Ekemere Law Inc.
620 Nine Mile Drive, Suite 208
Bedford, Nova Scotia
B4A 0H4
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 Insurance 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 Insurance numbers are most often used to positively identify parties. Most courts require Social Insurance 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 Province
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
Contact information
Prefix
First name
*
Middle name
Last name
*
Date of birth
Company
Emails
Email Address
*
Type
Upon submission, a copy of this form will be sent to the primary email.
Work
Home
Other
Primary
Default email false
Add email
Subscribe to receive legal updates, resources, and news from Ekemere Law Inc.
Addresses
Street address
Country
Australia
Canada
United Kingdom
United States
---------------
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Türkiye
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
City
State/Region
Alaska
Alabama
Arkansas
American Samoa
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Northern Mariana Islands
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
United States Minor Outlying Islands
Utah
Virginia
Virgin Islands, U.S.
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Province/Region
Zip/Postal code
Address type
Work
Billing
Home
Other
Primary
Default address false
Add address
Phone numbers
Phone number
Type
Work
Home
Mobile
Fax
Pager
Skype
Other
Primary
Default number false
Add phone number
County:
SIN:
Driver's Licence #:
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 post-secondary 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:
RRSP 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:
TSFA:
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:
SIN:
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:
RRSP 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:
TSFA:
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, Province & 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, TSFA, 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
.