Immigration Intake Consultation Form – Massey Law Associates

Reference:*

Individual

Corporate

Agent

Ref. Name:*

First

Last

Name:*

Title

First

Last

Middle

Phone:*

Best Time to call:

:

HH

MM

SS

AM/PM

Email:*

Email confirmation:*

Date of Birth:*

Gender:*

Male

Female

Prefer not to respond

Passport Address:*

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeCountry

Address outside India (if any):

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeCountry

Passport Number:*

Passport Country:*

Date of Expiry:*

What type of immigration assistance are you seeking and for which country?:*

Married

Unmarried

Divorced

Spouse Name:*

Title

First

Last

Middle

Citizen of:*

Is your spouse applying with you?:*

Yes

No

Are you and your spouse able to support yourselves and your children in the country you will migrate? :*

Yes

No

Children:*

Yes

No

Number of Children:*

Travel:

Country

Number of Days

Purpose

Year

Visa Rejected/Denied (if any)*

Yes

No

Denial/Rejection History:*

Country

Visa Type

Year

Rejection doc:*

Current Employer:*

Job Title:*

Salary/Profit (PA):*

Date of hiring:*

Employment in last four years::*

Employer

Job Title

Country

Duration

List the professional licenses or certifications you possess, from any state or country:

Total years of Experience:*

Please list all your education anywhere in the world:*

College/University

Degree & Major

Duration

Level

Have you ever been arrested or convicted of a crime anywhere in the world (even if the conviction was expunged or removed from your record) or have you ever had any problems with the police?:*

Yes

No

If yes, please explain in detail:*

Have you ever used another name for immigration purposes or for any other reason?:*

Yes

No

If yes, please explain in detail :*

During what years, if any, have you filed an Income Tax Return with the IRS?:*

Is there anything, not already covered in this form, that you feel we should know?:

Please answer all questions fully and honestly. The answers may affect your case. YOUR ANSWERS TO THESE QUESTIONS ARE COMPLETELY CONFIDENTIAL AND WILL NOT BE RELEASED TO ANYONE WITHOUT YOUR PERMISSION. Please click here and proceed with the form. This questionnaire is NOT an agreement to represent you. All clients must sign a written contract with the Massey Law Associates before any representation will begin.*

I AGREE

I certify that I have read and understood the instructions above this questionnaire I certify that all of the information contained in this form is true and correct to the best of my knowledge:*

I AGREE

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