EBBI Client Assessment Form — General Immigration Intake (Blank)

How to fill this out: Write dates as Day / Month / Year (e.g. 04 / 07 / 2026). UCI / Client ID (if any): 0000-0000 or 00-0000-0000. Where a question does not apply, write N/A. Print clearly in block letters. Use additional sheets labelled with section name if needed. Return by mail, in person, or scan and email to admin@explorebeyondborders.ca. Expected response: 2–3 business days.

1. Basic Information

Last Name

First Name(s)

Date of Birth (D/M/Y)

Citizenship / Nationality

Email Address

Phone Number

Preferred contact (phone / email / WhatsApp / Messenger)

Preferred language (English / Tagalog / French / Other)

Current mailing address (city, province/state, country)

UCI / Client ID (if any)

Existing Application / File # (if any)

2. Passport

Issuing Country

Passport Number

Issue Date (D/M/Y)

Expiry Date (D/M/Y)

3. Your Status in Canada

Check the physical permit document for expiry — the most common missing detail.

Are you currently in Canada? YesNo

Date First Arrived in Canada (D/M/Y)

Current Permit / Status Type (e.g. PGWP, Study Permit)

Expiry Date on Current Permit (D/M/Y)

Province you currently live in

Previous Permits Held in Canada (type and dates)

Express Entry profile? (Yes / No / Not sure)

Approximate CRS score (if known)

Settlement funds available (range, if applicable)

4. Immigration & Background History

Mirrors IRCC Schedule A background questions. Answer fully to avoid delays.

Have you ever applied to IRCC before? YesNo

Ever refused a visa, permit, or entry (Canada or any country)? YesNo

If yes, briefly explain (country, year, reason) — or N/A

Ever asked to leave, deported, or removed from any country? YesNo

Ever arrested, charged, or convicted of a crime in any country? YesNo

If yes, briefly explain — or N/A. Being upfront protects your file.

Any medical condition IRCC may consider relevant? YesNo

Biometrics completed for current application? YesNoNot sure

5. Travel History (all countries since age 18)

List every country lived in 6+ months since age 18 — determines police certificates needed.

Country	From (D/M/Y)	To (D/M/Y)	Purpose	6+ mo.?
				☐
				☐
				☐
				☐

Attach additional sheet if more countries apply.

6. Family & Relationship Situation

Marital Status (Single / Married / Common-law / Divorced / Separated / Widowed)

Date marriage or cohabitation began (D/M/Y)

Continuous cohabitation 12+ months? (Yes / No / N/A)

Spouse/partner is citizen or PR Parent is citizen or PR Sibling is citizen or PR Child is citizen or PR None of the above

Family ties in Canada (relationship + status; names optional)

Dependent children (ages, or N/A)

7. Work & Education

Current / most recent occupation

NOC or job title in plain language

Employer name

Total years experience in this field

Job start (D/M/Y)

Job end (D/M/Y or "current")

Highest education completed (country)

ECA completed? (Yes / No / N/A / Not sure)

8. Employer Offer & Relocation

Is an employer willing to hire you in Canada? YesNo

Employer / company name

Position / job title offered

Wage offered (hourly or annual)

Proposed start date (D/M/Y)

LMIA status (Not started / Applying / Positive / Exempt / Not sure)

Open to relocating for PR purposes? YesNo

If yes, which province(s)?

9. Language Test

Taken English or French test? YesNo

Test (CELPIP / IELTS / TEF / TCF / Other)

Test date (D/M/Y)

Listening

Reading

Writing

Speaking

Basic French ability? (Yes / No / Not sure)

10. Your Goal

Permanent residence Work in Canada Study in Canada Visit Canada Join family in Canada Citizenship (already PR) Renew / replace status Not sure — exploring

How soon hoping to move forward?

Status expiring within 30 days Status expiring within 60 days Status expiring within 90 days

Briefly describe your situation in your own words

11. Document Status — check all you have ready

Valid passport Education credentials / transcripts Work reference letters Language test results Marriage certificate Birth certificate Police clearance certificate(s) None of these yet

12. Philippine Documents Needed (if applicable)

NBI clearance PSA birth certificate PSA marriage certificate PSA CENOMAR None / not applicable

13. Humanitarian & Compassionate (optional)

H&C (IRPA s.25) is exceptional — N/A is a normal answer.

Years lived in Canada (this stay)

Establishment in Canada (work, community) — or N/A

Children in Canada whose interests could be affected? YesNo

If yes, briefly explain — or N/A

Hardship or risk if returning home? YesNo

If yes, briefly explain — or N/A

Subject to removal order or pending refugee decision? YesNo

If yes to removal order / refugee pending: contact EBBI urgently — direct review with Atty. Garvida before other applications.

Client Declaration

I declare that the information provided is true, complete, and accurate to the best of my knowledge. This form is for general assessment only, does not constitute legal advice, and does not guarantee eligibility for any pathway. I have read the Privacy Policy and Legal Notice at explorebeyondborders.ca. I authorize EBBI to share this information with supervising counsel, Atty. George M. Garvida.

☐ I have read and agree to the above declaration

Full name (print)

Signature

Date (D/M/Y)

For EBBI Staff Use Only

Received by

Date received (D/M/Y)

Reference code assigned

Pathway flagged

Reviewed by Atty. Garvida (date)

Follow-up method

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