Pineiro Law Professional Corporation

P.O. Box 2341
Peterborough, ON
K9J 7Y8

705-400-9444

Pineiro Law - New client 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.

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!

Please indicate the relevant area of law to your matter

FamilyWills & EstatesBoth

Tell us a little bit about your matter

Client's Personal Information

Contact information: Questions 1 through 8 are all about you.

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Former names:

if applicable - i.e. maiden name, birth name, prior names, etc.

If you wish, please provide your preferred name/personal pronouns

Spouse/Partner or Ex-spouse/Ex-partner (if separating) - Please enter N/A if not applicable

Please provide full name or N/A if not applicable

Identification Requirements: We require a copy of YOUR valid Ontario drivers licence (both front and back) OR Canadian Passport (we cannot accept Health Cards as ID)

Please attach a clear scan in PDF format of your Driver's License (Front side only)

Add attachment

Please attach a clear scan in PDF format of your Driver's License (Back side only)

Add attachment

IF no Driver's License, please attach a clear scan of your valid Canadian Passport

Add attachment

Driver's License #:

Identification Requirements: We also require documents to verify your name and confirm a financial account such as a credit card STATEMENT or bank STATEMENT.

This document must be downloaded directly from your financial institution's website or from your mobile app. We cannot accept a picture or screenshot.

Add attachment

Client's Employment

Employer:

Occupation/Position:

Workplace Address:

Workplace Phone No:

Length of Employment:

Complete the Following FOR COUPLES' WILLS ONLY

Name of client #2

Email address for client #2

FOR COUPLES' WILLS ONLY - CLIENT #2 - Identification Requirements: We require a copy of YOUR valid Ontario drivers licence (both front and back) OR Canadian Passport (we cannot accept Health Cards as ID)

Please attach a clear scan in PDF format of your Driver's License (Front side only)

Add attachment

Please attach a clear scan in PDF format of your Driver's License (Back side only)

Add attachment

IF no Driver's License, please attach a clear scan of your valid Canadian Passport

Add attachment

Driver's License #:

Couples Wills Only - Client #2 - Identification Requirements: We also require documents to verify your name and confirm a financial account such as a credit card STATEMENT or bank STATEMENT.

Please indicate the relevant area of law to your matter

Tell us a little bit about your matter

Client's Personal Information

Contact information: Questions 1 through 8 are all about you.

Former names:

If you wish, please provide your preferred name/personal pronouns

Spouse/Partner or Ex-spouse/Ex-partner (if separating) - Please enter N/A if not applicable

Please provide full name or N/A if not applicable

Identification Requirements: We require a copy of YOUR valid Ontario drivers licence (both front and back) OR Canadian Passport (we cannot accept Health Cards as ID)

Please attach a clear scan in PDF format of your Driver's License (Front side only)

Please attach a clear scan in PDF format of your Driver's License (Back side only)

IF no Driver's License, please attach a clear scan of your valid Canadian Passport

Driver's License #:

Identification Requirements: We also require documents to verify your name and confirm a financial account such as a credit card STATEMENT or bank STATEMENT.

This document must be downloaded directly from your financial institution's website or from your mobile app. We cannot accept a picture or screenshot.

Client's Employment

Employer:

Occupation/Position:

Workplace Address:

Workplace Phone No:

Length of Employment:

Complete the Following FOR COUPLES' WILLS ONLY

Name of client #2

Email address for client #2

FOR COUPLES' WILLS ONLY - CLIENT #2 - Identification Requirements: We require a copy of YOUR valid Ontario drivers licence (both front and back) OR Canadian Passport (we cannot accept Health Cards as ID)

Please attach a clear scan in PDF format of your Driver's License (Front side only)

Please attach a clear scan in PDF format of your Driver's License (Back side only)

IF no Driver's License, please attach a clear scan of your valid Canadian Passport

Driver's License #:

Couples Wills Only - Client #2 - Identification Requirements: We also require documents to verify your name and confirm a financial account such as a credit card STATEMENT or bank STATEMENT.

This document must be downloaded directly from your financial institution's website or from your mobile app. We cannot accept a picture or screenshot.

Client #2 Employment - Couples Wills ONLY

Employer:

Occupation/Position:

Workplace Address:

Workplace Phone No:

Length of Employment:

Thank You