🔒 This confidential questionnaire mirrors the questions on the Immigration and Refugee Board's official Basis of Claim (BOC) form (RPD.02.01) so we can accurately document everything you tell us before your official BOC form is prepared. Completing this form does NOT file your refugee claim with the IRB, your official BOC form is still prepared and filed separately, on its own strict deadline. Answer every question as completely and honestly as you can. If a question does not apply to you, write "N/A."
Who You Are Questions 1a to 1g on the official BOC form.
1a) Given or first name(s) *
1b) Family or last name(s) / surname(s) *
1c) Date of birth *
1d) Sex identified on your passport * Select... Male Female Other
If you do not identify with the sex/gender on your passport, you may self-identify here
1e) Nationality, ethnic and racial group or tribe *
1f) Religion and denomination or sect
1g) List all languages and dialects you speak *
Why You Are Claiming Refugee Protection Questions 2a to 2j. Explain everything in order, oldest information first. Include dates, names and places wherever possible.
2(a) Have you or your family ever been harmed, mistreated or threatened by any person or group? * Select... Yes No
2(a) If "Yes", explain in detail What happened; when it occurred; who you think caused it; what you think the reason was; whether people in situations similar to yours experienced the same.
2(b) If you returned to your country, do you believe you would be harmed, mistreated or threatened by any person or group? * Select... Yes No
2(b) If "Yes", explain in detail What would happen to you; who would harm, mistreat or threaten you; what you think the reason would be.
2(c) Did you ask any authorities, such as the police, or any other organization, in your country to protect or assist you? * Select... Yes No
2(c) Explain in detail (why not, if "No"; or who you approached, what steps you took, and what happened, if "Yes")
2(d) Did you move to another part of your country to seek safety? * Select... Yes No
2(d) Explain in detail (why not, if "No"; or why you left that place and why you could not live there or elsewhere in your country today, if "Yes")
2(e) When did you leave your country? *
2(f) Why did you leave at that time, and not sooner or later? *
2(g) Did you move to another country (other than Canada) to seek safety? * Select... Yes No
2(g) If "Yes", explain in detail Name of country; when you moved there; how long you stayed; whether you claimed refugee protection there and, if not, why not.
2(h) Give any other details you think are important for your claim for refugee protection
2(i) Are children who are less than 18 years old claiming refugee protection with you? * Select... Yes No
2(i) If "Yes", explain the situation Are you the child's parent? Is the other parent in Canada? Do you have legal documents or written consent to care for or travel with the child? If not, why not?
2(j) If a child six years old or younger is claiming refugee protection with you, explain in detail why you believe the child would be at risk of being harmed, mistreated or threatened if returned to their country Include only information specific to the child's situation, different from what you gave above.
Countries Where You Are at Risk of Serious Harm Question 3.
3) List each country where you believe you are at risk of serious harm *
Your Citizenship Question 4.
4) List each country of which you are or have been a citizen * One country per line. For each, include: present status; how citizenship was acquired (e.g. by birth, by marriage); date citizenship was acquired.
5) List your relatives, living or dead * List in this order: (i) spouse or common-law partner, (ii) children (including born outside marriage and adopted), (iii) parents, (iv) brothers and sisters (including half-siblings). One per line, with: full name; relationship; date of birth (or approximate age, or date of death if deceased); citizenship(s).
Previous Protection Claims Question 6.
6) Have you or any relative listed above ever claimed refugee protection or asylum in Canada or any other country (including at a Canadian office abroad or with the UNHCR)? * Select... Yes No
6) If "Yes", provide details One per line: full name; relationship; date of claim; country or UNHCR; result (e.g. accepted, rejected, not completed); IRB file number and/or CIC/IRCC client ID number.
Visa Applications to Canada Question 7.
7(a) Did you apply for a visa to enter Canada? * Select... Yes No
7(b) If "Yes", date of the application
7(c) At which Canadian office?
7(d) Was the application accepted? Select... Yes No N/A
7(e) Type of Canadian visa applied for Select... Work Visitor Immigrant Student Other N/A
7(f) Date visa was issued and duration
7(g) Date visa application was refused
7(h) Reason for visa refusal
Where You Can Be Contacted Question 8. This information is for our office; it is separate from the official BOC form's own contact-update process.
8(a) Street number and name *
8(b) Apartment, suite, or unit number
8(c) City *
8(d) Province * Select... Ontario Quebec British Columbia Alberta Manitoba Saskatchewan Nova Scotia New Brunswick Newfoundland and Labrador Prince Edward Island Northwest Territories Yukon Nunavut
8(e) Postal code *
8(f) Telephone number, including area code *
Email address (for our office, not on the official BOC form) *
Existing Representation For our conflict-of-interest check only, this is not on the official BOC form in this way.
Do you already have a lawyer, immigration consultant, or someone else helping you with this claim? Select... No Yes, another lawyer Yes, an immigration consultant (RCIC) Yes, a family member or friend
If "Yes", their name
Language and Interpreter Question 10.
10(a) Which official language would you like us, and eventually the IRB, to use with you? * Select... English French
Do you need an interpreter? * Select... Yes No
10(b) If "Yes", what language and dialect?
Supporting Documents Upload copies of anything that supports your claim: passport or travel documents, national ID, birth certificate, police reports, medical or psychological reports, membership cards, or other evidence. Include certified translations for documents not in English or French. PDF, JPG, PNG, DOCX. Max 25MB per file, 10 files max.
Choose file(s) 0 of 10 files attached.
Your Declaration Please read the warning above and the declaration below the form carefully before submitting.
Type your full legal name, this serves as your signature on this intake form *