VIRGINIA SUPREME COURT RULES
RULE 1A:5 VIRGINIA CORPORATE COUNSEL (PART I)
In the Matter of the Application of
AFFIDAVIT OF EMPLOYER
_______________________________________
for a certificate as a Virginia Corporate Counsel
_____________________________, being first duly cautioned, swears or affirms the following:
(Name)
1) I am an officer of the following company:
________________________________________________
Firm
________________________________________________
Address
________________________________________________
Phone
__________________
Fax ________________
Email:
_________________________________________
2) I hereby certify that _____________________________, an applicant for a certificate to practice law in Virginia
Name of Applicant
under Part I of Rule 1A:5 as a Virginia Corporate Counsel, is employed by ______________________________
(name of company)
and such employment or association became effective on ________________________.
3) I attest to the fact that the applicant is employed as a lawyer to provide legal services exclusively to the company,
including its subsidiaries and affiliates, that the nature of the applicant’s employment conforms to the requirements of
Part I of Rule 1A:5 and I shall notify the Virginia State Bar immediately of any change in the applicant’s
employment.
_____________________________________________
Typed Name and Title of Officer
_____________________________________________
Signature of Officer
Sworn to or affirmed before me and subscribed in my presence this ____ day of _______________, 20___.
____________________________________
Notary Public
Please complete and return to: Virginia State Bar, 1111 E. Main Street, Suite 700, Richmond, VA 23219-3565.
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