Legal Bio Form

LEGAL BIO FORM

This Legal Bio Form (the "Form") is made and entered into as of by and between Client Name: ("Client") and Firm Name: ("Firm").

RECITALS

WHEREAS, Client seeks to retain Firm to provide legal services with respect to the matter described as: ; and

WHEREAS, Firm requires certain biographical, conflict-of-interest, and contact information from Client in order to evaluate and undertake representation and to comply with Firm's internal procedures and applicable professional rules; and

WHEREAS, Client is willing to provide the requested information and to certify its accuracy for the purpose of retention, conflicts checking, and file administration.

NOW, THEREFORE, in consideration of the mutual promises set forth herein, the parties agree as follows:

1. CLIENT IDENTIFICATION

2. ENTITY STATUS AND AUTHORIZED REPRESENTATIVE

Client Entity Type (check all that apply): Individual Corporation Limited Liability Company (LLC) Partnership Other

3. MATTER BACKGROUND AND SCOPE

4. CONFLICTS, RELATED PARTIES, AND MATERIAL FACTS

Has Client engaged prior counsel on this matter? Yes No

Client represents that, to the best of Client's knowledge, the information provided herein identifies all persons and entities known to be adverse to Client in the matter and all persons or entities that may reasonably be viewed as having an interest materially adverse to Client.

5. CONFIDENTIALITY AND DATA USE

Client acknowledges that information provided to Firm will be used for conflicts checking, file opening, and internal administration. Firm shall treat Client information in accordance with applicable professional conduct rules and the attorney-client privilege, subject to the exceptions set forth in applicable law.

Client authorizes Firm to retain copies of documents and information produced in connection with conflicts checks and file administration and to disclose such information to Firm personnel and consultants on a need-to-know basis, provided such disclosure is made under obligations of confidentiality.

6. CLIENT CERTIFICATIONS

Client certifies that the biographical and matter-related information provided on this Form is complete and accurate to the best of Client's knowledge. Client agrees to promptly notify Firm in writing of any material changes or omitted information discovered after execution of this Form.

7. NOTICES

All notices and communications required or permitted under this Form shall be in writing and delivered to the addresses set forth below or to such other address as either party may designate in writing.

8. GOVERNING LAW; SEVERABILITY; ENTIRE AGREEMENT

This Form shall be governed by and construed in accordance with the substantive laws of the jurisdiction in which Firm maintains its principal office for the engagement, without regard to conflict-of-law principles. If any provision of this Form is held invalid or unenforceable, the remainder of this Form shall remain in full force and effect. This Form constitutes the entire understanding between the parties with respect to the subject matter herein and supersedes all prior written or oral communications regarding the same.

9. AMENDMENTS; WAIVER; COUNTERPARTS

Any amendment to this Form must be in writing and executed by both parties. No failure or delay by either party in exercising any right under this Form shall operate as a waiver of that right. This Form 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.

10. ACKNOWLEDGMENT

By signing below, Client acknowledges receipt of this Legal Bio Form, confirms the accuracy of the information provided, and authorizes Firm to use such information as described herein. Firm acknowledges receipt of Client's information and agrees to treat such information consistent with professional obligations and this Form.

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