Super Visa – Client Intake Form

This form is used to collect information for internal purposes only. All information provided will remain confidential and privileged. Please answer all questions fully and accurately to the best of your knowledge.

IMPORTANT: IF YOU ARE SUBMITTING THIS FORM ON BEHALF OF YOUR PARENT OR GRANDPARENT, PLEASE COMPLETE THIS FROM THE APPLICANT’S PERSPECTIVE.

Name *

First

Last

Email *

Phone Number *

Applicant's Age *

Applicant's Nationality *

Mailing Address

City

State / Province

Country

Postal Code

Have you ever visted Canada before? *

• Yes I have
• No I have not

If you answered yes to the previous question, please specify when your last visit to Canada was: *

Please leave blank if you have have not visited Canada before.

Past Immigration Application Rejections: *

• No past rejections
• One past rejection
• More than one past rejections

Are you a parent or grandparent of a Canadian citizen or permanent resident? *

• Yes I am
• No I am not

At the time of making an application for a Super Visa, will you have a signed invitation letter from your child or grandchild, including a promise of financial support during your stay, a list of household members, and a copy of their Canadian citizenship or permanent resident document? *

• Yes I am able to obtain these from my child or grandchild
• No I will not be able to obtain these from my child or grandchild

Have you looked into private medical insurance from a Canadian insurance company that covers health care, hospitalization, and repatriation, and provides at least $100,000 in emergency coverage?

• Yes I have looked into private medical insurance
• No I have not looked into private meidcal insurance

Have you looked into a private medical insurance company outside Canada that has been approved by the Minister of Immigration, Refugees and Citizenship?

• Single
• Common-Law (lived togetherfor at least one year)
• Married
• Conjugal (have been in a committed relationship for at least one year, but due to reasons beyond your control, could not live together)
• Other

Are you willing to undergo an immigration medical exam?

• Yes
• No

You must see a doctor on the list of panel physicians. Your own doctor can’t do the medical exam. Find a Panel Physician https://secure.cic.gc.ca/PanelPhysicianMedecinDesigne/en/Home

Are you able to provide proof that the child or grandchild inviting you meets the minimum necessary income?

• Yes
• No

Which of the following can your child or grandchild provide?

• Notice of Assessment (NOA) or T4/T1 for the most recent tax year
• Employment Insurance Benefit statements
• Employment letter, including salary, job title, job description, and date of hiring
• Pay stubs
• Bank statements

What other relevant information would you like to add about your immigration situation? *

Confirmation *

• I acknowledge that I have provided honest and complete information. I understand that all information will be kept strictly confidential.
• I acknowledge that submitting this form does not mean that Zaidi Legal PC has been retained and I acknowledge that there is no solicitor-client relationship until formal requirements are met.

Submit

Once you have submitted the form, please click here to schedule your free consultation.