RK Law Advocates
Emmanuel Way
High Rock, EG P O Box F44198
1-242-699-0529
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 National 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.
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
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Phone numbers
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Type
Work
Home
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Primary
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National Insurance Number
Social Security or Social Insurance Number
Driver's License Number:
Age:
Place of Birth:
Address Where Mail Can Be Sent To You Confidentially:
Island:
Maiden Name:
Do you want a name change?
Yes
No
Health Issues:
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/Relationship
(If applicable):
Child 1 From a previous Marriage:
Yes
Name:
Date of Birth:
Additional Infromation:
Ie: Adopted, Special Need, Current Living Situation.
No
Child 2 From a previous Marriage/Relationship:
Yes
Name:
Date of Birth:
Additional Infromation:
Ie: Adopted, Special Need, Current Living Situation.
No
Child 3 From A previous Marriage/Relationship:
Yes
Name:
Date of Birth:
Additional Infromation:
Ie: Adopted, Special Need, Current Living Situation.
No
Child 4 From A previous Marriage/Relationship:
Yes
Name:
Date of Birth:
Additional Infromation:
Ie: Adopted, Special Need, Current Living Situation.
No
Maintenance and Child Support Obligations:
Client's Education
State the total number of years of formal education you have completed:
If you have a college 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
Salary
Pay Frequency
Select an option
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 health insurance policy?
Yes
Cost and frequency Payment:
Name of Company:
Who is covered cost and frequency Payment:
No
Employee Life Insurance Policy:
Yes
Dates contributions Started and Amounts and Frequency of contributions:
No
Pension:
Credit Union:
Savings Plan:
Yes
Value of Account:
Contributions Amount and Frequency:
Addition Details
No
Profit Sharing:
Yes
Value of Account:
Contributions Amount and Frequency:
Addition Details
No
Stock Options:
Do you have any 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 Pay:
Net Amount:
No
Monthly Expenses
Do you have a Mortgage?
Yes
How much is your mortgage payment?
How often do you make the payments
No
Do you pay rent?
Yes
How much is your rent payment?
How often do you make the payments?
No
Do you pay electricity?
Yes
How much is your electricity payment?
How often do you make the payments?
No
Do you pay for Household Gas?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Water ?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Telephone Services ?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Internet Services ?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Fuel ?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for household repairs and maintenance?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for household repairs for furniture or replacement?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Domestic Help?
Maid, Handyman, etc.
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Laundry?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Groceries?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Homeowners Insurance?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Medical Insurance?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Life Insurance?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Medical Expenses?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Dental Expenses?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Eye Doctor Expenses?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Transportation?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Clothing?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Personal Maintenace?
Grooming
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Child Care?
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Education?
Tuition, Accommodation, Transportation, Books, Supplies etc.
Yes
How much is your payment?
How often do you make the payments?
No
Do you pay for Lessons?
Music, School, Dance, Arts, etc.
Yes
How much is your payment?
How often do you make the payments?
No
Spouse's Personal Information
Full Name:
Address:
Home Phone:
Cell Phone:
Work Phone:
Email:
National Insurance Number
Social Insurance Number, Social Security Number, etc
Island:
Date of Birth:
Age:
Place of Birth:
Maiden Name:
(if applicable)
Spouse's Physical Description:
(age, height, hair color, eye color, distinctive characteristic, tattoos, scars, nickname, etc)
Health Issues:
Does your spouse have any military history?
Yes
No
Spouse's Previous Marriages
(If any)
Previous Spouse's Full Legal Name:
Date of Marriage:
Date of Divorce:
How was Marriage Terminated:
Spouse's Children From A Previous Marriage
(If applicable)
Child 1 From A Previous Marriage:
Yes
No
Child 2 From A Previous Marriage:
Yes
No
Child 3 From A Previous Marriage:
Yes
No
Child 3 From A Previous Marriage:
Yes
No
Maintenace 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
Salary
Pay Frequency
Select an option
Weekly
Bi-weekly
Twice Per Month etc
Monthly
Gross Pay:
Per Period
Net Pay:
Per Period
Bonus:
Commision:
Stock Investment:
Does your spouse have a health insurance policy?
Yes
Cost of Frequency Payment:
Name of Company:
Who is covered and frequency payment:
No
Employee Life Insurance Policy?
Yes
Cost and Frequency Payment:
Dates Contributions Started and Amounts and Frequency of Contributions:
No
Pension
Yes
Explain
No
Credit Union
Yes
Explain
No
Stock Options
Yes
Explain
No
Does your spouse have any business interests?
Spouse's other Income information.
Does your spouse have any other source of income?
Yes
From Whom Such Income is Received:
Gross Amount:
Net Amount:
No
Is your spouse currently unemployed?
Yes
Name of Spouse'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:
Island:
Currently Living In:
City, State & Island
For how many years?
Are Parties Sharing the Same Household?
Yes
Date that "irreconcilable Breakdown" started:
No
Reason(s) for Divorce:
Previous Separation(s) Dates and Response:
Previous Counseling Dates and By Whom:
(Social Worker, Marriage Counselor, Psychologist, Priest, Rabbi, Minister, Doctor)
Previous Court Action:
Yes
Case No:
Prior Attorney:
Additional Details:
No
Children of This Marriage/Family
Children of the Family are children who have been treated as part of the family unit during the marriage or cohabitation, regardless of whether they are the biological or adopted children of both parties. This can include: Biological children of both spouses, adopted children (whether adopted jointly or by one spouse and treated as a family member), and stepchildren or children of one party who were raised by both parties as a child of the family.
Child 1:
Yes
Child's Full Legal Name:
Reside With:
Date of Birth:
Age:
School/Daycare:
No
Child 2:
Yes
Child's Full Legal Name:
Reside With:
Date of Birth:
Age:
School/Daycare:
No
Child 3:
Yes
Child's Full Legal Name:
Reside With:
Date of Birth:
Age:
School/Daycare:
No
Child 4:
No
Yes
Child's Full Legal Name:
Reside With:
Date of Birth:
Age:
School/Daycare:
Additional Information I.e:
(Adopted, Special Needs, Current Living Situation)
Day-Care or Baby-Sitters:
Names Cost Per Week, etc.
Educational Cost:
Registration Tuition, Books etc.
Extracurricular Activities or Lesson:
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 children'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:(If so, please state the original amount of the loan, the loan date, the remainding balanceand the 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:(If so, please state the original amount of the loan, the loan date, the remainding balanceand the 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:(If so, please state the original amount of the loan, the loan date, the remainding balanceand the due date.)
Net Equity of property:
No
Other Marital Property
Explain in full detail any property obtained, purchase or acquired by either you or your spouse before or during (via inheritance or girft only) the marriage.
Non-Marital Property
Explain in full detail any other property obtained, purchase or acquired by either you or your spouse during the marriage.
Checking Accounts, Saving Accounts, Credit Unions, Money on Deposit.
Account 1:
Yes
Bank or Name of Fund, Address:
Names on Title:
Date Acquired:
Last 4 Digits of Accounts No.:
Approx.Balance
No
Account 2:
Yes
Bank or Name of Fund, Address:
Names on Title:
Date Acquired:
Last 4 Digits of Accounts No.:
Approx.Balance
No
Account 3:
Yes
Bank or Name of Fund, Address:
Names on Title:
Date Acquired:
Last 4 Digits of Accounts No.:
Approx.Balance
No
Account 4:
Yes
Bank or Name of Fund, Address:
Names on Title:
Date Acquired:
Last 4 Digits of Accounts No.:
Approx.Balance
No
Account 5:
Yes
Bank or Name of Fund, Address:
Names on Title:
Date Acquired:
Last 4 Digits of Accounts 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 Vehicle (Cars, Boats, Motorcycle, etc.)
Motor Vehicles1:
Yes
Year, Make and Model:
Date Purchase:
Balance Owed:
Driven By:
Monthly Payments:
To:
Who is the linen-holder? (Client, Spouse, Joint)
Who is the title-holder? (Client, Spouse, Joint)
No
Motor Vehicles 2:
Yes
Year, Make and Model:
Date Purchase:
Balance Owed:
Driven By:
Monthly Payments:
To:
Who is the linen-holder? (Client, Spouse, Joint)
Who is the title-holder? (Client, Spouse, Joint)
No
Motor Vehicles 3:
Yes
Year, Make and Model:
Date Purchase:
Balance Owed:
Driven By:
Monthly Payments:
To:
Who is the linen-holder? (Client, Spouse, Joint)
Who is the title-holder? (Client, Spouse, Joint)
No
Motor Vehicles 4:
Yes
Year, Make and Model:
Date Purchase:
Balance Owed:
Driven By:
Monthly Payments:
To:
Who is the linen-holder? (Client, Spouse, Joint)
Who is the title-holder? (Client, Spouse, Joint)
No
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?
Supporting Documents
Marriage Certificate
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Birth Certificate or Affidavit of Birth Child 1
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Birth Certificate or Affidavit of Birth Child 2
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Birth Certificate or Affidavit of Birth Child 3
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Birth Certificate or Affidavit of Birth Child 4
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Legal Separation Order
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ACKNOWLEDGEMENT AND ACCEPTANCE
I acknowledge that I have read and hereby accept the above privacy policy regarding use of my personal information.
THANK YOU
Thank you so much for completing this intake questionnaire. This information will be extremely helpful in evaluating your case. We will contact you as soon as possible with any updates.
Please click the
SUBMIT
button below when you have finished answering all questions.
Petition (if Respondent)
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Notice of Petition (if Respondent)
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Memorandum of Appearance (if Respondent)
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