Annual Affidavit Form

ANNUAL AFFIDAVIT FORM

Affidavit Year:

Parties

WHEREAS

WHEREAS, the affiant named above (Affiant) has provided or will provide services or maintain records relevant to business activities during the Affidavit Year; and

WHEREAS, the Affiant affirmatively represents and warrants that the statements set forth in this Annual Affidavit are true, correct, and complete to the best of the Affiant's knowledge and belief as of the date of signature; and

WHEREAS, the undersigned parties desire to document certain representations, the scope of annual obligations, payment arrangements where applicable, and the terms governing this affidavit and any associated engagement.

Scope of Work / Statements

Affiant shall describe the services performed, records maintained, or assertions being made for the Affidavit Year. This description is incorporated into this affidavit and shall be relied upon by the Recipient for the purposes stated herein.

Payment Terms (If Applicable)

The parties agree that any compensation due to Affiant for services or obligations described in this affidavit will be governed by the following terms.

Term and Termination

This affidavit shall become effective on the Start Date and shall continue in effect until the End Date, unless earlier terminated in accordance with this section.

Start Date:    End Date:

Either party may terminate this affidavit for convenience upon written notice provided no fewer than days prior to the intended termination date. Immediate termination may occur for material breach, insolvency, or fraud.

Confidentiality

The Affiant acknowledges that in the performance of duties or in providing the statements contained herein, the Affiant may receive or create Confidential Information. "Confidential Information" shall mean nonpublic information disclosed in connection with this affidavit. The Affiant agrees to maintain such information in confidence and not to disclose it to any third party except as required by law or with prior written authorization from the affected party. The obligations of confidentiality shall survive termination or expiration of this affidavit for a period of three (3) years.

Representations and Warranties; Certification

The Affiant represents and warrants that: (a) all information, records and statements submitted in connection with this annual affidavit are true, accurate and complete; (b) no material information has been knowingly omitted; and (c) the Affiant is authorized to make this affidavit and to bind the Affiant to its terms. The Affiant understands that this affidavit may be relied upon by the recipient and that false statements are punishable under law.

Governing Law

This affidavit and any dispute arising out of or relating to it shall be governed by and construed in accordance with the laws of the State of , without regard to principles of conflict of laws.

Entire Agreement

This document constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior oral or written agreements, understandings, and representations. Any amendment or modification must be in writing and signed by both parties.

Affirmation

I, the undersigned Affiant, hereby declare under penalty of perjury under the laws of the governing jurisdiction that the foregoing statements are true and correct to the best of my knowledge, information and belief, and that I understand making a false affidavit may subject me to criminal penalties.

Sworn under oath    Affirmed (not sworn)

Notary Information (if required)

This section is provided for convenience if notarization is required. The notarization must be completed by an authorized notary public. The notary block on this form is for informational entry only and does not replace an official notarial certificate where required by law.

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