CLARK V. CRAIG

#1-3455 HARVESTER RD.

BURLINGTON, ONTARIO

L7N 3P2

Telephone:  631-1147

Fax (905) 333-1624

Confidential Matrimonial Client Information Form

Today’s Date:                                                                                                  

Who referred you to me?                                                                                

PERSONAL INFORMATION:

Name:                                                                                                              

Current Address:                                                                                              

            Street/Apt. No.                                                                                   

            City & Postal                                                                                       

            Home Phone                                                                                                               

            Work Phone                                                                                       

Where would you like mail to be sent?             Same as above

 Or:                                                                                                                                                                                                                                                                                           

Your occupation:                                                                                              

Name and address of

Your employer:                                                                                                

Your approximate income:

            From employment:                                                                             

            From other sources:                                                                           

            Your birthdate:                                                                                 

            Your birthplace:                                                                                

When did you begin to reside in Ontario?                                                        

YOUR SPOUSE:

Spouse’s name:                                                                                    

Spouse’s address:                                                                                  

Your spouse’s occupation:                                                                   

Name and address of

            Spouse’s employer:                                                                              

Spouse’s approximate income:

From employment:                                                                             

From other sources:                                                                              

Spouse’s birthdate:                                                                             

Spouse’s birthplace:                                                                           

When did your spouse begin to

            reside in Ontario?                                                                               

Does your spouse have a lawyer?                         Yes                         No            

            Your spouse’s lawyer:

            Name:                                                                                                 

            Address:                                                                                              

            Phone:                                                                                                 

DETAILS OF YOUR MARRIAGE:

Date of marriage:                                                           Place:                          

Wife’s maiden name:                                                                                       

Wife’s surname at marriage:                                                                              

Husband’s surname at birth:                                                                             

Have you been married before:               Yes                         No            

            If Yes:

            Date of previous divorce:                                                             

            Place of previous divorce:                                                             

Do you have a copy of the Certificate of Divorce or

The Decree Absolute?                                      Yes                         No            

What was your surname during that marriage:                                       

Has your spouse been married before:               Yes                         No            

            If yes:

            Date of previous divorce:                                                             

            Place of previous divorce:                                                            

            Do  you have a copy of the Certificate of Divorce or the       

            Decree Absolute?                                  Yes                         No            

What was your spouse’s name during that marriage:                                              

CHILDREN:             (Under 18 years or still dependent on you or your spouse)

Name(s)                             Birthdate                        Now living with             School/Grade

 CURRENT LIVING ARRANGEMENTS:

 Have you separated?:                    Yes                         No            

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?                                                      

EXISTING AGREEMENTS:

Have you signed a marriage contract, cohabitation agreement or other document dealing with rights between you and your spouse?              Yes                         No            

Have you and your spouse any agreement in place (in writing or otherwise) regarding your respective rights on separation?                            Yes                         No            

LITIGATION:

Have there been any court proceedings between you and your spouse?      Yes                  No             If yes, please give details:

MATRIMONIAL HOME:

Address:                                                                                                          

In whose name is title?                                                                                      

Approximate value today:                                                                                  

Mortgages total:                                                                                                

Who is living there today:                                                                                  

Did you or your spouse have any assets (including money) at the date of your marriage?

Yes                  No            

 If so, give details:                                                                                                             

 Have you or your spouse received any of the following during your marriage:

       An inheritance

       A substantial gift from someone other than your spouse

       Money from a personal injury claim

       Money from a life insurance policy

GENERAL:

 State what you hope your lawyer can achieve for you: