Pro Hac Vice Application

Legal Form Number46C
CourtUnited States Court of Appeals For Veterans Claims
SectionCourt of Appeals for Veteran Claims
APPLICATION TO PROCEED PRO HAC VICE BEFORE
THE UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS
IN THE CASE OF _______________________________DOCKET NO. ______________
er
Court Rule 46(b)(1)(G): "On motion and a showing of good cause, and submission of a completed application, the
Court may permit any attorney or non-attorney practitioner not admitted to practice before the Court, or any other
person in exceptional circumstances, to appear on behalf of a party or amicus curiae for the purposes of a particular
case. Whenever a person makes an appearance under this subsection, the person will be deemed to have conferred
disciplinary jurisdiction upon the Court for any alleged misconduct in the course of, in the preparation for, or in
connection with any proceeding in that case. Each attorney and non-attorney practitioner generally is limited to one
appearance under this subsection. Except as permitted by the Court, any subsequent appearances shall be made und
Rule 46(a) (1) (Admission of Attorneys to Bar of Court) or (a)(2) (Admission of Non-Attorneys to Practice)."
1. Attorney's Name: (Mr.)(Ms.)_____________________________________________________
Date of Birth: ________________________________________
2. Business Mailing Address:_______________________________________________
_______________________________________________
_______________________________________________
E-mail Address:___________________________________________
3. Telephone Numbers: (Office)________________________(fax)_________________________
4. Have you ever been suspended for misconduct or disbarred from the practice of law in any jurisdiction,
or are you pending action as to your conduct or fitness to practice law which could result in public discipline?
_______If yes, explain in full (including dates) on continuation sheet.
5. Have you ever had your right to practice in any jurisdiction or before any federal, state, or municipal
department, bureau, commission, office, or agency qualified, terminated, or withdrawn, or has any such entity
ever imposed public discipline on you, or is any such action pending? ______If yes, explain in full
(including dates) on continuation sheet.
6. State all courts in which you are currently admitted:
COURT BAR NO. DATE OF ADMISSION
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_____________________________________________________________________________________________
FORM 46C (9/11) Page 1

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