Pro Hac Vice Application

• Legal Form Number: 46C
• Court: United States Court of Appeals For Veterans Claims
• Section: Court 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. ______________

Court Rule 46(b)(1)(F): "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 under

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department, bureau, commission, office, or agency qualified, terminated, or withdrawn, or has any such entity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