1. Name: __________________________________________________________________

Firm: _____________________________________________________________________

Address: __________________________________________________________________

__________________________________________________________________________

Telephone: (____)_________________ VSB Membership Number: ____________________

2. Pursuant to Section 10(b)(i) of Part Six: Section IV of the Rules of the Supreme Court of Virginia, an advisory unauthorized practice of law opinion may be requested by any member of the Virginia State Bar concerning contemplated or actual professional conduct which may be violative of the Virginia Unauthorized Practice Rules. Please indicate the nature of your inquiry.

3. The Rules of Court require that requests for advisory opinions shall state in detail all operative facts, in the hypothetical, upon which the request is based. Please provide a brief and concise statement of the facts with no identifying information as to persons or entities involved. (Additional narrative and exhibits may be attached if necessary.)

4. State specific issue(s)/question(s) regarding the practice of law that you wish answered by the Committee.

5. I certify that I have researched the Virginia State Bar's Unauthorized Practice Rules, Unauthorized Practice Considerations, prior Unauthorized Practice of Law Opinions and appropriate case law and believe the following to be relevant:

Unauthorized Practice Rules: ____________________________________________________

Unauthorized Practice Considerations: ____________________________________________

Prior UPL Opinions: ___________________________________________________________

Case Law: ___________________________________________________________________

____________________________________________________________________________

6. Why do you believe the proposed conduct would or would not violate the Unauthorized Practice Rules?

7. Please note that in accordance with Part Six: Section IV: Paragraph 10(c)(ii) of the Rules of the Supreme Court of Virginia, the Committee may in its discretion decline to render an opinion regarding any matter which is currently the subject of any disciplinary proceeding or litigation.

Please indicate if the inquiry concerns:

______ Pending Litigation

______Civil

______Criminal

______ Pending Disciplinary Proceeding

8. ____________________________________________
    Signature

9. _____________________________
    Date