REQUEST FOR CONSULTATION WITH WARRANTY AND WAIVER

I/WE, whose names appear at the end of this document, swear and state the following:
1. I/WE requested a meeting with the law office of _____________, for the
purpose of consulting him on legal matters which concerns me/us;
2. I/WE warrant that all the facts disclosed during this meeting are true and
complete, and that none of it are false or misleading, or intended to mislead the
office of _____________ to give favorable a legal advice/opinion, or to cause
him or his office to agree to represent ME/US in a matter, or to perform actions for
ME/US.
3. I/WE do not have a retained lawyer as of the moment, or if I/WE have a retained
lawyer, I/WE warrant that I/WE have already informed MY/OUR retained lawyer
that I/WE will seek a second legal opinion on the matters which are the subject of
this consultation. In the event that I/WE have not yet informed MY/OUR retained
lawyer of MY/OUR intent to seek a second legal opinion, I/WE undertake to
inform our retained lawyer after this meeting or as soon as possible;
4. I/WE likewise acknowledged that the law office of _____________ has
explained to ME/US thoroughly that it is a matter of ethical importance that I/WE
should first go to MY/OUR retained lawyer for any legal matters, and that despite
such explanation, I/WE still insist to get second legal opinion on the matters which
are subject to this consultation. Further, the law office of _____________ has
clearly explained to ME/US that his legal opinions are solely based on the facts
disclosed during this meeting;
5. Based on these representations and warranties, I/WE undertake to hold the law
office of _____________ harmless from any liability directly or indirectly
arising from this meeting, or any subsequent matters which arose as a result of this
meeting, and in the event that the law office of _____________ is sued by reason
of this meeting, I/WE further undertake to defend him or his law office from such
complaint, or to pay the costs of his defense;
6. As proof MY/OUR representations and warranties, I/WE have signed this
document and provided MY/OUR address and competent evidence(s) of
identification below:

Complete Address Contact ID Type and Signature

Name Number No.

WITNESS

___________________ ____________________