TEMPLATE — HAVE COUNSEL REVIEW BEFORE USE
It is written in the style of Federal Rule of Evidence 902(13) and (14).
Adapt it with counsel to the court and the facts.
Pasqio prints this declaration pre-filled on page 4 of every Certificate of
Integrity; this blank copy is for editing.

DECLARATION OF [NAME] REGARDING THE INTEGRITY OF AN ELECTRONIC FILE

I, [NAME], declare as follows:

1. I am [ROLE, e.g. an attorney] of [FIRM] and have personal knowledge of the
   facts stated here.

2. On [DATE AND TIME, UTC] I used the Pasqio document management system to
   certify the electronic file named "[FILE NAME]", maintained in the matter
   "[MATTER NAME]".

3. Certification computes the SHA-256 hash of the file's exact contents.
   SHA-256 is specified in NIST FIPS 180-4. Any change to the file produces a
   different hash.

4. The SHA-256 hash of the file is [64-CHARACTER HASH].

5. That hash was submitted to the OpenTimestamps service and anchored in
   Bitcoin block [HEIGHT], block hash [BLOCK HASH], whose header records the
   time [BLOCK TIME, UTC].

6. [IF PRESENT] The hash was also time-stamped under RFC 3161 by [AUTHORITY]
   at [SIGNED TIME, UTC].

7. The OpenTimestamps proof attached to the accompanying Certificate of
   Integrity links the hash to that block's merkle root, and can be checked by
   anyone without access to Pasqio.

8. Comparing the hash of the file produced with this declaration to the hash
   above shows whether the file is identical to the file that was certified.

I declare under penalty of perjury under the laws of [JURISDICTION] that the
foregoing is true and correct.

Executed on [DATE] at [CITY, STATE].

________________________________
[SIGNATURE]

[PRINTED NAME]