Legal Name Registration Form

LEGAL NAME REGISTRATION FORM

This Legal Name Registration Form is entered into on this by and between Registrant Name: (hereinafter "Registrant"), Entity Type: Individual Corporation LLC Partnership Other , and Registrar Name: (hereinafter "Registrar").

RECITALS

WHEREAS, Registrant seeks to register and record the legal name or names under which it will conduct business and to provide official notice of such registered name to third parties and governmental or regulatory authorities as required; and

WHEREAS, Registrar maintains records and receives applications for registration of legal and trade names, reviews submitted information for completeness, and issues confirmations of registration in accordance with applicable policies and this Form; and

WHEREAS, the parties desire to set forth the terms, conditions and representations governing the registration, use and maintenance of the name(s) identified below.

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

1. REGISTRATION

2. REPRESENTATIONS AND WARRANTIES

Registrant represents and warrants that the information provided on this Form is true, complete and correct to the best of Registrant's knowledge and that Registrant has the full authority to adopt and register the requested name. Registrant further represents that use of the requested name does not knowingly infringe the rights of any third party and is not submitted for any unlawful purpose.

Registrant shall promptly notify Registrar of any change in the Registrant's legal name, corporate status, address, or other material information affecting the registration. Registrar reserves the right to refuse registration or to record conditions or disclaimers if Registrar reasonably determines that the requested name conflicts with an existing registered name or is otherwise prohibited.

3. USE AND RESTRICTIONS

Registration of a name under this Form confers only a record of the Registrant's assertion of use or intent to use the name and does not constitute a determination of trademark rights or entitlement to exclusive use. Registrant shall not use the registered name in any manner that violates law, contractual obligations, or the rights of third parties.

Registrar may impose conditions on the registration and may record such conditions in the registration record. Registrant agrees to comply with any conditions reasonably imposed and acknowledges that Registrar may suspend or cancel a registration for cause, including but not limited to fraud, misrepresentation, or repeated third-party challenges.

4. AMENDMENT, RENEWAL AND CANCELLATION

Registrant may submit amendments to the registration to update the registered name, address, or other details. Registrar will process amendments upon receipt of satisfactory documentation and may require additional proof of authority. Registrations may be renewed, suspended, or cancelled in accordance with Registrar procedures or upon written request supported by evidence satisfactory to Registrar.

5. FEES AND PAYMENT

Registrant agrees to pay all required fees for processing registration, amendment, renewal or cancellation. Fees paid are nonrefundable except as expressly provided by Registrar policy. Failure to timely pay fees may result in suspension or cancellation of the registration.

6. NOTICES

All notices, demands, and other communications required or permitted under this Form shall be in writing and delivered to the parties at the addresses provided below. Notice is effective upon delivery in person or by electronic transmission with confirmation, or three (3) business days after deposit with a nationally recognized courier service.

7. GOVERNING LAW

This Form and any dispute arising out of or related to it shall be governed by and construed in accordance with the laws of the jurisdiction of the Registrar's principal place of business, without regard to conflict-of-law principles that would result in the application of another jurisdiction's laws.

8. ENTIRE AGREEMENT

This Form constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals or communications, whether written or oral, relating to the registration of the name(s) specified herein.

9. SEVERABILITY

If any provision of this Form is held to be invalid, illegal, or unenforceable in any respect, the validity, legality, and enforceability of the remaining provisions shall not in any way be affected or impaired.

10. COUNTERPARTS; ELECTRONIC SIGNATURES

This Form may be executed in counterparts and by electronic signature, each of which shall be deemed an original and all of which together shall constitute one instrument. The parties consent to execution by facsimile or electronic signature and to delivery of executed counterparts by electronic transmission.

11. CERTIFICATION

The undersigned certifies under penalty of perjury under the laws of the governing jurisdiction that the information contained in this Form is true, accurate and complete, and that the signatory is authorized to submit this Form on behalf of the Registrant.

Registrants acknowledges and agrees that false statements may subject the registrant to penalties under applicable law.

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