Questionnaire
Client's Name
Sex
Male
Female
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
S.I.N.
Marital status on December 31st?
Please Select
Single
Married
Separated
Divorced
Widowed
Common-Law
Spouse's Name
Spouse's Income
Date of Birth
-
Month
-
Day
Year
Date
S.I.N.
Who is claim Climate Action? (Only one per couple)
Please Select
Are you claiming children to your file?
Yes
No
If yes, How many? (If more then two, please add information to bottom of page)
Please Select
Child's Name
Date of Birth
-
Month
-
Day
Year
Date
S.I.N.
Relationship
Please Select
Son
Daughter
Brother
Sister
Grandson
Granddaughter
Other
If relationship is other (Explain)
Child's Name
Date of Birth
-
Month
-
Day
Year
Date
S.I.N.
Relationship
Please Select
Son
Daughter
Brother
Sister
Grandson
Granddaughter
Other
If relationship is other (Explain)
Elections Canada?
Yes
No
Did you sell any property?
Yes
No
Do you have Foreign Property worth over $100,000?
Yes
No
GO PAPERLESS!
Yes
No
Credit Card
Expiry Date
Questions or additional info you want to provide.
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