EBBI Client Assessment Form — Complete IRCC 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 the section name if needed. Fill every line that applies so staff can type your IRCC online file without calling you back. Return by mail, in person, or scan and email to admin@explorebeyondborders.ca. Expected response: 2–3 business days.

1. Personal Details

Family name (Surname)

Given name(s)

Middle name (as on passport — or N/A)

Other names used (alias / maiden — or N/A)

Date of Birth (D/M/Y)

Place of birth (city)

Country of birth

Sex (as on passport)

Country of citizenship

Current marital status

Email Address

Phone Number

Preferred contact (phone / email / WhatsApp / Messenger)

Preferred language (English / Tagalog / French / Other)

Mailing address — street and postal code are required for IRCC IMM 0008 / 5476. Do not write only the city.

Street address (unit / house number and street)

City

Province / state

Postal / ZIP code

Country

UCI (Unique Client Identifier) — leave blank if none; do not guess

Existing Application / File # (if any)

2. Passport / Travel Document

Country of issue

Issuing authority (e.g. DFA Manila, PCG Osaka)

Passport number

Place of issue (city)

Date of issue (D/M/Y)

Date of expiry (D/M/Y)

4. Status in Canada

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

Currently in Canada? YesNo

Date first arrived in Canada (D/M/Y) — or N/A

Current status type (e.g. Open Work Permit / PGWP)

Current status expiry date (D/M/Y)

Province you currently live in

Previous status held (type and dates) — or N/A

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

Approximate CRS score (if known)

Settlement funds available (Under $10k / $10–25k / $25–50k / Over $50k / N/A)

3b. Current employment in Canada

Employer name in Canada

Job title

Start date (D/M/Y)

Hours per week

NOC code (if known)

Main duties (brief)

9. Background Declaration (Schedule A)

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

Previously applied to IRCC? YesNo

If Yes, list each prior application below — type, year, country, result, and file number. Do not leave this as a one-line explanation only.

Application type	Year	Country	Result (approved / refused / withdrawn)	File #

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.

Currently subject to a removal order or refugee claim? YesNoNo indication / not sure

Any medical condition IRCC may consider relevant? YesNo

Biometrics completed for current application? YesNoNot sure

8. Family Ties in Canada

IMM 5406 needs parents’ names even if they are not coming to Canada. Write N/A only if unknown.

Father’s full name

Mother’s full name (including maiden name)

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

Spouse / partner full name (required if married or common-law — or N/A)

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? I have no dependent childrenI have dependent child(ren) — list below

List each child IRCC would ask about: name, date of birth, relationship, where they live, and status. Ages only is not enough.

Full name	Date of birth	Relationship	Location (city, country)	Status (in Canada / abroad)

Travel, work & education (IRCC copy-paste) — Travel

Have you lived or travelled outside your home country for 6+ months since age 18? YesNo

List every country lived in 6+ months since age 18 — determines police certificates needed. Most recent first. Leave To blank if you still live there.

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

Attach additional sheet if more countries apply.

5b. Address history since age 18

IMM 5669 / personal history. List where you have lived since age 18 (city or street, country, dates). Better to write extra addresses now than to be asked later.

City / street address	Country	From (D/M/Y)	To (D/M/Y)

Travel, work & education (IRCC copy-paste) — Employment

From	To	Company	Position	NOC	Hrs/wk	City	Country	Main duties

Primary NOC for the main skilled job (if known)

Total years in that skilled field

Travel, work & education (IRCC copy-paste) — Education

From	To	Institution	Credential	Field of study	City	Country

Highest education completed — IRCC / CRS level only (not a job title)

Country where that credential was earned

ECA completed? (Yes / In progress / No / N/A)

ECA organization (WES, ICAS, IQAS…)

ECA completion date (D/M/Y)

9. 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)

Offer dated (D/M/Y)

Offer signed (D/M/Y)

Hours (full-time / weekly)

Related to the employer (family business)? (No / Yes / Not sure) + genuineness notes

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

Open to relocating for PR purposes? YesNo

If yes, which province(s)?

7. 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)

11. Pathway & Goal

Tick the IRCC pathway that applies. Staff use this to apply the extra questions — a goal alone (PR / work / study) is not enough.

Not sure — general assessment Express Entry / PR Family sponsorship Work permit Study permit Visitor visa / eTA Citizenship PR card renewal Caregiver Humanitarian & compassionate RCIP / rural community LMIA (employer)

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

11b. Pathway extras — fill the pack you ticked

Write N/A in unused packs. These match the online pathway questions.

Express Entry

PNP (Nominated / Applied / Interested / No)

PNP province (if any)

Sibling in Canada who is a citizen or PR? (Yes / No)

Settlement funds available (CAD, approximate)

Family sponsorship

Relationship (Spouse / Common-law / Conjugal)

Processing route (Inland / Outland / Not sure)

Sponsor status (Citizen / PR)

Marriage or cohabitation start (D/M/Y)

Study permit

DLI name

DLI number

Program of study

Program start date (D/M/Y)

Proof of funds (savings / GIC / scholarship / family / loan / not sure)

Visitor visa / eTA

Purpose (tourism / family / business / transit / other)

Intended travel dates

Host in Canada or accommodation details

Proof of funds (how you will show them)

Citizenship · PR card · Caregiver · RCIP · LMIA employer

Citizenship — date you became a PR (D/M/Y)

Citizenship — days in Canada (last 5 years)

PR card number

PR card expiry (D/M/Y)

Caregiver — Canadian employer or job offer, plus experience (NOC / months)

RCIP community

RCIP designated employer

LMIA — company legal name

LMIA — job title / wage / NOC

12. 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

13. Philippine Documents Needed (if applicable)

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

14. 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

Main H&C grounds (hardship, family ties, risk if removed) — 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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