Legal Solicitor Information Form

LEGAL SOLICITOR INFORMATION FORM

This Legal Solicitor Information Form is entered into as of Effective Date: by and between Solicitor Name: of Firm: whose principal office is at (hereinafter "Solicitor"), and Client Name: of Address: (hereinafter "Client").

RECITALS

WHEREAS, Client desires to retain Solicitor to provide legal services in connection with the matter described as: (the "Matter");

WHEREAS, Solicitor has represented that it is duly authorized and admitted to practice law in the jurisdictions identified below and maintains the professional qualifications and insurance set forth herein; and

WHEREAS, the parties wish to record Solicitor's contact, billing and authority details, and to set forth certain administrative terms that will govern notices, service, and information exchange between the parties.

NOW THEREFORE, in consideration of the mutual promises set forth below, the parties agree as follows:

1. DEFINITIONS

In this Form, unless the context otherwise requires, the following defined terms apply: "Matter" means the legal matter described in the Recitals; "Notices" has the meaning set forth in Section 6; "Representative" means an individual authorized in writing by a party to receive communications on its behalf.

2. SOLICITOR INFORMATION AND REPRESENTATIONS

3. SCOPE OF INFORMATION / AUTHORITY

Solicitor represents and warrants that the information provided herein is true and correct to the best of Solicitor's knowledge. Solicitor is authorized by Client to receive notices, accept service of documents and receive materials on behalf of Client in relation to the Matter only if Client so indicates below.

Solicitor is authorized to accept service of process on behalf of Client for the Matter: Yes

Solicitor agrees to accept electronic service for documents related to the Matter via:

4. CONFIDENTIALITY; DATA SECURITY

Solicitor acknowledges its obligations under applicable rules of professional conduct and agrees to maintain the confidentiality of all client information obtained in the Matter. Solicitor shall implement reasonable administrative, technical and physical safeguards to protect nonpublic information and shall notify Client promptly in the event of any unauthorized disclosure affecting Client data.

5. CONFLICTS; NOTIFICATION

Solicitor represents that, except as disclosed in writing to Client, Solicitor is not aware of any conflict of interest that would preclude representation in the Matter. If a potential or actual conflict arises, Solicitor shall notify Client immediately and cooperate in resolving the matter in accordance with applicable ethical rules.

6. NOTICES

All notices, requests, demands and other communications required or permitted under this Form shall be in writing and shall be delivered to the addresses set forth below. A notice shall be deemed given when delivered personally, one business day after delivery by overnight courier, or three business days after deposit in the mail, postage prepaid.

7. INDEMNITY; LIMITATION

To the extent permitted by law, each party shall indemnify and hold harmless the other against losses arising from the indemnifying party's willful misconduct or gross negligence in connection with the Matter. Nothing in this Form limits a party's obligations under applicable rules of professional responsibility.

8. AMENDMENTS; WAIVER; COUNTERPARTS

This Form may be amended only by a writing signed by both parties. No waiver of any provision shall be effective unless in writing signed by the waiving party. This Form may be executed in counterparts, each of which constitutes an original and all of which constitute one agreement.

9. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Form shall be governed by and construed in accordance with the laws of the jurisdiction in which the Matter is pending, exclusive of its conflicts of law rules. This Form constitutes the entire agreement between the parties with respect to the subject matter hereof, and supersedes all prior communications and agreements. If any provision of this Form is held invalid or unenforceable, the remaining provisions shall continue in full force and effect.

10. CERTIFICATION

Each undersigned certifies under penalty of perjury that the information contained in this Form is true, accurate and complete, and that the undersigned is authorized to execute this Form on behalf of the party indicated.

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