Business Oath Declaration

BUSINESS OATH DECLARATION

Declarant Business Name:

Corporation LLC Sole Proprietorship Partnership Other:

Declaration Date:

RECITALS

WHEREAS, Declarant is a business entity duly organized and validly existing under the laws of the state of , with its principal place of business at the address set forth above;

WHEREAS, Declarant conducts the following business activities and hereby submits this sworn declaration to attest to the accuracy of representations regarding such activities and compliance with applicable law;

WHEREAS, Recipient of this Declaration (if applicable), identified as: Recipient: , requires a sworn statement as part of an administrative or contractual process;

DECLARATION

I, , the undersigned Principal Officer of Declarant Business Name set forth above, being duly sworn, state under penalty of perjury that the following assertions are true, complete and correct to the best of my knowledge:

1. Declarant is authorized to conduct the business activities described above and holds all licenses, permits, registrations and authorizations required by law to perform such activities in the jurisdictions in which Declarant operates. Declarant's primary registration or tax identification number is: .

2. To the best of Declarant's knowledge, Declarant is in material compliance with applicable federal, state and local laws, regulations, tax obligations and reporting requirements related to the activities described herein, except as expressly disclosed in writing to Recipient:

SCOPE OF STATEMENT

The scope of this Declaration is limited to the factual statements set forth herein and to representations regarding compliance and business operations for the period commencing on and ending on .

PAYMENT TERMS

In consideration of Recipient's review, filing or administrative processing related to this Declaration, Declarant agrees to the following payment terms.

TERM AND TERMINATION

This Declaration is effective as of the Effective Date set forth below and shall continue in effect until the End Date set forth below, unless earlier terminated in accordance with the terms herein.

Effective Date:    End Date:

CONFIDENTIALITY

For purposes of this Declaration, "Confidential Information" means non-public commercial, financial, technical or business information disclosed in connection with this Declaration. Declarant shall: (a) hold Confidential Information in strict confidence; (b) not disclose Confidential Information to third parties except to employees, agents or advisors who have a need to know and who are bound by confidentiality obligations no less protective than those contained herein; and (c) use Confidential Information solely to the extent necessary to comply with or carry out the purposes of this Declaration. Confidential Information does not include information that is or becomes publicly known other than through breach of this Declaration, independently developed without use of Confidential Information, or rightfully received from a third party without restriction.

GOVERNING LAW

This Declaration shall be governed by and construed in accordance with the laws of the state of , without regard to its conflict of laws principles.

ENTIRE AGREEMENT

This Declaration, together with any schedules or attachments expressly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings and representations, whether written or oral.

CERTIFICATION AND OATH

I certify under penalty of perjury under the laws of the state specified in the Governing Law section that the statements contained in this Declaration are true and correct to the best of my knowledge and belief. I understand that intentional misrepresentation or omission of material information may subject me and Declarant to civil and criminal penalties under applicable law.

Sign Now