TO:       JAY CHAUHAN
            Barrister and Solicitor
            330 Highway 7 East, Suite 309
            Richmond Hill, Ontario
            L4B 3P8
            Telephone: (905) 771-1235
            Facsimile:   (905) 771-1237
            Email: jaylawyer@hotmail.com  

ASSESSMENT FORM

Please answer all questions either by printing or typing. If a question is not applicable indicate N/A. If there is insufficient space, continue your answer on a separate sheet of paper. In order to make a proper assessment, it is important that all applicable questions are answered fully and accurately. Please write a separate resume (bio data) describing your education, your experience, and your job description and send it to us.

BACKGROUND INFORMATION

Full Name of Husband:

Full Name of Wife:

Mailing Address:



Telephone Numbers       Home:
                                    Business:
                                    Mobile:
                                    Fax:

Email Address:

Husband’s job title:

Wife’s job title:

Age and Date of Birth of Husband:

Age and Date of Birth of Wife:

Citizenship:

Marital Status:   (Single)  (Engaged)  (Married)  (Separated)  (Divorced)  (Widowed)

JOB EXPERIENCE

How many years of experience does the husband have in his profession?

Can you obtain a letter from your employer confirming your position and job description?
Yes________    No________

How many years of experience does the wife have in her profession?

Can she obtain a letter from her employer confirming her position and job description?
Yes________    No________

CHILDREN

            Name                                                    Date of Birth

1          __________________________   __________________________

2          __________________________   __________________________

3          __________________________   __________________________

HEALTH

Have you or any of your immediate family ever had any medical problems?
Yes________    No________ 

If yes, explain:



CRIMINAL RECORD

Do you or any family member have a criminal record?       Yes________    No________

If yes, explain:



LANGUAGE ABILITY

English: How well do you speak, write, and read English?
Very well________         Well________    With difficulty________

French: How well do you speak, write, and read French?
Very well________         Well________    With difficulty________ 

Would you be prepared to take language courses in English or French to improve your chances?
Yes________    No________      Which language? 

What other languages do you speak?

EDUCATION (provide copies of the certificates)

List Husband’s Diploma or Degrees and number of years required to complete them:




List Wife’s Diploma or Degrees and number of years required to complete them:




CANADIAN CONNECTION

Do you have any relatives in Canada?      Yes________    No________

If yes, give details: Relationship: _______________

Does the relative have a business in Canada?       Yes________    No________

Name and full address of the relative:




Office Telephone Number:
Home Telephone Number:
Email address: 

Have you studied in Canada?                                          What did you study?

Have you worked in Canada?                                          How long?

NET WORTH

What is your current financial net worth in your currency?

How much is that in Canadian Dollars?

How much of that can you bring to Canada?

GENERAL INFORMATION

List countries you have visited:



Where do you want us to submit your application?

Where do you wish to settle in Canada?

Are there other matters which are not included in this questionnaire which you believe should be added?




POST LANDING SERVICES

Will you require assistance after arrival to Canada for:

Accommodation?                                               Registration of Social Insurance Number?

Registration for Health Coverage?                        Obtaining a driver’s licence?

Purchase of a business?                                    Purchase of a property?

Employment services?

CONFIRMATION AND RETAINER

All above statements are true and the file will be opened and work commenced when the first retainer instalment is paid.

___________________________
Date

__________________________________________________
Client’s Signature