Foreign Agent Filing Form

FOREIGN AGENT FILING FORM

This Foreign Agent Filing Form is submitted on by Agent Name: (the "Agent") on behalf of Principal Name: (the "Principal"), whose principal address is: .

RECITALS

WHEREAS, the Principal has engaged the Agent to undertake certain activities on behalf of the Principal in the jurisdiction(s) and before the audiences described in this Form; and

WHEREAS, the Agent has knowledge of and agrees to comply with the obligations, recordkeeping, disclosures and certifications required by applicable law governing the representation of foreign principals and related public communications; and

WHEREAS, the parties desire to set forth the scope, terms and certifications associated with the Agent's representation of the Principal.

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the sufficiency of which is acknowledged, the parties agree as follows:

1. REGISTRATION AND DISCLOSURE

1.1 Registration. The Agent shall register as required by applicable law to report representation of the Principal and shall file accurate, complete and timely disclosures describing the Agent's activities, expenditures, and the identity of the Principal. Registration effective date: . Registration reference or file number (if any):

1.2 Disclosure Accuracy. The Agent certifies that all information provided in this Form and in any subsequent filings will be true, complete and correct to the best of the Agent's knowledge, and that the Agent will promptly amend any disclosure that becomes materially inaccurate.

2. SCOPE OF REPRESENTATION

2.1 Services. The Agent shall perform the services described below on behalf of the Principal:

2.2 Geographic and Audience Scope. The Agent's activities on behalf of the Principal are intended to be carried out in the following jurisdictions and directed to the following audiences:

3. COMPENSATION AND PAYMENT

3.1 Compensation Terms. The Principal agrees to pay the Agent for services rendered in accordance with the terms below.

4. RECORDKEEPING AND REPORTING

4.1 Records. The Agent shall maintain contemporaneous and complete books, records, correspondence, receipts, disbursements and other documents related to activities performed on behalf of the Principal. Such records shall be retained for a period of years from the date of creation.

4.2 Reports. The Agent shall prepare and submit reports and disclosures required by applicable law, including periodic statements of activity and expenditures, and shall provide copies of public communications as required.

5. PUBLIC COMMUNICATIONS

5.1 Attribution and Notices. All public materials prepared, distributed or published by the Agent in furtherance of the representation shall contain clear attribution that the materials were produced on behalf of the Principal, if required by applicable law. The Agent shall submit representative copies of such materials to the appropriate authorities as required.

6. REPRESENTATIONS, WARRANTIES AND CONFLICTS

6.1 Agent Representations. The Agent represents and warrants that it has full authority to enter into this Form, that it will act in good faith, and that it will disclose any material conflicts of interest that arise during the term of representation. The Agent further represents that it will not knowingly engage in activities prohibited by applicable law.

6.2 Principal Representations. The Principal represents that it has authority to enter into this engagement and to provide necessary information, approvals and funding for the Agent's performance.

7. TERM AND TERMINATION

7.1 Term. This engagement commences on the effective date of registration and continues until terminated by either party in accordance with this Section. Commencement date: .

7.2 Termination. Either party may terminate this engagement upon days' written notice to the other party. Termination shall not relieve either party of obligations accrued prior to termination, including record retention and outstanding payment obligations.

8. NOTICES

All notices and communications required or permitted under this Form shall be in writing and delivered by hand, nationally recognized courier, or certified mail, return receipt requested, to the addresses provided below or to such other address as either party may designate in writing.

9. AMENDMENT; WAIVER

No amendment, modification or waiver of this Form shall be effective unless set forth in a writing signed by both parties. No failure or delay by either party to exercise any right or remedy shall operate as a waiver of that right or remedy.

10. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

10.1 Governing Law. This Form shall be governed by and construed in accordance with the laws of the State of without regard to its conflict of laws principles.

10.2 Entire Agreement. This Form, together with any attachments or schedules, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings and negotiations.

10.3 Severability. If any provision of this Form is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

11. CERTIFICATION AND PENALTIES

The Agent certifies that the information contained in this Form is true, complete and correct. The Agent acknowledges that filing false statements, failing to file required disclosures, or knowingly concealing material facts may give rise to civil or criminal penalties under applicable law.

I certify under penalty of perjury and other applicable penalties that the information in this filing is true, complete and accurate.

12. ATTACHMENTS

List or describe any attachments, exhibits or supplemental materials submitted with this Form (e.g., contracts, copies of public communications, invoices, payment records).

Sign Now