Veterans Affairs Signed Form

VETERANS AFFAIRS SIGNED FORM

Parties

Recitals

WHEREAS, Veteran Name: is a recipient of veterans benefits and seeks assistance with administrative, benefits advocacy, or related services described herein;

WHEREAS, Service Provider: possesses experience and authority to provide such services consistent with applicable rules and ethical obligations;

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

Scope of Work

Service Provider shall perform the services described below on behalf of the Veteran. The services may include representation before benefits authorities, preparation and submission of claims, appeals, documentary support, and case management. Specific tasks, deliverables, and timelines shall be set forth by the parties and documented in this section.

Payment Terms

Compensation for services under this Agreement shall be as follows:

Late payments shall accrue interest and collection costs as set forth below. Parties acknowledge that timely payment is material to the performance of this Agreement.

Term and Termination

This Agreement commences on the effective date and continues until completion of the Scope of Work or until terminated in accordance with this section.

Effective Date:

Scheduled End Date:

Confidentiality

For purposes of this Agreement, "Confidential Information" includes any non-public information disclosed by either party in connection with the performance of services, including personal records, medical or benefits records, case strategies, and other sensitive data. The receiving party shall:

(a) hold Confidential Information in strict confidence; (b) not disclose Confidential Information to third parties except to the extent necessary to perform obligations under this Agreement or as required by applicable law; and (c) implement reasonable safeguards to prevent unauthorized disclosure. Confidentiality obligations shall not apply to information that (i) is or becomes public through no breach of this Agreement, (ii) was lawfully known to the receiving party prior to disclosure, or (iii) is rightfully obtained from a third party without restriction.

Confidentiality obligations shall survive termination of this Agreement for a period of five (5) years, except for personally identifying or medical records which shall remain protected to the maximum extent permitted by law.

I acknowledge and agree to the confidentiality provisions above.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to principles of conflicts of law. The parties submit to the exclusive jurisdiction of courts located in that state for disputes arising under this Agreement, subject to any mandatory statutory or regulatory requirements applicable to veterans benefits representation.

Entire Agreement; Amendments

This Agreement, including all attachments and statements of work expressly incorporated by reference, constitutes the entire agreement between the parties concerning the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, representations, and communications, whether written or oral. Any amendment or modification to this Agreement must be in writing and signed by both parties.

Certifications and Authority

Each party certifies that it has the full right, power, and authority to enter into this Agreement and to perform its obligations hereunder. The Veteran acknowledges that the Service Provider may need to access certain confidential benefit-related records to perform services and hereby authorizes limited disclosure of such records to the Service Provider to the extent necessary to carry out the Scope of Work.

Authorization to Obtain Records: Veteran authorizes release of benefit-related records to the Service Provider for purposes of representation and case management.

By signing below, the parties acknowledge that they have read, understand, and agree to be bound by the terms and conditions of this Agreement.

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