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EN FR AR BN DE HI PA FA PT RU ES TL TR UK

Eastman Immigrant Services - New Client Intake Form

Your Personal Details

DD slash MM slash YYYY

Current Residential Address

Immigration Related Information

DD slash MM slash YYYY
DD slash MM slash YYYY
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This can be a Confirmation of Permanent Residence, a Work Permit, a Refugee Claimant document, a Permanent Resident Card, etc.

If uploading a Permanent Resident Card or other two-sided document, please ensure both sides are attached.
Drop files here or
Accepted file types: pdf, docx, doc, jpg, gif, tiff, Max. file size: 10 MB, Max. files: 1.

    Details of Family Members

    Would you like to register your family members so that they can also receive services with us?

    Member 1

    DD slash MM slash YYYY

    Member 2

    DD slash MM slash YYYY

    Member 3

    DD slash MM slash YYYY

    Member 4

    DD slash MM slash YYYY

    Member 5

    DD slash MM slash YYYY

    Member 6

    DD slash MM slash YYYY

    Consents and Confidentiality Statement

    Mail Consent

    I consent to your organization collecting, storing, and using my personal information for the purposes of providing services and communications related to events, workshops, and other relevant activities. I understand that appropriate security measures will be in place to protect my data from unauthorized access or misuse.

    I consent to the sharing of my personal information with trusted third-party partners of your organization solely for the purpose of delivering services and communications as described. I am aware that I have the right to withdraw my consent at any time, which may impact the services provided to me.

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    DD slash MM slash YYYY
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    D4-284 Reimer Ave, Steinbach, Manitoba R5G 0R5 Canada

    (204) 346-6609 |

    info@eastmanis.com

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