Legal Conflict Declarations Form

LEGAL CONFLICT DECLARATIONS FORM

This Legal Conflict Declarations Form (the form) is executed by the parties identified below as of the effective date indicated herein. Client Name: and Other Party Name: . Effective Date: .

RECITALS

WHEREAS, the parties are engaged in a professional relationship pursuant to the agreement titled: (the related agreement), and during the course of that relationship each party may obtain confidential information and engage counsel or advisors; and

WHEREAS, the parties desire to identify, disclose, and, where appropriate, mitigate known or potential conflicts of interest that could affect representation, advice, or other services provided to either party; and

WHEREAS, timely and accurate disclosure of conflicts, and agreed procedures for resolving them, are necessary to preserve the integrity of the parties' dealings and to permit informed consent where required;

NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows:

1. DEFINITIONS

1.1 "Conflict" means any direct or indirect interest, relationship, engagement, or circumstance that could materially limit, impair, or appear to impair a party's ability to provide impartial advice or services to the other party under the related agreement. "Known Conflict" means a Conflict identified as of the Effective Date. "Potential Conflict" means a circumstance that may develop into a Conflict in the future.

2. DISCLOSURE OBLIGATIONS

2.1 Each party represents and warrants that it has exercised reasonable inquiry and has made diligent efforts to discover any Known Conflicts. Each party shall promptly disclose in writing any material Known Conflict and any Potential Conflict that arises after the Effective Date.

2.2 Disclosures required by this Form shall include sufficient detail to permit evaluation of the nature, parties, timing, and potential impact of the Conflict, including the identity of persons or entities involved and the type of relationship or interest giving rise to the Conflict.

3. KNOWN CONFLICTS

3.1 The parties state the following Known Conflicts (if none, check the box and sign below):

No known conflicts exist as of the Effective Date.

4. POTENTIAL CONFLICTS

4.1 The parties shall identify known circumstances that could reasonably give rise to a Potential Conflict, together with a proposed course of action to monitor, avoid, or resolve such Potential Conflict.

5. CONSENT TO CONTINUE / RESOLUTION

5.1 Where a disclosed Conflict is material but waivable, the parties may agree in writing to specific, limited consents that set conditions under which the conflicted relationship may continue, including screening, informed written consent, and limitations on the scope of representation or services.

5.2 Any consent to continue despite a Conflict must be explicit, documented in writing, signed by the affected parties, and shall specify the duration and any mitigation measures. Such consent shall not waive claims for prior breaches or concealment.

6. CONFIDENTIALITY

6.1 Information disclosed under this Form shall be treated as Confidential Information subject to the confidentiality provisions of the related agreement. If the related agreement lacks adequate confidentiality protection, the parties agree that disclosures hereunder shall be held in confidence to the same standard as attorney-client or similarly protected information where applicable.

7. REPRESENTATIONS AND WARRANTIES

7.1 Each party represents and warrants that the disclosures made herein are true, accurate, and complete to the best of its knowledge after reasonable inquiry. Each party further warrants that it will supplement disclosures promptly upon discovering additional relevant information.

8. REMEDIES AND MITIGATION

8.1 If a party breaches its disclosure obligations or conceals a Conflict, the non-breaching party may pursue all available legal and equitable remedies, including termination of the related agreement, injunctive relief, and recovery of damages resulting from the breach or concealment.

9. NOTICES

9.1 All notices required under this Form shall be in writing and delivered to the addresses provided below or to such other address as either party designates in writing.

10. AMENDMENTS; WAIVER

10.1 This Form may be amended or modified only by a written instrument signed by both parties. No waiver of any provision or default shall be effective unless in writing and signed by the party granting the waiver.

11. GOVERNING LAW

11.1 This Form shall be governed by and construed in accordance with the laws of the jurisdiction specified below, without regard to conflict of law principles. Governing Law State:

12. ENTIRE AGREEMENT

12.1 This Form, together with the related agreement, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous understandings and agreements, whether written or oral, relating to conflicts of interest and disclosures.

13. SEVERABILITY

13.1 If any provision of this Form is held invalid or unenforceable by a court of competent jurisdiction, the remaining provisions shall remain in full force and effect and the invalid or unenforceable provision shall be reformed to the minimum extent necessary to make it valid and enforceable.

14. COUNTERPARTS

14.1 This Form may be executed in counterparts, each of which shall be an original and all of which together shall constitute one instrument. Facsimile and electronic signatures shall be effective as originals to bind the signing party.

15. CERTIFICATION

15.1 By signing below, each party certifies under penalty of perjury that the disclosures made in this Form are true, complete, and correct to the best of the signing party's knowledge after reasonable inquiry, and that the signing party has authority to bind the entity or individual executing this Form.

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