Applicant Signature Date Sample Clauses

Applicant Signature Date. This applicant is recommended for appointment as a Distributor assigned to my jurisdiction, subject to the terms of my contract with Medico and/or Medico Corp. I certify to the best of my knowledge the applicant is of good personal and business reputation, trustworthy, and competent to act in the capacity of an insurance agent. Recruiting Distributor Signature Date Medico’s and Medico Corp’s BUSINESS ASSOCIATE AGREEMENT
Sample 1
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Applicant Signature Date. I hereby approve and authorize the permittee use of the stated government facilities as described in this permit, during the period stated above to use the National Great Rivers Museum facilities for the purposes stated above. Damage Deposit: Required Not Required Amount $ Liability Insurance: Required Not Required Amount $ _____________________________________________________________ _______________ Foundation Representative Date 5 _____________________________________________________________ _______________ Corps of Engineers Representative Date Terms and Conditions of Permit
Sample 1
Applicant Signature Date. If you are not selected for this year’s class, would you like your application kept on file? □ yes □ no
Sample 1

Related to Applicant Signature Date

  • Signature Date PLEASE INITIAL PAGE 2 Please retain a photocopy of this form for your own records. Terms and Conditions on Reverse Side TERMS AND CONDITIONS

  • Witness Signature 4. PARENT/GUARDIAN CONSENT: (for applicants under 18 years) – I hereby certify and decree that all the information contained in the declarations above is true and accurate Print Name:................................................................... Signature …………………………………………....……... Relationship to applicant ……………………………… Phone Contact ……………………................................... Address …………………………………………………………………….....................................................................

  • Vendor Agreement Signature Form (Part 1)

  • Your Signature (Sign exactly as your name appears on the face of this Note) Signature Guarantee*: _________________________ * Participant in a recognized Signature Guarantee Medallion Program (or other signature guarantor acceptable to the Trustee).

  • Authorised signatories The Authority shall require the Independent Engineer to designate and notify to the Authority and the Concessionaire up to 2 (two) persons employed in its firm to sign for and on behalf of the Independent Engineer, and any communication or document required to be signed by the Independent Engineer shall be valid and effective only if signed by any of the designated persons; provided that the Independent Engineer may, by notice in writing, substitute any of the designated persons by any of its employees.

  • Form of Signature The parties hereto agree to accept a facsimile transmission copy of their respective actual signatures as evidence of their actual signatures to this Agreement and any modification or amendment of this Agreement; provided, however, that each party who produces a facsimile signature agrees, by the express terms hereof, to place, promptly after transmission of his or her signature by fax, a true and correct original copy of his or her signature in overnight mail to the address of the other party.

  • Contract Signature If the Original Form of Contract is not returned to the Contract Officer (as identified in Section 4) duly completed, signed and dated on behalf of the Supplier within 30 days of the date of signature on behalf of DFID, DFID will be entitled, at its sole discretion, to declare this Contract void. No payment will be made to the Supplier under this Contract until a copy of the Form of Contract, signed on behalf of the Supplier, is returned to the Contract Officer.

  • Witness Name Address: The Corporate Seal of THE SECRETARY OF STATE FOR EDUCATION affixed to this deed is authenticated by: ……………………….. Duly Authorised ANNEXES

  • Delivery/Installation Instructions Due to the varying locations and circumstances involved in deliveries and installations, all deliveries and installations will be quoted on a project by project basis. All installation, labor, and or delivery charges must be shown as a separate line item on quotes and invoices. One of the following delivery methods must be specified on every Agency Purchase Order:

  • Representation of Signatories Each of the undersigned expressly warrants and represents that they have full power and authority to sign this Agreement on behalf of the party indicated and that their signature will bind the party indicated to the terms hereof.

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