Legal Nominations Form

LEGAL NOMINATIONS FORM

This Legal Nominations Form is made and entered into on this day of , (the "Effective Date"), by and between Nominator Name: , with principal address , and Nominee Name: , with principal address .

RECITALS

WHEREAS, the Nominator wishes to designate one or more persons to act in specified legal capacities on behalf of the Nominator or to be considered as successor or alternate officeholders, and to record the scope and limitations of any such designations; and

WHEREAS, the Nominee is willing to accept such nomination subject to the terms, conditions and limitations set forth in this Form and to perform duties consistent with the capacities nominated; and

WHEREAS, the parties desire to confirm the nomination in writing to create a clear record of the nominated role, its scope, effective date, and any conditions or limitations.

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

1. NOMINATION

1.1 Nomination. The Nominator hereby nominates the Nominee to serve in the capacities and with the powers selected below. The parties acknowledge that a nomination constitutes an expression of intent by the Nominator and, where applicable, a request that appropriate instruments or third parties recognize the Nominee in such capacity.

Select nominated capacity (check all that apply):

Agent under Power of Attorney
Successor Trustee
Executor of Estate
Guardian of Minor or Incapacitated Person
Corporate Officer / Director
Other (describe below)

2. SCOPE AND LIMITATIONS

2.1 Powers. The powers conferred on the Nominee shall be limited to the specific authorities set forth in this Form and any attached instruments. Unless otherwise specified below, the Nominee shall not exercise powers beyond those necessary to accomplish the duties of the nominated capacity.

2.2 Term. The nomination shall become effective on the Effective Date specified above and shall continue until revoked in writing by the Nominator or until the occurrence of a condition specified below.

Condition terminating nomination (if applicable):

3. ACCEPTANCE BY NOMINEE

3.1 Acceptance. By signing this Form, the Nominee acknowledges receipt of the nomination, accepts the nomination subject to the terms and limitations set forth herein, and agrees to perform the duties of the nominated capacity in a fiduciary manner where applicable.

3.2 Conditions to Acceptance. The Nominee may condition acceptance upon compliance with statutory requirements, execution of additional instruments, background verification, or the provision of indemnity or insurance. Any such conditions must be set forth in writing and attached to this Form.

4. REPRESENTATIONS AND WARRANTIES

4.1 Nominator Representations. The Nominator represents and warrants that the Nominator is legally competent and has the authority to make the nomination, and that no legal restriction presently prevents the Nominator from nominating the Nominee for the specified capacity.

4.2 Nominee Representations. The Nominee represents and warrants that the Nominee is legally able and willing to serve in the nominated capacity, that there are no conflicts of interest or legal disqualifications known to the Nominee at the time of signing, and that the Nominee will comply with applicable law and fiduciary duties.

5. REVOCATION; RESIGNATION

5.1 Revocation. The Nominator may revoke this nomination at any time by delivering a written notice of revocation to the Nominee and to any third parties reasonably expected to rely on the nomination. Revocation shall be effective upon receipt by the Nominee or by such third parties.

5.2 Resignation. The Nominee may resign from a nominated capacity by giving written notice to the Nominator. The resignation shall be effective as specified in the resignation notice or, if no effective date is specified, upon thirty (30) days' delivery of such notice.

6. NOTICES

All notices, consents, and other communications required or permitted under this Form shall be in writing and delivered to the parties at the addresses set forth below or to such other address as a party may designate by written notice in accordance with this Section.

7. MISCELLANEOUS PROVISIONS

7.1 Governing Law. 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.

7.2 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, understandings and communications, whether written or oral, regarding such subject matter.

7.3 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 thereby.

7.4 Amendments; Waiver. No amendment, modification or waiver of any provision of this Form shall be effective unless in writing and signed by both parties. Failure to insist upon strict performance of any provision shall not be a waiver of any subsequent breach.

7.5 Counterparts. This Form may be executed in two or more counterparts, each of which shall be deemed an original but all of which together shall constitute one and the same instrument.

8. ADMINISTRATIVE

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