Common use of Client Certification Clause in Contracts

Client Certification. Please read and check next to each statement I verify that all information contained herein is correct and true to the best of my knowledge. I also understand that the information provided will be used by Tobii Dynavox for the purpose of obtaining funding and hereby give permission to Tobii Dynavox to release this information as required by the funding sources listed. I understand that I may be able to rent or purchase the equipment that has been prescribed by my physician. The rental duration will be according to the manufacturers’ policy. I understand that if my insurance coverage requires a capped rental, I will be subject to the Terms and Conditions of the Capped Rental program. Signature(s) of person(s) completing this form: