Consultation Portal DIVORCE QUESTIONNAIRE To give us the information we need, please answer ALL questions as fully and completely as possible. Please enable JavaScript in your browser to complete this form.1. CLIENT (you) Full Name *Maiden or Former SurnameAge *Date of Birth *Place of BirthAddressMailing AddressTelephone(work)(home)(fax)EmployerAddressOccupationPositionLength of Employment (please check)Full-TimePart-TimeTemporaryPermanentBenefitsGross IncomePay Dates month was: (copy) Previous EmployerTotal income declared on your income tax return 19___ was: ____________ and your net taxable income was: ____________________Length of residence in N.W.T. Places of residence in the Nunavut and Dates PlacesDates SPOUSE (Husband or Wife) Full Name *Maiden or Former SurnameAge *Date of Birth *Place of BirthAddressMailing AddressTelephone(work)(home)(fax)EmployerAddressOccupationPositionLength of Employment (please check) Full-TimePart-TimeTemporaryPermanentBenefitsGross IncomePay DatesPrevious EmployerTotal income declared on your spouse's last income tax return in 20_______ was: ____________ and your spouse's net taxable income was: _________Length of residence in Northwest TerritoriesSpouse currently lives atMARRIAGE Date of marriagePlace of marriageWhen you married you wereWidowSingleDivorcedSpouse wasWidowSingleDivorcedDates and place of previous marriage(Husband)Dates and place of previous marriage(Wife) Dates of divorce decree(Husband)Dates of divorce decree(Wife)SEPARATION Date husband and wife ceased to live togetherWhereReasons for separationEfforts to get back togetherAny possibility of returning?YesNoDates and length of previous periods of separation:Any written or oral agreements or financial arrangements made between husband and wifeAny court proceedings regarding the marriage, support, custody and/or access CHILDREN (including adopted and step children but not children adopted out) Full NamesDate of Births The children have been in the custody of _____________________ since _________________________.I claim custody of the following childrenI agree for my spouse to have custody of the following childrenI claim custody for the following reasonsI agree to my spouse's custody for the following reasonsI propose the following access arrangementsWhat do you want (please check)DivorceCustody OrderAccess OrderSupport for children in the amount of $__________ per monthSupport for myself in the amount of $___________ per monthRestraining OrderDivision of PropertySupport for children in the amount of $__________ per monthSupport for myself in the amount of $___________ per monthPlease give us any of the following if available Your original marriage certificate Any written agreement Any court papers Any old divorce papers Attach: * Click or drag a file to this area to upload. Book Appointment select Date & Time Select DateSelect TimeSubmit
