Confidential Family Questionnaire IMPORTANT: Your personal information will be kept confidential and is intended solely to streamline our intake process as our legal team discerns the best way to serve you. Please fill out this questionnaire to the best of your ability. If a particular question or section does not apply to you please write N/A. We need to collect the following information from you in order to represent you with respect to your family law matter.Name: Middle Last Date Received: MM slash DD slash YYYY I was served with court documents on: MM slash DD slash YYYY I want a Divorce and/or Court Order for: Custody of my child(ren) Joint Custody of my child(ren) Access to my child(ren) Support for my child(ren) Support for myself (spousal support) Paternity Test To have the Court declare a certain person is the father of my child(ren) To assist with dividing family property A Restraining Order I want to change an Order or Agreement that is already in place dealing with: Custody of and/or access to my child(ren) Child support Spousal support Division of Property and/or assets Other Please specify: Information About YouYour Full Name: First Middle Last Address: Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home Phone:Work Phone:Cell Phone: Messaging Phone: Are your address or number confidential? Yes No Maiden Name: Maiden Your Date of Birth: MM slash DD slash YYYY Your Age:Please enter a number from 1 to 150.Place of Birth: Period of Residence in B.C.: Citizenship: Date arrived in Canada: MM slash DD slash YYYY Are you a Student? Yes No If so, what are you taking? Name of Institute: Do you work? Yes No If so, is it full-time or part-time?Full-timePart-timeName of Employer: Address of Employer: Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Job Title: Annual Income: If you are NOT working what is your source of income? Social Assistance Student Loan EI Benefits Training Allowance Child/Spousal Support Pension Income Worker’s Compensation Other If other, please specify: Are you currently: Single Married Common-Law Do you live with any other adults? Yes No If so, what is their source of income? What is their Monthly Income? Information About The Other PartyThe other party is my: Spouse Ex-spouse Common-law Former Common-law Current Boyfriend/Girlfriend Former Boyfriend/Girlfriend Date Married: MM slash DD slash YYYY Date Separated: MM slash DD slash YYYY Date of Divorce MM slash DD slash YYYY Date Started Dating: MM slash DD slash YYYY Date Started Living Together: MM slash DD slash YYYY Date Stopped Living Together: MM slash DD slash YYYY His/Her Full Name: First Middle Last His/Her Current Address: Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country His/Her Telephone Number:His/Her Date of Birth: MM slash DD slash YYYY His/Her Place of Birth: Educational and Vocational Training: Work History:Present Employment: Salary: MarriagePlace & Date: Particulars of previous marriage(s) of either party:Particulars of divorce(s) or death(s) of previous spouse(s) (date and locations):Is a current marriage certificate available? Is there any chance of reconciliation? Was a marriage or cohabitation agreement entered into at the time of marriage? Yes No Do you have a copy? Was a separation agreement entered into at the time of separation? Yes No Do you have a copy? Unmarried CouplesWhen did you meet? When did you start dating? How long did you date? When did you separate? Reason for separation: Is there any chance of reconciliation? Did you live together during the relationship? Yes No Do you still live together? Yes No If you no longer live together, when did you move out? Does your Ex still have any of your personal property? Yes No If yes, please list the items: Use the (+) button on the right side of the field to add additional items.ChildrenChildren Names & Date of Birth:Full NameDate of BirthCitizenshipSchool / Grade Location of child(ren)'s passport(s): Residence history of children in the previous year:Daycare arrangements and costs:Significant medical history of the child(ren):Children's Physician InformationNameAddressPhone Do the children have any assets, trust property, bank accounts, etc.. Please describe:Who has physical custody of the Child(ren)? Are there any Court orders in place respecting the Child(ren)? Yes No Is there (likely) an argument about custody/access? Yes No AssetsDo you own a House? Yes No Do you own Recreational Property? Yes No HouseAddress: Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Purchase: MM slash DD slash YYYY Title: Mortgage: Market Value: In whose name(s) is the property registered: Legal description: Mortgage holder(s): Amount of mortgage owing: Annual taxes, water rates etc.: Recreational PropertyAddress: Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Purchase: MM slash DD slash YYYY Title: Mortgage: Market Value: In whose name(s) is the property registered: Legal description: Mortgage holder(s): Amount of mortgage owing: Annual taxes, water rates etc.: Other AssetsCar(s)DescriptionRegistration Substantial personal property (house contents, antique collections, jewellery etc.):AssetDescription Do you have a copy of your current household insurance policy available? If yes, please attach. Yes No Investments (Stocks, Bonds, Receivables):TypeName of BrokerValue Savings / Bank Arrangements:In Whose NameBank NameBranchType of AccountAccount NumberApproximate Balance Life Insurance (Particulars):Term or Whole LifePremium PaymentsAre copies of policies available? (If so, please attach):Who is a Beneficiary Details of RRSP'sDetails of Pensions, approximate valueSafety Deposit Box:LocationContentsIn whose name(s)Who has key(s) Hospital and Medical coverage: Business AssetsBusiness NameLocationAddress of registered & recordsShareholder's Name(s)Approximate Value (if known)Name of corporate solicitor & accountantAre income tax returns available? LiabilitiesLoans payable:ParticularsDateAmountInterest Rate Other significant debts, including personal guarantees and loans for which you have co-signed:DescriptionDateAmountInterest Rate Are copies of the loan documents available? If yes, please attach. Yes No Credit CardsCard TypeAccount NumberJoint or IndividualAmount Owing Have retailers and financial institutions been advised of separation? Yes No Date: Is a copy of the letter or notice available? Yes No Other ProceedingsDates & Durations of Previous SeparationsPartner NameDate SeparatedDuration Other legal proceedings (court, date, action numbers). Please provide copies of any court documents, if available, and name(s) of previous lawyers:Present financial arrangements between spouses:Wills & EstatesDo you and/or your partner/spouse have a Will? Yes No Date signed: Location of Will: Executor of your estate and/or partner's/spouse's: Major BeneficiariesNameRelationship Other InformationPlease supply any other applicable information below:
