UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF VIRGINIA APPLICATION TO QUALIFY AS A FOREIGN ATTORNEY UNDER LOCAL BANKRUPTCY RULE 2090-1(E)(2) In Case No.: _______________,* Case Name __________________________________________ PERSONAL STATEMENT FULL NAME (no initials, please) __________________________________________________________________ Bar Identification Number ________________ State ________________ Firm Name ____________________________________________________________________________________ Firm Phone # ________________________ Direct Dial # _______________________ FAX #__________________ E-Mail Address_________________________________________________________________________________ Office Mailing Address __________________________________________________________________________ Name(s) of federal court(s) in which I have been admitted _______________________________________________ I certify that the rules of the federal court in the district in which I maintain my office extend a similar pro hac vice admission privilege to members of the bar of the Eastern District of Virginia. I have not been reprimanded in any court nor has there been any action in any court pertaining to my conduct or fitness as a member of the bar. I hereby certify that, within 90 days before the submission of this application, I have read the Local Rules of this Court and that my knowledge of the Federal Rules of Civil Procedure, the Federal Rules of Bankruptcy Procedure, and the Federal Rules of Evidence is current. _______________________________________ (Applicant's Signature) I, the undersigned, do certify that I am a member of the bar of this Court, not related to the applicant; that I know the applicant personally, that the said applicant possesses all of the qualifications required for admission to the bar of this Court; that I have examined the applicant's personal statement. I affirm that his/her personal and professional character and standing are good, and petition the court to admit the applicant pro hac vice. __________________________________________ (Signature) __________________________________________ (Typed or Printed Name) _________________________ (Date) ___________________________ *Pro hac vice admission in a case shall include an adversary proceeding(s) in the case. ________________________________________________________________________________________________ Court Use Only: The motion for admission is GRANTED ________ or DENIED ________ ________________________________________ (Judge's Signature) Ver. 11/05/09 [effective 12/01/09] __________________________ (Date) American LegalNet, Inc. www.FormsWorkFlow.com