Legal Representative Registration Form

Legal Representative Registration Form

This Legal Representative Registration Form is executed on Date: by and between Principal Name: with Principal Address: (\"Principal\") and Legal Representative Name: with Representative Address: (\"Representative\").

RECITALS

WHEREAS, Principal desires to register and appoint Representative to act on Principal's behalf for the purposes and within the scope defined in this Form; and

WHEREAS, Representative represents that Representative is authorized, competent and willing to act as legal representative and that any required professional licenses or authorizations are valid and in good standing; and

WHEREAS, the parties wish to record the terms of the registration and the scope of authority granted herein.

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

1. APPOINTMENT AND ACCEPTANCE

1.1 Appointment. Principal hereby appoints Representative as Principal's legal representative and agent to act on Principal's behalf in accordance with the terms of this Form. Representative accepts such appointment and agrees to perform duties consistent with this appointment.

1.2 Representative Identification. Representative License/Bar No.:

2. SCOPE OF AUTHORITY

2.1 General Authority. Subject to any limitations set forth in this Form, Representative shall have full authority to act for and on behalf of Principal in matters described below and to execute, sign, deliver and file all documents and instruments necessary or advisable to carry out such authority.

2.2 Specific Authorities (check all that apply): Initiate, defend, settle, or discontinue litigation or administrative proceedings Execute and deliver contracts, agreements and amendments Conduct banking, sign checks, and manage funds related to matters authorized Obtain and inspect records and confidential information as necessary Represent Principal in tax matters and file required tax documents Other (describe below)

3. TERM; TERMINATION; REVOCATION

3.1 Effective Date. This registration becomes effective on Effective Date: unless otherwise mutually agreed in writing.

3.2 Termination. This registration terminates upon written revocation delivered by Principal to Representative, by resignation of Representative, by operation of law, or on Termination Date: if provided.

4. DUTIES AND STANDARDS OF REPRESENTATIVE

4.1 Fiduciary Duty. Representative shall act in the best interests of Principal, exercise reasonable care, comply with applicable law and professional standards, and promptly disclose any conflicts of interest.

4.2 No Delegation Without Consent. Representative shall not delegate material responsibilities under this Form without Principal's prior written consent.

5. CONFIDENTIALITY

Representative shall maintain confidentiality of all non-public information obtained in the course of representation and shall use such information solely for purposes authorized by Principal, except as required by law.

6. COMPENSATION AND EXPENSES

6.1 Fees. Compensation for Representative's services, if any, shall be as follows:

6.2 Expenses. Representative shall be reimbursed for reasonable out-of-pocket expenses incurred in connection with performance of duties, subject to documentation and Principal's reimbursement policies.

7. RECORDS; REPORTING

Representative shall maintain accurate records of actions taken on behalf of Principal and shall furnish reports to Principal upon reasonable request or as otherwise agreed in writing.

8. NOTICES

All notices, requests and other communications required or permitted hereunder shall be in writing and delivered to the addresses set forth below or to such other address as a party designates by written notice.

9. REPRESENTATIONS AND WARRANTIES

Each party represents and warrants that it has full power and authority to enter into this Form, that the individual signing on its behalf is duly authorized to execute this Form, and that execution will not violate any other agreement or applicable law.

10. GOVERNING LAW

This Form shall be governed by and construed in accordance with the laws of the state or jurisdiction identified by Principal's address without regard to conflicts of law principles.

11. ENTIRE AGREEMENT

This Form constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous understandings and agreements, written or oral, regarding such subject matter.

12. SEVERABILITY

If any provision of this Form is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect and shall be construed to effectuate the parties' intent.

13. AMENDMENT; WAIVER; COUNTERPARTS

This Form may be amended only by a written instrument executed by both parties. No failure or delay in exercising any right shall operate as a waiver. This Form may be executed in counterparts, each of which shall be deemed an original.

14. ATTACHMENTS AND DOCUMENTS

The following documents are attached and form part of this registration (check as applicable): Power of Attorney Representative Identification (copy) Other documents (describe below)

CERTIFICATION

Each party certifies under penalty of perjury that the information provided in this Form is true and correct, that the party has the authority to enter into this Form, and that the signatures below are genuine.

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