UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF VIRGINIA CASE MANAGEMENT/ELECTRONIC CASE FILING (CM/ECF) SYSTEM USER WITH LIMITED PRIVILEGES REGISTRATION FORM Live System This form is to be used to register to become a user with LIMITED FILING PRIVILEGES for filing documents via the Internet component of the Case Management/Electronic Case Filing system (hereafter CM/ECF), in the United States Bankruptcy Court for the Eastern District of Virginia. Limited filing privileges shall include the authorization to file or withdraw a proof of claim, notice of mortgage payment change, notice of postpetition mortgage fees, expenses, and charges, response to a notice of final cure payment, request for notices or notice/service, notice of appearance, reaffirmation agreement, creditor change of address, or transfer of claim via the Internet with the Clerk's Office. The Clerk may authorize the registration of a person for other, limited purposes. The following information is required for CM/ECF registration and MUST BE TYPEWRITTEN: Name (First, Middle, Last): Agency/Company: Mailing Address: _____________________________________ _____________________________________ _____________________________________ _____________________________________ If Attorney, State of Admission and Bar ID #: Voice Phone Number: E-Mail Address: State: ___________; Bar ID#: _____________ (_____)_______________________________ _____________________________________ By signing and submitting this registration form, I agree to abide by the following requirements: 1. Signatures on proofs of claim and, if authorized by the Clerk, notices of appearance and/or requests for service/notice and notices of transfer of claims, shall be indicated by "/s/" and the typed name of the person signing in the following format: "/s/ Jane Smith" on the signature line. My password constitutes my signature. 2. The login and password for filing via the Internet shall be used exclusively by me and by any of my employees to whom I give authorization. I will not knowingly permit my login and password to be used by anyone who is not so authorized. American LegalNet, Inc. www.FormsWorkFlow.com 3. I will select and activate a new password in CM/ECF if an employee of mine who has been authorized to use my login and password no longer serves in such a capacity. 4. I will report any suspected compromise of my password to the DQA Team/Training Contact at the appropriate Divisional Office of the Eastern District of Virginia Bankruptcy Court. 5. I will abide by all of the requirements set forth in the Electronic Case Files Policy currently in effect, and any changes or additions that may be made in the future. ____________________________ Applicant Name (please print) ____________________________ Applicant Signature ____________________________ Last 4 Digits of SS # (for security purposes) ____________________________ Deputy Clerk of USBC (to be signed upon receipt of application) ____________________________ Clerk of Court (or Designee) Mail or deliver this completed form to our Alexandria divisional office: U. S. Bankruptcy Court Attn: DQA Team 200 S. Washington Street Alexandria, VA 22314 Ver. 08/12 American LegalNet, Inc. www.FormsWorkFlow.com