Preliminary Form – Luminex Immigration

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Client Contact & Preliminary Assessment Form

CLIENT CONTACT & PRELIMINARY ASSESSMENT FORM

(Immigration Services Intake)

Important Notice:
Personal information is collected for preliminary assessment purposes only and is protected in accordance with Canadian privacy laws. Submission of this form does not create a consultant–client relationship. Immigration advice or representation will be provided only after execution of a written retainer agreement.

PERSONAL INFORMATION

First Name

Last Name

Email Address

Phone Number ( with country code )

Age

English Language Proficiency (self declared)

Education Level

WORK EXPERIENCE

Total Years of Skilled Work Experience

Current Occupation / NOC (if known)

Country(ies) of Work Experience

COUNTRY INFORMATION

Country of Current Residence

Country of Citizenship

IMMIGRATION SERVICES – INTAKE FORM MENU

Please select the service(s) you are seeking assistance with:

A. Temporary Residence

B. Study Permits

C. Work Permits

D. Permanent Residence

E. Family Sponsorship

F. Permanent Resident Status

G. Canadian Citizenship

H. Appeals & Admissibility

I. Refugee & Protection Matters

J. General Consultation

EXPRESS ENTRY / PNP PRE-SCREENING QUESTIONS

(If applicable)

Do you have a valid language test (IELTS/CELPIP/TEF)?

Yes

Have you completed an Educational Credential Assessment (ECA)?

Yes

Education completed in Canada

Do you have skilled Canadian work experience?

Less than 1 year

1 year or more

Do you currently have a valid job offer supported by LMIA?

Yes

Have you received a provincial nomination?

Yes

In progress

ADDITIONAL INFORMATION / MESSAGE

DECLARATION & CONSENT

Your personal information is collected for a preliminary immigration assessment only. It will be protected in accordance with Canadian privacy laws (PIPEDA) and the CICC Code of Professional Conduct.

Please read our full Privacy Policy before submitting your information.

I have read and agree to the privacy policy and consent to the collection, use, and storage of my personal information for the purpose of a preliminary immigration assessment.

Applicant Name

Electronic Signature (Full Legal Name)

Date

Illuminating Pathways. Transforming Lives

Consult@ lumineximmigration.com

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