DOJ-OGR-00026021.jpg

The image shows a blank form with a header that reads "Certificate of Compliance with Regulatory Requirements." Below the header are two columns titled "Company/Entity Name" and "Contact Person's Name," which are both empty. The date at the bottom right corner of the form appears to be redacted or obscured, but it suggests that this is a document related to regulatory compliance for a specific company or entity, although no details about the subject matter are visible in this image.