Model Dual Investigations Acknowledgement Form

[Section address]
[Witness name and address]
Re: Widget and Gadget Investigations
Dear [witness name]:
On , 20XX the Antitrust Division of the United States Department of Justice and
[Generic Company, Ltd. (“Applicant”)] entered into an agreement granting Applicant conditional
leniency for its participation in a conspiracy to suppress and eliminate competition by [allocating
customers/employees, rigging bids, and fixing prices] for [affected product or service] in the
United States and elsewhere, in violation of Section 1 of the Sherman Act, 15 U.S.C. § 1
(“Applicant Agreement”). A copy of the Applicant Agreement is attached. You are included as
“Covered Personnel” as defined in paragraph 2(b) of the Applicant Agreement. You are also a
[subject/target of] [defendant in] the Antitrust Division’s gadget investigation as referenced in
paragraph 7 of the Applicant Agreement.
The Applicant Agreement governs the terms and conditions of your eligibility for
leniency protection in the widget investigation. Your signature below signifies that you have
read, understood, and will comply with the terms and conditions of the Applicant Agreement.
Please sign, and have your attorney sign, below in acknowledgment.
Sincerely yours,
[
Attorney name]
[Section/office]
Date:

[Witness name] Date
[Counsel name]
Counsel for [witness name]
Date