Legal Application Declaration Form

LEGAL APPLICATION DECLARATION FORM

This Legal Application Declaration Form is made between Applicant Name: and Recipient Name: (collectively, the Parties), with Application Reference No.: , filed on: .

RECITALS

WHEREAS, Applicant has submitted an application and supporting materials to Recipient in connection with the purpose described as: ;

WHEREAS, Recipient administers, reviews and processes applications and requires a formal declaration and authorizations from Applicant to verify information, obtain records, and take adverse actions consistent with applicable law; and

WHEREAS, the Parties wish to set forth the terms, certifications and authorizations attendant to the application process and the use and disclosure of information provided by Applicant.

NOW, THEREFORE, in consideration of the mutual covenants and representations contained herein and for other good and valuable consideration, the Parties agree as follows:

1. DEFINITIONS

1.1 "Application" means all materials submitted by Applicant, including this Declaration, attachments, forms, and any supplemental information provided in connection with the application reference number set forth above.

1.2 "Confidential Information" means nonpublic information contained in or derived from the Application, except information that is or becomes public through no wrongful act of Recipient.

2. REPRESENTATIONS AND WARRANTIES

2.1 Applicant represents and warrants that all statements, documents and supporting information submitted as part of the Application are true, complete and correct to the best of Applicant's knowledge and belief as of the date of submission. Applicant further warrants that it has disclosed all material facts known to Applicant that could materially affect the evaluation of the Application.

2.2 Applicant will promptly notify Recipient in writing of any change in circumstances that renders any representation, warranty or statement in the Application untrue or incomplete.

3. AUTHORIZATIONS AND CONSENTS

3.1 Applicant authorizes Recipient and its authorized agents to obtain, verify and exchange information concerning Applicant's identity, qualifications, financial status, criminal history, employment history, professional licenses, educational credentials and other records reasonably relevant to the Application. This authorization includes, without limitation, release of records by educational institutions, employers, licensing authorities, credit reporting agencies and governmental bodies.

3.2 Applicant consents to the release of information about the Application to third parties where such disclosure is necessary for evaluation, background checking, fraud prevention, legal compliance, or as required by law.

4. CERTIFICATION UNDER PENALTY

4.1 Applicant certifies, under penalty of perjury and other civil or criminal penalties that may apply under governing law, that the statements contained in the Application are true and correct. Applicant acknowledges that making false statements, failing to disclose material facts, or submitting forged or altered documents may result in denial of the Application, rescission of any grant or approval, civil liability and criminal prosecution.

5. USE, STORAGE, AND DISCLOSURE OF INFORMATION

5.1 Recipient may retain copies of the Application and related documents, and may store and process such information in physical or electronic form. Recipient will handle Confidential Information in accordance with its internal policies and applicable law.

5.2 To the extent Recipient discloses Applicant information to third parties under Sections 3 or 5, Recipient will require that such third parties limit use of the information to purposes consistent with the Application process and maintain reasonable safeguards to protect the information.

6. REMEDIES; INDEMNITY

6.1 If Applicant breaches any representation, warranty or obligation in this Declaration, Recipient may, in addition to other remedies available at law or equity, deny or rescind any authorization granted in reliance on the Application. Applicant shall indemnify Recipient for losses, costs, and expenses (including reasonable attorneys' fees) arising from material misrepresentations or omissions in the Application.

7. NOTICES

Notices under this Declaration shall be in writing and effective upon delivery to the addresses provided above or to any other address a Party designates in a written notice to the other Party.

8. AMENDMENTS; WAIVER

8.1 This Declaration may be amended only by a written instrument executed by both Parties. No waiver of any provision shall be effective unless in writing and signed by the party granting the waiver.

9. COUNTERPARTS; EXECUTION

9.1 This Declaration may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument. Signatures transmitted by electronic means shall be binding.

10. GOVERNING LAW

This Declaration shall be governed by and construed in accordance with the laws of the jurisdiction identified as: without regard to conflict of laws principles.

11. ENTIRE AGREEMENT; SEVERABILITY

11.1 This Declaration constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior oral or written understandings. If any provision of this Declaration is held invalid or unenforceable, such provision shall be modified to the extent necessary to make it enforceable, or if modification is not possible, severed, and the remaining provisions shall remain in full force and effect.

DECLARANT INFORMATION

ACKNOWLEDGMENTS AND CHECKBOXES

Applicant understands that providing false information may result in adverse action, including denial, rescission, civil liability, or criminal prosecution under applicable law.

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