Questionnaire For Attorney Seeking Admission Pro Hac Vice

QUESTIONNAIRE FOR ATTORNEY SEEKING ADMISSION PRO HAC VICE BEFORE THE SUPERIOR COURT OF THE VIRGIN ISLANDS PURSUANT TO SUPERIOR COURT RULE 301 PERSONAL INFORMATION 1. Attorney's name seeking pro hac vice Admission: ______________________________________________________________ 2. Professional Address: _______________________________________ _______________________________________ _______________________________________ (a) Office Telephone Number: _____________________________ (b) Office Fax Number: __________________________________ (c) Email Address: _____________________________________ 3. Home Address: ________________________________________ ________________________________________ ________________________________________ (a) Home Telephone Number: _____________________________ (b) Fax Number: _______________________________________ CASE INFORMATION 4. Case caption for which pro hac vice admission is being sought: ______________________________________________________________ (a) (b) (c) (d) 5. Case Number: ________________________________________ District of: __________________________________________ Motion is being made by: ________________________________ Attorney for: _________________________________________ (a) Admitted to practice and in good standing in what U.S. or foreign jurisdictions? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ (b) Have you ever been disbarred or suspended, from practicing law in any jurisdiction(s)? (c) Yes No If yes, list the jurisdiction (s):______________________________________ ___________________________________________________________ ___________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com Questionnaire for Pro Hac Vice Admission Page 2 of 3 PRIOR ADMISSION INFORMATION 6. (a) Have you ever been denied full or pro hac vice admission in any jurisdiction? Yes No (b) If yes, list the jurisdiction (s): ___________________________________ ________________________________________________________ ________________________________________________________ 7. (a) Have you ever been admitted pro hac vice in any previous Superior Court (formerly the Territorial Court of the Virgin Islands) or District Court matter(s)? Yes No (b) If yes, list previous cases by caption and case number, covering the last five years in which you participated. Also list the admission date(s), the case filing dates and Court: (Please list cases chronologically. Use an extra page if necessary.) Case Caption (1): _____________________________________ ____________________________________________________ Case No. _____________________________________________ Pro Hac Vice Admission Date: _______________________________ Case filing date: _________________________________________ Name of Court in which appearance was made: ____________________ ____________________________________________________ Case Caption (2): ______________________________________ ____________________________________________________ Case No. _____________________________________________ Pro Hac Vice Admission Date: _______________________________ Case filing date: _________________________________________ Name of Court in which appearance was made: ____________________ ____________________________________________________ Case Caption (3): ______________________________________ ____________________________________________________ Case No. _____________________________________________ Pro Hac Vice Admission Date: _______________________________ Case filing date: _________________________________________ Name of Court in which appearance was made: ____________________ ____________________________________________________ Case Caption (4): _____________________________________ ____________________________________________________ Case No. _____________________________________________ Pro Hac Vice Admission Date: _______________________________ Case filing date: _________________________________________ Name of Court in which appearance was made: ____________________ ____________________________________________________ ____________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com Questionnaire for Pro Hac Vice Admission Page 3 of 3 8. Did your participation include your presence in the U.S. Virgin Islands? Yes No MEMBERSHIP DUES/LICENSING FEES 9. Have you, the attorney seeking pro hac vice admissions, paid the Virgin Islands bar dues and/or licensing fees pursuant to Superior Court Rule 301(a)(4)? (Please attach receipt issued from the VI Bar Association.) No Yes 10. With respect to any income earned from the Superior Court of the Virgin Islands and/or District Court of the Virgin Islands cases, have you filed all necessary reports with and paid all income and gross receipt taxes to the Virgin Islands Bureau of Internal Revenue? Yes No Not Applicable 11. If not, state the reason for such non-compliance: _______________________________________________________________ ________________________________________________________________ ACKNOWLEGEMENT AND SIGNATURE I acknowledge by this application that the Superior Court, and its representatives, may make further inquiry with any governmental or private entity or individual concerning myself, in the furtherance of this application and I hereby consent to said disclosures. Further, I acknowledge that I have attached to this questionnaire, all Certificates of Good Standing, evidencing my bar membership in all jurisdictions admitted, receipts evidencing the full payment of all bar membership fees to the Virgin Islands Bar Association and the Virgin Islands Department of Licensing and Consumer Affairs in accordance with Superior Court Rule 301(a)(4). Finally, I acknowledge that copies have been forwarded to all counsel Dated: _________ __________________________________________________ (Attorney's signature who is seeking pro hac vice Admission) NOTARY SIGNATURE AND SEAL Subscribed and sworn to before me this ___ day of ____________, 200___ ________________________________________________________ (NOTARY PUBLIC) My Commission expires: American LegalNet, Inc. www.FormsWorkflow.com