Intake Form – crystalstoneimmigration.com

Client Intake Form

Preliminary Assessment — Kindly complete all relevant sections in their entirety, ensuring that all information provided is accurate and complete.

All information provided is strictly confidential and protected under Canada’s privacy legislation (PIPEDA). This form is for preliminary assessment purposes only and does not constitute legal advice or establish a formal consultant–client relationship.

1. Personal Information

Legal name as it appears on your passport or travel document

Full Name *

Phone Number *

Date of birth *

Country of Citizenship *

Country of Current Residence* *

Current Immigration Status (if in Canada) *

Marital Status *

Single

Married

Divorced

Separated

Number of Dependent Children *

2. Services Requested

Select all that apply

Temporary Residence

Visitor Visa (TRV)

Study Permit

Visitor Visa (TRV) Study Permit Work Permit – LMIA-Based

Work Permit – LMIA-Exempt

Permanent Residence

Express Entry – Federal Skilled Worker (FSW)

Express Entry – Canadian Experience Class (CEC)

Express Entry – Federal Skilled Trades (FST)

Provincial Nominee Program (PNP)

Family Sponsorship (Spouse / Common-Law / Dependent Child)

Family Sponsorship (Parents & Grandparents)

Humanitarian & Compassionate (H&C) Grounds

PR Card Renewal / Status Issues

Citizenship

Citizenship Application

Citizenship Refusal / Reconsideration

Citizenship Revocation

Appeals and Enforcement

Refugee and Protection

Refugee Claim (RPD)

Refugee Appeal Division (RAD)

Pre-Removal Risk Assessment (PRRA)

Refugee / Protection Consultation

3. Education & Language Proficiency

Highest Level of Education

Country Where Education Was Obtained

Has an Educational Credential Assessment (ECA) been obtained?

Yes

4. Employment History

Most recent occupation details

Current Occupation / Job Title

NOC Code (if known)

Total Years of Skilled Work Experience

Countries Where Experience Was Gained

Canadian Work Experience

Do you have a valid Canadian job offer?

Yes

5. Immigration History

Have you previously applied for Canadian immigration?

Yes

Have any of your applications been refused?

Yes

Have you ever had a removal order issued against you?

Yes

Have you ever lost Permanent Resident (PR) status?

Yes

Have you ever been found inadmissible to Canada?

Yes

Have you ever made a refugee or protection claim in any country?

Yes

6. Additional Information

Any other context that may be relevant to your case

7. Declaration & Consent

Declaration of Accuracy
I certify that all information provided in this form is accurate, complete, and truthful to the best of my knowledge and belief. I acknowledge that any false, misleading, or omitted information may result in the refusal of my application and could lead to legal or regulatory consequences.

Consent to Collection and Use of Personal Information
I authorize Crystal Stone Immigration to collect, use, store, and retain my personal information for the purpose of evaluating my immigration matter and providing immigration consulting services. My personal information will be managed in compliance with applicable privacy laws, including the Personal Information Protection and Electronic Documents Act (PIPEDA). It will not be shared with third parties without my written consent, except where disclosure is required by law, regulation, or applicable professional obligations.

Full Name (Print) *

Signature (Type your full name) *

Date *

Declaration of Accuracy and Consent

I have read and understood the Declaration of Accuracy and Consent to Collect and Use Personal Information, and I agree to the terms set out above. *