Name: Address: Phone Number: E-mail Address: Pro Se UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA CASE NUMBER v. PLAINTIFF(S) APPLICATION FOR PERMISSION FOR ELECTRONIC FILING DEFENDANT(S) As the (Plaintiff/Defendant) in the above-captioned matter, I respectfully ask the Court for permission to participate in electronic filing ("e-filing") in this case. I hereby affirm that: 1. I have reviewed Local Rule 5-4.1.1 and the instructions available at the Pro Se E-Filing webpage located on the Court's website. 2. I understand that once I register for e-filing, I will receive notices and documents only by e-mail in this case and not by U.S. mail. 3. I understand that if my use of the CM/ECF system is unsatisfactory, my e-filing privileges may be revoked and I will be required to file documents in paper, but will continue to receive documents via e-mail. 4. I understand that I may not e-file on behalf of any other person in this or any other case. 5. I have regular access to the technical requirements necessary to e-file successfully: Check all that apply. A Computer with internet access. An e-mail account on a daily basis to receive notifications from the Court and notices from the e-filing system. A scanner to convert documents that are only in paper format into electronic files. A printer or copier to create required paper copies such as chambers copies. A word-processing program to create documents; and A PDF reader and a PDF writer to convert word processing documents into PDF format, the only electronic format in which documents can be e-filed. Date: CV-05 (12/15) Signature: APPLICATION FOR PERMISSION FOR ELECTRONIC CASE FILING American LegalNet, Inc. www.FormsWorkFlow.com