1.  Name of business
                  Headquarters address
                  State and date of incorporation
                  Licensed to do business in California?
                  Fictitious business name(s)
                  Corporate affiliates (parent and or subsidiary companies)

       2.  General counsel's name
                  Business address
                  Home telephone number
                  Work telephone number
                  Telecopier or Fax number
                  Telex number
       3.  Officer in charge of litigation
                  Title
                  Business address
                  Home telephone number
                  Work telephone number
                  Telecopier or Fax number
                  Telex number
                  Car telephone number
       4.  Where and to whom should attorney's billings be sent?
       5.  Insurance information
                  Officer in charge of risk/insurance
                  Outside broker
                  CGL carrier(s) and date(s)
                  Auto carrier(s) and date(s)
                  Workers' comp carrier(s) and date(s)
                  Employer's liability carrier(s) and date(s)
       6.  Have you consulted another (outside) counsel about
this case?
                  Name
       7.  Have you been served with any papers concerning this
case? Describe briefly
       8.  Have you conducted any internal investigation concerning
this case?
                  Who/when
       9. Have you made any statements to anyone outside the company
concerning this case?
                  To whom/when/what
      

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Legal Forms : Set Two