VERIFIED APPLICATION FOR ADMISSION PRO HAC VICE IN THE STATE OF SOUTH CAROLINA Plaintiff vs. Case No. Mailing Address of Tribunal: Tribunal Defendant Comes now following: 1. Applicant resides at: Street Address City Telephone 2. Applicant is an attorney and a member of the law firm of (or practices law under the name of) , with offices at Street Address City Primary Telephone County Cell Phone State Fax Number Zip Code Email Address County State Zip Code , applicant herein, and respectfully represents the 3. Applicant has been retained personally or as a member of the above-named law firm by to provide legal representation in connection with the above case now pending before the above-named tribunal of the State of South Carolina. 4. Since of , applicant has been, and presently is, a member in good standing of the bar of the highest court of the District of Columbia or the State of where applicant regularly practices law. Attached is a certificate of good standing dated within the last 90 days from the bar of the highest court of the District of Columbia or the State where applicant regularly practices law. 5. Applicant has been admitted to practice before the following courts: (List all of the following courts applicant has been admitted to practice before: United States District Courts; United States Circuit Courts of Appeals; the Supreme Court of the United States; and courts of other states or the District of Columbia.) Court: Date Admitted: American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 4 Court: Date Admitted: Applicant is presently a member in good standing of the bars of those courts listed above, except as listed below: (List any court named in the preceding paragraph that applicant is no longer admitted to practice before.) 6. Applicant presently is not subject to any suspension or disbarment proceedings, and has not been formally notified of any complaints pending before a disciplinary agency, except as provided below (give particulars, e.g., jurisdiction, court date): 7. Applicant never has had any application for admission pro hac vice in this or any other jurisdiction denied or any pro hac vice admission revoked, except as provided below (give particulars, e.g., date, court, docket number, judge, circumstances; attach a copy of any order of denial or revocation): 8. Applicant never has had any certificate or privilege to appear and practice before any court or administrative body suspended or revoked, except as provided below (give particulars, e.g., date, court, administrative body, date of suspension and reinstatement): 9. Local counsel of record associated with applicant in this case is of the Street Address City Primary Telephone South Carolina Bar Number 10. Applicant has previously filed an application to appear pro hac vice in the following South Carolina cases (give case name and status of litigation, date of application, local counsel of record in each case, and state whether application is pending or was granted). County Cell Phone State Fax Number Zip Code Email Address law firm, which has offices at: 11. Applicant agrees to comply with the applicable statutes, laws and rules of the State of South Carolina and will familiarize him/herself with and comply with the South Carolina Rules of Professional Conduct. Applicant consents to the jurisdiction of the South Carolina courts and Commission on Lawyer Conduct. American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 4 12. Applicant respectfully requests to be admitted to practice in the above-named tribunal for this case only. DATED this day of , 20 APPLICANT American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 4 VERIFICATION STATE OF COUNTY OF ) ) I, , do hereby swear or affirm under penalty of perjury that I am the applicant in the above-styled matter; that I have read the foregoing application and know the contents thereof; and that the contents are true of my own knowledge, except as to those matters stated on information and belief, and that as to those matters I believe them to be true. I understand that I am under a continuing duty to promptly update the information provided in the application until the tribunal has ruled on the motion for admission pro hac vice. Further, if the motion is granted, I understand that I am under a continuing duty to promptly update the information provided in the application as long as I continue to appear pro hac vice in the action or proceeding. Any updated information shall be provided to both the tribunal that granted the motion and to the tribunal in which the action or proceeding may then be pending. APPLICANT/AFFIANT Subscribed and sworn to before me this day of , 20 Notary Public for the State of My Commission Expires: LOCAL COUNSEL CONSENT I hereby consent, as local counsel of record, to the association of applicant in this cause pursuant to Rules Governing Admission Pro Hac Vice to the South Carolina Bar. DATED this LOCAL COUNSEL OF RECORD day of , 20 CERTIFICATE OF SERVICE I hereby certify that I have served a copy of this application upon the South Carolina Supreme Court by mail addressed to: South Carolina Supreme Court Office of Bar Admissions, PO Box 11330, Columbia, SC 29211, accompanied by payment of the $250 filing fee payable to the South Carolina Supreme Court on this day of , 20 APPLICANT/AFFIANT American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 4