Todays Date
Who referred you to us?
Name *
Current address
Street/Apt. No.
City
Postal Code
Home Phone *
Work Phone
Where would you like mail to be sent ? Same as above
Or
E-mail address *
Can confidential information be sent to this e-mail address
YesNo
Your occupation
Name and address of your employer
Your approximate income
From employment
From other sources
Date of Birth
Your Birth Place
When did you begin to reside in Ontario
Spouse's name
Spouse's Address
Spouse's Phone No.
Spouse's E-mail
Spouse's Income
From employement
Spouse's Date of Birth
Spouse's Birth Place
When did you spouse begin in reside on Ontario?
Does you spouse have a lawyer
SPOUSE'S LAWYER (IF KNOWN)
Name
Address
Phone No.
Date of Marriage
Marriage Place
Name of Wife at Marriage
Name of Husband at Marriage
Have you been married before?
YesNO
Do you have Original Marriage Certificate?
If yes
Date of previous divorce
Place of previous divorce
Do you have a copy of the Certificate of Divorce or the Divorce Judgment
What was your previous Spouse
Age
Now living with
Have you separated
If so, on what date?
Who is living in the matrimonial home?
Have you had marriage counselling?
If yes, with whom?
Do you think counselling would be helpful?
Have you signed a marriage contract, cohabitation agreement or other document dealing with rights between you and your spouse?
Have you sand your spouse any agreements in place (in writing or otherwise) regarding your respective rights on separation?
Do you have any court proceedings between you and your spouse
If yes, please give details
