Client Information Record

PLEASE NOTE ALL INFORMATION PROVIDED BELOW IS STRICTLY CONFIDENTIAL AND WILL NOT BE SHARED OR COPIED WITH ANYONE OUTSIDE OUR ORGANIZATION

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Step 1 of 6

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Part I: Client Information

Referral Source:

Your Name:*

Residential Address:*

City/Town:*

Postal Code:*

Telephone No:*

Date of Birth:*

MM slash DD slash YYYY

Email address:*

Country of Birth:*

In Ontario Since:*

Occupation(s):*

Employer’s Name & Address (If Self-Employed, Name of corporation and/or business)*

Annual Income:*

Part II: Other Party’s Information

Name:*

Residential Address:*

City/Town:*

Postal Code:*

Telephone No:*

Date of Birth:*

MM slash DD slash YYYY

Email address:*

Country of Birth:*

In Ontario Since:*

Occupation(s):*

Employer’s Name & Address (If Self-Employed, Name of corporation and/or business)*

Annual Income:*

Name of Other Party’s Lawyer (if known):

Part III: Children (Please list all children, regardless of age)

Full Legal Name:

Birth Date:

MM slash DD slash YYYY

Untitled

Female

Male

Address:

Age:

School (Attending or attended) and grade:

Was this child born of the relationship which is the subject of this matter?

Yes

Full Legal Name:

Birth Date:

MM slash DD slash YYYY

Untitled

Female

Male

Address:

Age:

School (Attending or attended) and grade:

Was this child born of the relationship which is the subject of this matter?

Yes

Full Legal Name:

Birth Date:

MM slash DD slash YYYY

Untitled

Female

Male

Address:

Age:

School (Attending or attended) and grade:

Was this child born of the relationship which is the subject of this matter?

Yes

Full Legal Name:

Birth Date:

MM slash DD slash YYYY

Untitled

Female

Male

Address:

Age:

School (Attending or attended) and grade:

Was this child born of the relationship which is the subject of this matter?

Yes

Part IV: Particulars of Relationship

Status*

Married

Not Married

Common-law

Date Cohabitation Commenced:*

MM slash DD slash YYYY

Is there an Existing Marriage Contract or Cohabitation Agreement (Pre-Nuptial Agreement)?*

Yes

Date of Marriage:*

MM slash DD slash YYYY

Place of Marriage:*

Date of Separation:*

MM slash DD slash YYYY

Existing Separation Agreement?*

Yes

My surname before marriage (if different):

Other party’s surname before marriage (if different):

At the time of the marriage/Cohabitation

I was:*

Never Married

Divorced

Widowed

Other party was:*

Never Married

Divorced

Widowed

I believe this matter concerns:*

Decision Making Responsibility (Custody)

Parenting Time (Access)

Enforcement of Support

Child Support

Spousal Support

Division of property

Variation

Divorce

Other:

If you feel comfortable doing so, please provide a brief summary of your matter in the space set out below

(e.g. Is your matter in court? If so, what is the next court date set for? Are there any highly contested issues?)

Legal Aid*

I have a Legal Aid Certificate

I do not have a Legal Aid Certificate

Does your matter include any property issues:*

Yes

Currently, I:*

have a Will

need to have a will prepared or revised

Lawyer will explain need to revise Will and Powers of Attorney on separation

PLEASE PROVIDE A COPY OF YOUR PHOTO ID (FRONT AND BACK) WITH THIS CLIENT INFORMATION RECORD*

Max. file size: 300 MB.

COMMUNICATION BY E-MAIL WAIVER

Communicating via e-mail can be beneficial in terms of timeliness and efficiency. There are, however, inherent risks with respect to confidentiality when communicating via e-mail. For example, the message can be intercepted or “hacked” in certain circumstances at the recipient’s computer or at the sender’s computer.

While appropriate measures have been put into place at Snell Balka Scovino Lawyers to prevent this from happening, it is impossible to provide a complete guarantee that confidentiality will be maintained when using electronic methods of communication. It is also important to understand that any information sent to you by way of e-mail to an employment e-mail address may be accessible by your employer.

Despite the risks as stated above, by signing this document you confirm that you consent to e-mail communication between you and your lawyer at Snell Balka Scovino Lawyers.

The privacy and security risks of e-mail communication, although small, have been explained within this document. Please set out the e-mail address you would like to use in communication with Snell Balka Scovino Lawyers:

Email for communication*

By signing this document, you acknowledge and accept the risks that are inherent in any e-mail communications and are releasing Snell Balka Scovino Lawyers and all the lawyers and employees thereof from any liability with respect to interception of confidential e-mail communication.

Signed at (town or city)*

Date*

DD slash MM slash YYYY

Name*

Signature*

CONSULTATION AGREEMENT

Full name*

(hereinafter “I”, the “client”) hereby retains Snell Balka Scovino Lawyers on a consultation-only basis to discuss my legal matters.

1. I will pay a consultation fee to the lawyer in the amount of $300.00 + HST (total $339.00), prior to the consultation. This fee will cover a consultation up to one hour. Consultations may cover a different time period depending on your circumstances and costs may be adjusted at the discretion of the lawyer.

2. I agree to provide the lawyer with relevant information and documents necessary for the lawyer to provide legal advice.

3. I understand that the lawyer will provide verbal advice only, with no written follow-up.

4. I understand that the initial consultation, whether by zoom or telephone, will not be recorded by the lawyer and I agree that I will not record the consultation. Further, I agree that I will be the only person privy to the discussion such that no other person shall be listening to the consultation unless prior agreement is obtained from the lawyer.

5. I understand that legal advice will be provided on the basis of the information provided during the consultation and that the lawyer cannot confirm that the information provided is complete or accurate.

6. I may be advised to retain a lawyer in this matter. As limitation periods may apply, I understand that it is in my best interests to retain a lawyer as soon as possible to protect my interests. If any limitation periods are missed, I understand that I shall bear full responsibility for same and shall save the lawyer harmless and indemnify the lawyer from any liability with respect to same.

7. The lawyer will protect all information received from the client as strictly confidential, except as required by law or the rules of the Court. I understand that if I disclose any confidential or privileged information discussed during the consultation with any other third party the lawyer cannot guarantee the confidentiality of information shared to other third parties.

8. I understand that the lawyer is not retained to take any steps on my behalf with respect to the issues discussed during the consultation and the lawyer will not be taking any steps on my behalf to protect my interests.

9. I understand that a further Retainer Agreement must be signed and a retainer fee must be paid before the lawyer will take any steps on my behalf.

10. I acknowledge having read this Agreement in its entirety and receiving a fully executed copy.

Signed at (Ontario)*

Date*

DD slash MM slash YYYY

Client signature*

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