Win Law
Win Law
4611 Canada Way
Burnaby, BC
V5G4X3
(437)703-7554
Divorce Intake Form
Thank you so much for contacting our law office! Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.
Privacy Policy
All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.
Your Social Security number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.
Social Security numbers are most often used to positively identify parties. Most courts require Social Security numbers of all parties in a case. Some other examples of how this information may be used include:
initial service
in court orders
in required reports or other documents filed with the State
If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!
Client's Personal Information
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Primary
Add phone number
County:
SSN:
Driver's License #:
Age:
Place of Birth:
Address Where Mail Can Be Sent To You Confidentially:
County:
Maiden Name:
if applicable
Do you want a name change?
Yes
New Name:
No
Health Issues:
Do you have any military history?
Yes
Please Describe:
No
Client's Previous Marriages
(if applicable)
Previous Spouse's Full Legal Name:
Date of Marriage:
Date of Divorce:
How Marriage Terminated:
Client's Children From A Previous Marriage
(if applicable)
Child From A Previous Marriage 1:
Yes
Name:
Date of Birth:
Additional Information:
i.e. - Adopted, Special Needs, Current Living Situation
No
Child From A Previous Marriage 2:
Yes
Name:
Date of Birth:
Additional Information:
i.e. - Adopted, Special Needs, Current Living Situation
No
Child From A Previous Marriage 3:
Yes
Name:
Date of Birth:
Additional Information:
i.e. - Adopted, Special Needs, Current Living Situation
No
Child From A Previous Marriage 4:
Yes
Name:
Date of Birth:
Additional Information:
i.e. - Adopted, Special Needs, Current Living Situation
No
Child From A Previous Marriage 5:
Yes
Name:
Date of Birth:
Additional Information:
i.e. - Adopted, Special Needs, Current Living Situation
No
Maintenance and Child Support Obligations:
if applicable
Client's Education
State the total number of years of formal education you have completed:
If you have a college degree, or degrees, state what those degrees are:
Client's Employment
Employer:
Occupation/Position:
Address:
Phone No:
Length of Employment:
How are you paid?
Hourly
Gross Hourly Rate:
Net Hourly Rate:
How many hours per week?
Salary
Gross Amount:
Net Amount:
Pay Frequency:
(Weekly, Bi-Weekly, Twice Per Month, etc.)
Gross Pay:
(per pay period)
Net Pay:
(per pay period)
Bonus:
Commissions:
Expense Account:
Stock Interests:
Do you have a health insurance policy?
Yes
Name of Company:
Who is covered?
Cost and Frequency of Payment:
No
Employee Life Insurance Policy:
Yes
Cost and Frequency of Payment:
Dates Contributions Started and Amounts and Frequency of Contributions:
No
Pension:
Credit Union:
401(k) or Savings Plan:
Yes
Value of Account:
Contribution Amount and Frequency:
Additional Details:
No
Profit Sharing:
Yes
Value of Account:
Contribution Amount and Frequency:
Additional Details:
No
Stock Options:
IRA:
Do you have Business Interest Income?
Yes
Please Describe:
No
Client's Other Income Information
Do you have any income other than from your chief employment?
Yes
From Whom Such Income Is Received:
Gross Amount:
Net amount:
No
Are you currently unemployed?
Yes
Name of Your Last Employer:
Occupation:
(what you did)
The amount of income you received from your last employment.
No
Spouse's Personal Information
Full Name:
Address:
Home Phone:
Cell Phone:
Work Phone:
Email:
SSN:
County:
Date of Birth:
Age:
Place of Birth:
Maiden Name:
(if applicable)
Spouse’s Physical Description:
(age, ethnicity, height, weight, hair color, eye color, distinctive physical characteristics, tattoos, scars, nicknames, etc.)
Health Issues:
Does your spouse have any military history?
Yes
Please Describe:
No
Spouse’s Previous Marriages
(if any)
Previous Spouse’s Full Legal Name:
Date of Marriage:
Date of Divorce:
How Marriage Terminated:
Spouse's Children From A Previous Marriage
(if applicable)
Child From A Previous Marriage 1:
Yes
Name:
Date of Birth:
Additional Comments:
i.e. - Adopted, Special Needs, Current Living Situation
No
Child From A Previous Marriage 2:
Yes
Name:
Date of Birth:
Additional Comments:
i.e. - Adopted, Special Needs, Current Living Situation
No
Child From A Previous Marriage 3:
Yes
Name:
Date of Birth:
Additional Comments:
i.e. - Adopted, Special Needs, Current Living Situation
No
Child From A Previous Marriage 4:
Yes
Name:
Date of Birth:
Additional Comments:
i.e. - Adopted, Special Needs, Current Living Situation
No
Child From A Previous Marriage 5:
Yes
Name:
Date of Birth:
Additional Comments:
i.e. - Adopted, Special Needs, Current Living Situation
No
Maintenance and Child Support Obligations:
Spouse's Education
State the total number of years of formal education your spouse has completed:
If your spouse has a college degree, or degrees, state what those degrees are:
Spouse's Employment
Employer:
Occupation/Position:
Address:
Phone No:
Length of Employment:
How is your spouse paid?
Hourly
Gross Hourly Rate:
Net Hourly Rate:
How many hours per week?
Salary
Gross Amount:
Net Amount:
Pay Frequency:
(Weekly, Bi-Weekly, Twice Per Month, etc.)
Gross Pay:
(per pay period)
Net Pay:
(per pay period)
Bonus:
Commissions:
Expense Account:
Stock Interests:
Does your spouse have a health insurance policy?
Yes
Name of Company:
Who is covered?
Cost and Frequency of Payment:
No
Employee Life Insurance Policy:
Yes
Cost and Frequency of Payment:
Dates Contributions Started and Amounts and Frequency of Contributions:
No
Pension:
Credit Union:
401(k) or Savings Plan:
Yes
Value of Account:
Contribution Amount and Frequency:
Additional Details:
No
Profit Sharing:
Yes
Value of Account:
Contribution Amount and Frequency:
Additional Details:
No
Stock Options:
IRA:
Does your spouse have any business interests?
Yes
Please Describe:
No
Spouse's Other Income Information
Does your spouse have any other sources of income?
Yes
From Whom Such Income Is Received:
Gross Amount:
Net Amount:
No
Is your spouse currently unemployed?
Yes
Name of Spouses’s Last Employer:
Occupation:
(what spouse did)
The Amount of Income Spouse Received From Last Employment:
No
Marriage Information
Date of Present Marriage:
Pre-nuptial Agreement?
Yes
When was it executed?
No
Place Marriage Performed:
County:
Currently Living In:
City, State & County
For how many years?
Are Parties Sharing the Same Household?
Yes
Date that “Irreconcilable Breakdown” Started:
No
Give Date of Separation:
Reason(s) for Divorce:
Previous Separation(s), Dates and Reasons:
Previous Counseling Dates and By Whom:
(Social Worker, Marriage Counselor, Psychologist, Priest, Rabbi, Minister, Doctor)
Previous Court Action:
Yes
Case No.:
Prior Attorney:
Disposition:
Additional Details:
No
Children of This Marriage
(if applicable)
Child 1:
Yes
Child's Full Legal Name:
Resides With:
Date of Birth:
Age:
School/Day Care:
No
Child 2:
Yes
Child's Full Legal Name:
Resides With:
Date of Birth:
Age:
School/Day Care:
No
Child 3:
Yes
Child's Full Legal Name:
Resides With:
Date of Birth:
Age:
School/Day Care:
No
Child 4:
Yes
Child's Full Legal Name:
Resides With:
Date of Birth:
Age:
School/Day Care:
No
Child 5:
Yes
Child's Full Legal Name:
Resides with:
Date of Birth:
Age:
School/Day Care:
No
Additional Information:
i.e. - Adopted, Special Needs, Current Living Situation
Day-Care or Baby-Sitters:
(Names, Cost per Week, etc.)
Educational Costs:
(Registration, Tuition, Books, etc.)
Extracurricular Activities or Lessons:
(Soccer, Dance, Swimming, etc.)
Are any children adopted?
Yes
Who:
No
Are you and your spouse expecting?
Yes
Details:
No
Children’s Disabilities:
(if any)
Describe any unusual health or psychological problems of any child.
Are both parents listed on the child/ren’s birth certificate(s)?
Assets
Real Estate 1:
Yes
Address:
How Title Is Held:
Purchase Date:
Purchase Price:
Your Estimate Of Current Value:
Balance of Mortgage(s):
Mortgage:
(name of bank or savings and loan)
Is there a second mortgage?
If so, please state the original amount of the loan, the loan date, the remaining balance, and due date.
Net Equity of Property:
No
Real Estate 2:
Yes
Address:
How Title Is Held:
Purchase Date:
Purchase Price:
Your Estimate Of Current Value:
Balance of Mortgage(s):
Mortgage:
(name of bank or savings and loan)
Is there a second mortgage?
If so, please state the original amount of the loan, the loan date, the remaining balance, and due date.
Net Equity of Property:
No
Real Estate 3:
Yes
Address:
How Title Is Held:
Purchase Date:
Purchase Price:
Your Estimate Of Current Value:
Balance of Mortgage(s):
Mortgage:
(name of bank or savings and loan)
Is there a second mortgage?
If so, please state the original amount of the loan, the loan date, the remaining balance, and due date.
Net Equity of Property:
No
Checking Accounts, Savings Accounts, Credit Unions, Money on Deposit
Account 1:
Yes
Bank or Name of Fund, Address:
Names on Title:
Date Acquired:
Last 4 Digits of Account No.:
Approx. Balance:
No
Account 2:
Yes
Bank or Name of Fund, Address:
Names on Title:
Date Acquired:
Last 4 Digits of Account No.:
Approx. Balance:
No
Account 3:
Yes
Bank or Name of Fund, Address:
Names on Title:
Date Acquired:
Last 4 Digits of Account No.:
Approx. Balance:
No
Account 4:
Yes
Bank or Name of Fund, Address:
Names on Title:
Date Acquired:
Last 4 Digits of Account No.:
Approx. Balance:
No
Account 5:
Yes
Bank or Name of Fund, Address:
Names on Title:
Date Acquired:
Last 4 Digits of Account No.:
Approx. Balance:
No
CD’s, IRA’s, Mutual Funds
Account 1:
Yes
Bank or Name of Fund, Address:
Names on Title:
Date Acquired:
Last 4 Digits of Account No.:
Approx. Balance:
No
Account 2:
Yes
Bank or Name of Fund, Address:
Names on Title:
Date Acquired:
Last 4 Digits of Account No.:
Approx. Balance:
No
Account 3:
Yes
Bank or Name of Fund, Address:
Names on Title:
Date Acquired:
Last 4 Digits of Account No.:
Approx. Balance:
No
Account 4:
Yes
Bank or Name of Fund, Address:
Names on Title:
Date Acquired:
Last 4 Digits of Account No.:
Approx. Balance:
No
Account 5:
Yes
Bank or Name of Fund, Address:
Names on Title:
Date Acquired:
Last 4 Digits of Account No.:
Approx. Balance:
No
Stocks and Bonds
Stock or Bond 1:
Yes
Name of Company:
Number of Shares:
Present Value:
Title:
No
Stock or Bond 2:
Yes
Name of Company:
Number of Shares:
Present Value:
Title:
No
Stock or Bond 3:
Yes
Name of Company:
Number of Shares:
Present Value:
Title:
No
Stock or Bond 4:
Yes
Name of Company:
Number of Shares:
Present Value:
Title:
No
Stock or Bond 5:
Yes
Name of Company:
Number of Shares:
Present Value:
Title:
No
Safe Deposit Box(es)
Safe Deposit Box(es):
Yes
Location:
Name(s) on Title:
Who has Access:
Contents:
No
Motor Vehicles
(Cars, Boats, Motorcycles, Etc.)
Motor Vehicle 1:
Yes
Year, Make and Model:
Date Purchased:
Balance Owed:
Driven By:
Monthly Payments:
To:
Who is the lien-holder?
Client, Spouse, Joint
Who is the title-holder?
Client, Spouse, Joint
No
Motor Vehicle 2:
Yes
Year, Make and Model:
Date Purchased:
Balance Owed:
Driven By:
Monthly Payments:
To:
Who is the lien-holder?
Client, Spouse, Joint
Who is the title-holder?
Client, Spouse, Joint
No
Motor Vehicle 3:
Yes
Year, Make and Model:
Date Purchased:
Balance Owed:
Driven By:
Monthly Payments:
To:
Who is the lien-holder?
Client, Spouse, Joint
Who is the title-holder?
Client, Spouse, Joint
No
Motor Vehicle 4:
Yes
Year, Make and Model:
Date Purchased:
Balance Owed:
Driven By:
Monthly Payments:
To:
Who is the lien-holder?
Client, Spouse, Joint
Who is the title-holder?
Client, Spouse, Joint
No
Life Insurance
Do you have a life insurance policy?
Yes
Through employment:
Private plan:
Amount of death benefit: $
Beneficiary:
No
Does your spouse have a life insurance policy?
Yes
Through employment:
Private plan:
Amount of death benefit: $
Beneficiary:
No
Other Marital Property
Explain in full detail any other property obtained, purchased or acquired by either you or your spouse during the marriage.
Non-Marital Property
Explain in full detail any other property obtained, purchase or acquired by either you or your spouse before or during (via inheritance or gift only) the marriage.
Debts
Debt 1:
Yes
To Whom Owed:
Incurred by:
Client, Spouse, Joint
Total Amount:
Monthly Payments:
No
Debt 2:
Yes
To Whom Owed:
Incurred by:
Client, Spouse, Joint
Total Amount:
Monthly Payments:
No
Debt 3:
Yes
To Whom Owed:
Incurred by:
Client, Spouse, Joint
Total Amount:
Monthly Payments:
No
Debt 4:
Yes
To Whom Owed:
Incurred by:
Client, Spouse, Joint
Total Amount:
Monthly Payments:
No
Debt 5:
Yes
To Whom Owed:
Incurred by:
Client, Spouse, Joint
Total Amount:
Monthly Payments:
No
Additional Debts:
Special Concerns
Please describe the issues most important to you pertaining to this divorce:
Additional Information
Any additional information?
Thank You
If you have completed the form, please click
SUBMIT
.