Name and address: UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA CASE NUMBER v. Plaintiff(s) Defendant(s). APPLICATION OF REGISTERED LEGAL SERVICES ATTORNEY TO PRACTICE BEFORE THE COURT INSTRUCTIONS FOR APPLICANTS (1) Complete Section I of this Application, sign the certification in Section II, and have your designated supervising attorney sign in in Section III; note that electronic signatures are not accepted. Space to supplement your responses is provided in Section IV. (2) Have your supervising attorney e-file your Application, using the Court's CM/ECF System, and submit a Proposed Order (using Form CV-99 ORDER, available from the Court's website). SECTION I - INFORMATION Applicant's Name (Last Name, First Name & Middle Initial) Qualifying Legal Services Provider Telephone Number Street Address City, State, Zip Code I will represent the following parties: Plaintiff Plaintiff Name(s) of Party(ies) Represented (list additional parties in Section IV if necessary) Defendant Defendant Other: Other: Fax Number E-Mail Address Applicant's Cal. State Bar Number (if one been issued) Have you previously registered as a CM/ECF user in the Central District of California ? If yes, was your CM/ECF User account associated with the e-mail address provided above? Yes Yes No No: Previous E-Mail Used (if applicable) You must be registered to use the Court's Case Management/Electronic Case Filing ("CM/ECF") System to be admitted to practice in this Court as a Registered Legal Services Attorney. Submission of this Application will constitute your registration (or re-registration) to use CM/ECF. If the Court signs an Order granting your Application, you will either be issued a new CM/ECF login and password, or the existing account you identified above will be associated with your case. Pursuant to Local Rule 5-3.2.3, registering to use CM/ECF is deemed consent, for purposes of Fed. R. Civ. P. 5(b)(2)(E), to electronic service of documents through the CM/ECF System. You have the right to withhold or revoke your consent to electronic service at any time; simply complete and return a Central District Electronic Service Exemption Form (Form G-05, available from the Court's website). If the Court receives an Electronic Service Exemption Form from you, you will no longer receive notice by e-mail when Court orders or other documents are filed in cases in which you are counsel of record; instead, copies of such documents will be sent to you through the mail. CV-99 (12/15) APPLICATION OF REGISTERED LEGAL SERVICES ATTORNEY TO PRACTICE BEFORE THE COURT Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com SECTION II - CERTIFICATION I declare under penalty of perjury that: (1) All of the above information is true and correct. (2) I am a Registered Legal Services Attorney authorized to practice law in the state courts of California pursuant to California Rules of Court, Rule 9.45. (3) I am familiar with the Court's Local Civil and Criminal Rules, the Federal Rules of Civil and Criminal Procedure, and the Federal Rules of Evidence. (4) I designate the attorney listed in Section III below, who is a member in good standing of the Bar of this Court, as my supervising attorney pursuant to Local Rule 83-2.1.5(a)(4) and California Rules of Court, Rule 9.45. Dated Applicant's Name (please type or print) Applicant's Signature SECTION III - DESIGNATION OF SUPERVISING ATTORNEY Designee's Name (Last Name, First Name & Middle Initial) Qualifying Legal Services Provider Telephone Number Street Address City, State, Zip Code E-Mail Address Designee's California State Bar Number Fax Number I am employed by a Qualified Legal Services Provider, as defined in California Rules of Court, Rule 9.45(a)(1). The Applicant will work, with or without pay, for this same Qualified Legal Services Provider. I am a member in good standing of the State Bar of California and the Bar of the Central District of California. I meet the requirements of California Rules of Court, Rule 9.45(h), and I hereby agree that I will provide direct supervision of the Applicant as required by Rule 9.45, and that I will assume professional responsibility for any work performed by the Applicant under that Rule. Dated Designee's Name (please type or print) Designee's Signature SECTION IV - SUPPLEMENT ANSWERS HERE (ATTACH ADDITIONAL PAGES IF NECESSARY) CV-99 (6/13) APPLICATION OF REGISTERED LEGAL SERVICES ATTORNEY TO PRACTICE BEFORE THE COURT Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com