsCharge AccountAccount NumberType of Account Joint Individual Amount OwingCharge AccountAccount NumberType of Account Joint Individual Amount OwingCharge AccountAccount NumberType of Account Joint Individual Amount OwingChild SupportPrior spousal/child support obligationsOther LiabilityOther significant debt, including personal guarantees and loans for which you have co-signedAre Copies Available? Yes No If available please uploadAccepted file types: pdf, Max. file size: 4 MB.Retailers and Financial InstitutionsHave retailers and financial institutions been advised of separation? Yes No Date Month Day Year Is copy of letter or notice available? Yes No If available please uploadAccepted file types: pdf, Max. file size: 4 MB. Section Seven - Other Court ProceedingsDates and duration of previous separationsOther legal proceedingsCourtDate Month Day Year Action NumberName of Prior Lawyers First Last Name of Prior Lawyers First Last Please provide copies of any court documents, if available Drop files here or Select files Accepted file types: pdf, Max. file size: 4 MB. Existing separation agreementDate of execution Month Day Year Jurisdiction where executedIs copy of the separation agreement available? Yes No If so please uploadAccepted file types: pdf, Max. file size: 4 MB.Present financial arrangements between spousesPhoneThis field is for validation purposes and should be left unchanged.
