Immigration Services Client Conflict Evaluation Form

Date Staff Member Completing Evaluation Client Name Client Date of Birth Client Contact Information Type of Immigration Service/Case Adverse Party Names (if any) Relationship of Adverse Party to Client Has this office previously represented or consulted with the adverse party in any immigration or related matter? Yes No If yes, provide details: Are there any other known or potential conflicts of interest? Yes No If yes, describe: Staff Comments / Evaluation Conflict Check Result No Conflict Conflict Identified Further Review Needed

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Reviewed By (Supervisor/Manager) Review Date