IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF VIRGINIA APPLICATION TO QUALIFY AS A FOREIGN ATTORNEY UNDER LOCAL CIVIL RULE 83.1(D) AND LOCAL CRIMINAL RULE 57.4 In Case Number _______________, Case Name ______________________________ Party Represented by Applicant: ___________________________________________ To: The Honorable Judges of the United States District Court for the Eastern District of Virginia 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(s) in which I have been admitted and have 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 ninety (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 Criminal Procedure, and the Federal Rules of Evidence is current. I am ____ am not ____ a full-time employee of the United States of America, and if so, request exemption from the admission fee. _______________________________________ (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) (Date) __________________________________________ (Typed or Printed Name) Court Use Only: Clerk’s Fee Paid ________ or Exemption Granted ________ The motion for admission is GRANTED ________ or DENIED ________ ________________________________________ __________________________ (Judge’s Signature) (Date) American LegalNet, Inc. www.FormsWorkflow.com