Fill and Sign the Clientcertificationdoc Form

- 1 - STATE OF RHODE ISLAND _______________ COURT , SC : : v. : C.A. No. : : CLIENT CERTIFICATION I, _________________________________________, certify that: 1. I am the plaintiff/defendant or an authorized representative of a corporate or business entity which is the plaintiff/defendant in this case; 2. I am aware that Attorney ____________________, is not a member of the Rhode Island bar, but that he/she has applied for permission to appear in this case on my behalf; 3. I am also aware that, if Attorney _______________________ is permitted to appear in this case, I will also be required to engage as co-counsel and pay for the services of a lawyer who is a member of the Rhode Island bar; 4. I am also aware that the Rhode Island lawyer engaged must be fully prepared to assume complete responsibility for the case at any time, and may be required to conduct the trial/ hearing/appeal in this case on my behalf (or on behalf of the corporate or business entity); 5. Having been advised of the matters set forth above, I support the request of Attorney _______________________ to be permitted to appear in this case on my behalf (or on behalf of the corporate or business entity), in accordance with the rules of this Court and of the Supreme Court of the State of Rhode Island. ________________________________ ____________________________________ Witness Signature ____________________________________ Print Name ____________________________________ Date - 2 -