Legal Self-Representation Form

LEGAL SELF-REPRESENTATION FORM

This Legal Self-Representation Form (the "Agreement") is entered into on Effective Date: by and between Client Name: whose mailing address is Client Address: , and Other Party Name: whose mailing address is Other Party Address: .

RECITALS

WHEREAS, Client elects to proceed in the above-identified matter without retained or appointed counsel and intends to personally prepare, file, prosecute, defend or otherwise handle pleadings, appearances, and communications in the matter; and

WHEREAS, Other Party acknowledges the Client's election to self-represent and agrees that, except as expressly provided in this Agreement, all communications and service of papers may be directed to the addresses provided in this form; and

WHEREAS, both parties wish to record the scope, responsibilities, and acknowledgements attendant to Client's self-representation to avoid misunderstanding and to preserve the orderly administration of the matter.

NOW, THEREFORE

In consideration of the mutual covenants set forth herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the parties agree as follows:

1. SCOPE OF SELF-REPRESENTATION

Client affirms that Client will appear and act pro se in the matter referenced above. Client shall be solely responsible for preparing and filing all documents, attending all hearings, complying with applicable rules of procedure, and meeting all deadlines applicable to the matter. Client acknowledges that the Other Party may continue to be represented by counsel and that the rights and obligations of the parties shall be governed by applicable procedural and substantive law.

2. KNOWLEDGE, RISKS AND WAIVER

Client acknowledges that Client has the right to be represented by counsel at Client's expense and that by electing to proceed without counsel Client knowingly and voluntarily waives the right to representation for the duration of the matter unless otherwise ordered. Client understands the risks associated with self-representation, including but not limited to the potential for unfavorable rulings, forfeiture of rights due to procedural defaults, and the inability to obtain legal advice or representation without retaining or requesting counsel.

3. CONTACT INFORMATION AND SERVICE

Unless otherwise ordered by a tribunal, service of process, notices, correspondence, and documents to a party shall be effective if delivered to the mailing address or email address provided above. A party that changes its contact information must deliver written notice of the change to the other party in accordance with the Notices provision below.

4. CONFIDENTIALITY; PRIVILEGE

Client acknowledges that by proceeding without counsel certain privileges and protections ordinarily arising from attorney-client communications do not apply to communications with third parties. Client retains any privileges that exist by law; however, Client is responsible for preserving claimed privileges and must follow applicable rules and orders regarding confidentiality and disclosure.

5. FILINGS, DEADLINES AND SANCTIONS

Client acknowledges responsibility for calendaring and complying with all filing deadlines, hearing dates, and procedural requirements. Client understands that failure to comply may result in adverse rulings, dismissal, default, or other sanctions as permitted by law or court rule. Client shall not use the fact of self-representation as a basis for delay or to harass opposing parties.

6. REPRESENTATIONS AND CERTIFICATIONS

Client certifies under penalty of perjury that the information provided in this form is true and correct to the best of Client's knowledge. Client further certifies that Client is not under guardianship or other incapacity that would prevent meaningful participation in litigation, unless such status has been fully disclosed in writing to the Other Party and any tribunal with jurisdiction.

Individual Corporation / Business Other (describe)

7. NOTICES

Any notice required or permitted under this Agreement shall be in writing and shall be deemed sufficiently given if delivered personally, sent by first-class mail, or by electronic mail to the addresses provided in Section 3. Notices are effective upon receipt or, if mailed, three business days after deposit in the United States mail, postage prepaid.

8. FEES AND COSTS

Client is responsible for all filing fees, service costs, courier charges, transcript costs, and other expenses incurred in connection with the matter unless a tribunal or agreement provides otherwise. Other Party may seek recovery of costs and fees to the extent permitted by law.

9. GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction in which the matter is pending, without regard to conflict-of-law principles.

10. ENTIRE AGREEMENT; SEVERABILITY; AMENDMENT

This Agreement constitutes the entire understanding between the parties with respect to the subject matter hereof. If any provision is found to be invalid or unenforceable, that provision shall be severed and the remaining provisions shall remain in full force and effect. No amendment to this Agreement is effective unless in writing and signed by both parties.

11. WAIVER; COUNTERPARTS

The failure of a party to enforce any right or remedy under this Agreement shall not operate as a waiver of such right or remedy. This Agreement may be executed in counterparts, each of which shall be deemed an original, and execution by electronic signature shall have the same force and effect as an original signature.

12. CERTIFICATION OF UNDERSTANDING

By signing below, Client confirms that Client has read this Agreement, understands its terms, and voluntarily elects to proceed without counsel. Client further acknowledges that Client may seek legal advice at any time and that this Agreement does not limit any right to obtain counsel in the future.

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