Los Angeles Office
845 S. Figueroa Street
Los Angeles, CA 90017
www.calbar.ca.gov
San Francisco Office
180 Howard Street
San Francisco, CA 94105
Certificate of Out-of-State Attorney Arbitration Counsel (OSAAC)
California CCP § 1282.4 and California Rules of Court Rule 9.43
This form must be uploaded to your application case record in order for your filing to be approved.
1. Arbitral Forum (or name of arbitrator(s)): ___________________________________________
2.
Address of Arbitral Forum (or arbitrator(s)):_________________________________________
City: _______________________________State: _____Zip: ____________ + ______________
3. a) Arbitrator Case Number: ______________________________________________________
b) Arbitration Name (or names of parties): __________________________________________
4.
Street Address of Arbitration Hearing Site in California:_____________________________
City: ______________________State: ___________Zip: ____________ + ______________
5. Name of Out-of-State Attorney (applicant): __________________________________________
6. Applicant’s Firm Name: __________________________________________________________
7.
Applicant’s Office Address:_______________________________________________________
City: ________________________________State: _____Zip: ____________ + _____________
Phone: __________Fax Number: __________Email: __________________________________
8. Applicant’s Residence Address:
City: ______________________________State: _____Zip: ____________ + ______________
9. Bar # of Active State Bar of California Attorney of Record Associating with Applicant: ___________
10. Name of California Attorney of Record: ________________________________________________
OFFICE OF ADMISSIONS
Instructions (1) One Certificate must be completed and signed by each out-of-state attorney (applicant). This Certificate
must be served on all parties and counsel in the arbitration, whose addresses are known to the applicant, the arbitral
forum and the State Bar of California a nonrefundable processing fee must be paid online during the application filing.
(2) If the Arbitral forum or arbitrator(s) approve(s) the appearance of the applicant, the applicant must serve a copy of
this Certificate bearing such written approval on all other parties and counsel in the arbitration whose addresses are
known to the applicant and upload the arbitrator signed Certificate to your application case record through the
Applicant Portal. Service must comply with California Code of Civil Procedure Section 1013a. Your filing will not be
approved without the uploaded arbitrator signed copy of this form, to your online application case record.
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11. Address of California Attorney of Record:
City: ________________________________State: _____Zip: ____________ + ______________
Phone: ____________________
12.
All courts before which applicant has been admitted to practice and is in good standing. (Attach
additional sheets if necessary)
Date Admitted State/Court Status
(e.g., Active)
____________ ______________________ ____________
____________ ______________________ ____________
13. All applications by applicant to appear in California courts as counsel pro hac vice or
out-of-state arbitration counsel in the last two years from the date of this application. (Attach
additional sheets if necessary)
Date Case Name (or Names of Parties) Court or Forum Result
(Denied/Granted)
__________ __________________________ ___________________ ___________
__________ __________________________ ___________________ ___________
14. If applicant has made repeated appearances, list any special circumstances warranting Applicant’s
appearance in this arbitration. ________________________________________________________
_________________________________________________________________________________
15.
Applicant represents that applicant: (i) is not currently on suspension or disbarred from the
practice of law before any court; (ii) is not a resident of the State of California (iii) is not regularly
employed in the State of California; and (iv) is not regularly engaged in substantial business,
professional or other activities in th
e State of California.
16. Applicant agrees to be subject to the jurisdiction of the courts of the State of California with
respect to the law of the State of California governing the conduct of attorneys to the same extent
as a licensee of the State Bar of California.
Applicant declares under penalty of perjury under the laws of the State of California that the foregoing is
true and correct and that this certificate is executed on:
Date: ______________ Applicant’s Signature: ______________________________________
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(AN UPLOADED CERTIFICATE BEARING ALL SIGNATURES IS REQUIRED FOR APPROVAL)
APPROVAL/DISAPPROVAL OF ARBITRAL FORUM/ARBITRATOR
(Certificate bearing all signatures must be returned to the applicant)
(Applicant: Certificate bearing signature of Arbitral Forum/Arbitrator must be provided to the State Bar by
uploading a copy to your online application case record.)
Subject to the provisions of California Code of Civil Procedure (CCP) Section 1282.4 and applicable
law, applicant’s appearance in the arbitration matter referenced in Section 1 above is (check one).
☐Approved ☐Disapproved
Approved By:
(signature)
Name: ______________
(print or type)
Title:
Date: __________________________
* Note that CCP Section 1282.4 states that, in the absence of special circumstances, repeated appearances shall be grounds for disapproval of
the appearance and disqualification from serving as an attorney in the arbitration for which the Certificate was filed. Also, failure within a
reasonable period of time to serve this Certificate on all other parties and counsel in the arbitration whose addresses ar
e known to the
applicant and file the Certificate with the State Bar of California shall be grounds for disapproval of the appearance and disqualification
from serving as an attorney in the arbitration for which the Certificate was filed. An applicant is not an Out-of-State Arbitration Counsel
until approved, and the application is not complete until such approval is sent to the State Bar.
