(1) Supporting Affidavit

An affidavit from the attorney seeking admission pro hac vice shall be attached to the motion for admission.  The affidavit must include:

(A) the attorney's office address and telephone number;

(B) a listing of court(s) to which the attorney has been admitted to practice and the year(s) of admission;

(C) a statement that the attorney is in good standing and eligible to practice in the court(s);

(D) a statement that the attorney is not currently suspended or disbarred in any jurisdiction;

(E) a statement describing the nature and status of any (1) previously imposed or pending disciplinary matters involving the attorney, and (2) prior felony or misdemeanor criminal convictions; and

(F) a statement disclosing and explaining any prior denials or revocations of pro hac vice status in any court.