Acknowledgement/Disclosure of Settlement Terms and Authorization to Execute

1. _______________________ (hereinafter “Client”) retained _______________________ (hereinafter “Law Firm” to represent him on ___________________in connection with ___________________ (e.g., a vehicular accident) which event took place on ______________.

2. Client hired Law Firm as his attorney to represent him and Client acknowledges that Law Firm reasonably and competently supplied legal services, took reasonable steps to keep Client informed as to the progress of the case and adequately responded to all Client inquires.

3. Client further agrees that Law Firm has kept him informed of developments, has abided by the Contingency Fee Agreement and has fully disclosed the terms and conditions of the settlement agreement which Client has agreed to execute and concurrently does execute on the date stated below (either directly or through the Special Power of Attorney).

4. Client understands that Law Firm, with the Client’s permission, has settled his case for the sum of ___________. Additional terms and conditions of the settlement are _____________.

5. Client further understands that by executing the settlement document, Client will be releasing _______________________ (the defendant) for all time in connection with the above stated incident.

6. Client acknowledges having also been advised of his right to seek independent counsel before executing this Acknowledgment/Disclosure and the Settlement Agreement between himself and ________________ (the defendant).

7. Client confirms that other than the receipt of the consideration called for in the Settlement Agreement, (attached as Exhibit “1” and...