Immigration Client Intake Form

Assemble a new client's full file in a single submission. It walks through identification, address, nationality, previous visas, marital details, relatives already settled, job offers, past refusals, criminal record and any asylum claim. Immigration practices send it before opening a matter so nothing is missed.

Use this template

Name

Nombre

Apellido

Date of Birth

Home Phone Number

Business Phone Number

Current Address

Dirección

Ciudad

Estado / Provincia

Código postal

Nationality

Do you hold another nationality?

Yes No

Please specify

Location Issued

Type of Non-immigrant Visa

First Family Member Details

Name

Nombre

Apellido

Date of Birth

Phone Number

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Second Family Member Details

Name

Nombre

Apellido

Date of Birth

Phone Number

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Marital Status and Spouse Details

What is your marital status?

Date of Marriage

City and State/Country of Marriage

Spouse's Name

Nombre

Apellido

Spouse's Birth Date

Spouse's Nationality

Emergency Contact

Name

Nombre

Apellido

Current Address

Dirección

Ciudad

Estado / Provincia

Código postal

Background Questions

Are you known by any other names, including maiden or native spellings?

Yes No

List the other names you have used

Do you have a job or an offer from a U.S. employer?

Yes, I am employed there Yes, I have a written offer No

Employer's Name

Employer's Address

Dirección

Ciudad

Estado / Provincia

Código postal

Description of the Job Offered

Do you have family members living in the U.S. right now?

Yes No

Family Member Name

Nombre

Apellido

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Describe how you are related to that family member

Set out the reasons you wish to enter or remain in the U.S.

If you are applying for a visa, do you wish to bring family members with you?

Yes No Undecided

Have you ever entered the U.S. on a visa other than a tourist visa?

Yes No

Provide the dates you were in the U.S. and the visa type used

Have you ever been refused entry to the U.S. or ordered to leave?

Yes No

Give the reason and the relevant dates

Have you ever been convicted of a crime other than a non-criminal traffic offence?

Yes No

Detail the offence, the sentence imposed and the date it occurred

Are you making a claim for political asylum?

Yes No

Detail the reasons behind your claim

Immigrant's Signature

Sign here

Date

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