Legal Client Identification Form

LEGAL CLIENT IDENTIFICATION FORM

This Legal Client Identification Form (the "Form") is executed by Client Name: (hereinafter "Client") and Law Firm Name: (hereinafter "Firm"), effective Date: . The parties enter this Form for the purpose of establishing identity, confirming authority to retain counsel, performing conflict and compliance checks, and authorizing verification of the information provided below.

RECITALS

WHEREAS, the Firm requires verified identification and related information from prospective clients and their representatives to fulfill professional, regulatory and anti-money laundering obligations; and

WHEREAS, the Client seeks to retain the Firm for one or more legal matters and will provide truthful, complete and current information necessary for engagement, conflict clearance and regulatory compliance; and

WHEREAS, the parties wish to document the Client's identity, authority of signing representatives, beneficial ownership (if any), and the Client's consent to information verification and use as set forth in this Form.

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

1. CLIENT IDENTIFICATION

2. ENTITY STATUS & TAX IDENTIFIERS

Entity Type: (check all that apply)

3. IDENTIFICATION DOCUMENTS

Provide primary government-issued identification details. The Client certifies that copies or documentary evidence of the listed documents will be provided upon request.

4. BENEFICIAL OWNERS & AUTHORIZED REPRESENTATIVES

If the Client is an entity, list all beneficial owners holding, directly or indirectly, 25% or more of ownership or control, and any individual with significant control or authority. For individuals, list any appointed authorized representative who may instruct the Firm.

5. CONFLICTS, SANCTIONS & AML REPRESENTATIONS

The Client represents, warrants and certifies the following to enable the Firm to perform conflict checks and required compliance screening:

1. The information supplied in this Form is true, complete and correct to the best of the Client's knowledge and belief, and the Client will promptly notify the Firm of any material change.
2. The Client is not a person or entity subject to financial sanctions, trade embargoes, or other governmental prohibitions that would prohibit the Firm from providing legal services on the Client's behalf.
3. The Client consents to the Firm conducting identity verification, background screening, sanctions and adverse media checks, and the Firm's retention of records of such screening for compliance purposes.
4. The Client will provide additional documentation reasonably requested by the Firm to verify identity, ownership, and authority to retain counsel.

6. CONFLICT DISCLOSURE

The Client shall disclose any relationships, adverse interests, prior engagements or other facts that could give rise to a conflict of interest. Failure to disclose material facts may be grounds for withdrawal or termination of representation.

7. USE, STORAGE AND SHARING OF INFORMATION

By signing this Form, the Client authorizes the Firm to collect, retain and use the information provided for purposes of legal representation, conflict checks, regulatory compliance, billing and record-keeping. The Firm will use reasonable safeguards to protect personal data and will disclose information to third parties only when necessary for representation or required by law.

8. CERTIFICATIONS AND ACKNOWLEDGMENTS

The Client certifies under penalty of perjury and other applicable law that the information provided in this Form is complete, true and accurate. The Client understands that knowingly providing false information may subject the Client to civil or criminal penalties and that the Firm may decline or terminate representation based on inaccurate or incomplete information.

The Client acknowledges that the Firm's acceptance of representation is conditioned upon satisfactory completion of conflict checks and compliance screening, and that the Firm may request additional documentation prior to commencing substantive legal work.

9. MISCELLANEOUS

Governing Law: This Form shall be governed by and construed in accordance with the substantive laws of the jurisdiction where the Firm maintains its principal office, without regard to principles of conflicts of law.

Entire Agreement: This Form constitutes the entire agreement between the parties with respect to the matters addressed herein and supersedes all prior written or oral understandings concerning identification and verification.

Severability: If any provision of this Form is determined to be invalid, illegal or unenforceable, in whole or in part, the remaining provisions shall remain in full force and effect.

Amendments; Waiver: No amendment or waiver shall be effective unless executed in writing by both parties. The waiver of any breach shall not constitute a waiver of any subsequent breach.

Counterparts: This Form may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

10. AUTHORIZATION TO OBTAIN INFORMATION

The Client authorizes the Firm and its authorized agents to obtain consumer or commercial reports, verification of employment, banking references, or other records as necessary to verify identity, ownership and authority, and to satisfy regulatory obligations. This authorization shall remain in effect while the Firm is retained and for a reasonable period thereafter for record retention and compliance purposes.

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