DECLARATION AND SIGNATURE. The Client hereby declares that:-
DECLARATION AND SIGNATURE. I the Borrower hereby declare that:
DECLARATION AND SIGNATURE. I, the Assured confirm that I have provided the active at work warranty and declarations, a copy of the Policy has been provided to me and that I have exercised my right of choice. Borrower:
DECLARATION AND SIGNATURE. 33. Please sign below to confirm that you have read and understand the terms of this Agreement. Your signature signifies that you have also read the documents referred to below which should be read before signing this Agreement. Name: (please print name clearly) Course: (including level ND, FDeg, BSc etc.) Signed: Dated: Signed by Parent/Guardian: (for students under 18 years of age) Dated: Signed for and on behalf of Writtle University College: X Xxxxxx The £250.00 damage deposit can be paid either by xxxxxxxx cheque/banker’s draft, direct bank transfer or debit/credit card. BANK ACCOUNT DETAILS FOR PAYMENTS Barclays Bank PLC. Chelmsford Business Centre 00-00 Xxxx Xxxxxx, Xxxxxxxxxx Xxxxx XX0 0XX Sort Code: 20-20-35. Account Number: 00000000.
DECLARATION AND SIGNATURE. 10. I DECLARE THAT: 1. This application form was completed by me, the applicant, or the legal representative of a deceased person. 2. The information provided in this form is true, based on my personal records, experience, and knowledge 3. If the information described above or attached is false or misleading, I may be required to repay any compensation I that I receive. / / Applicant’s or Legal Representative’s Signature Date (dd/mm/yyyy)
DECLARATION AND SIGNATURE. I the Borrower hereby declare that: I confirm that should the Lender grant a loan to me, I understand that this Schedule 4 –DEDUCTION AUTHORIZATION together with Schedules 1, 2, and 3 together constitute the binding loan agreement (the “Agreement”) between myself as the Borrower, and the Lender.
DECLARATION AND SIGNATURE. Buyer, Xxxxxx Hareket ve Kontrol Sis. Tic. Ltd. Sirket., and Seller Mutually agree and declare that this text shall be respected as an appendix for all contracts which will occur between parties and all terms in this text shall be applied to contracts. ……………./…………./… / Xxxxxx Hareket ve Kontrol Sis. Tic. Ltd. Sirket.
DECLARATION AND SIGNATURE. 13. I DECLARE THAT: - This application form was completed by me, a legal representative authorized to submit this form on my behalf or the legal representative of a deceased person. - The information provided in this form is true, based on my personal records, experience, and recollection. If the information described above is inaccurate, false, or misleading, I may be required to repay the compensation that I receive. - I have read and agree to the Indemnity provision set out in paragraph 11 above. - I have read and agree to the Privacy Statement and Consent provision set out at paragraph 12 above. Applicant’s Signature Date
DECLARATION AND SIGNATURE. 10. I DECLARE THAT: - This application form was completed by me, the applicant, or the legal representative of a deceased person. - The information provided in this form is true, based on my personal records, experience and knowledge - If the information described above or attached is false or misleading, I may be required to repay any compensation I that I receive. / / Applicant’s or Legal Representative’s Signature Date (dd/mm/yyyy) INSTRUCTIONS AND FEE This form should be submitted to: AE Hospitality Class Action Referee [ADDRESS] Attention: [NAME] Please also mail a cheque of $100 payable to [INSERT] as the fee to appeal. This payment will be returned to you if, upon review of this Appeal Form and your supporting documentation: (i) the Defendants agree with your objection and issue a Notice of Re-Assessment revising your settlement entitlement in accordance with the information set out herein; or (ii) your appeal is referred to the Referee and the Referee decides the appeal in your favour. If your appeal is referred to a referee, a file containing the documents relevant to the Decision will be emailed to the Referee. If you have any questions about the process, please contact AE Hospitality at the following: AE Hospitality Class Action INSERT ADDRESS and EMAIL 1517-1 AE Hospitality Settlement Agreement AE Hospitality Se...s & Bookmarks.pdf 37ed6a7aca9bb72eccf696ad1649c9c9bbc9647a MM / DD / YYYY Completed 11 / 29 / 2021 15:53:18 UTC Sent for signature to Xxxxx Xxxxxxx (xxxxxxxxxxxx00@xxxxx.xxx) from xxxxxxxxx@xxxxxxxxxxxx.xxx IP: 192.0.195.112 11 / 29 / 2021 16:29:41 UTC 11 / 29 / 2021 16:32:14 UTC 11 / 29 / 2021 16:32:14 UTC Viewed by Xxxxx Xxxxxxx (xxxxxxxxxxxx00@xxxxx.xxx) IP: 72.137.45.177 Signed by Xxxxx Xxxxxxx (xxxxxxxxxxxx00@xxxxx.xxx) IP: 72.137.45.177
DECLARATION AND SIGNATURE. I have read and I understand the above information regarding the Terms of Agreement, the Deficit Reduction Act of 2005, the Summary of Admission Services and Admission Policies, including the Policy Statement regarding Resident Resuscitation. By signing below, the Applicant and/or Representative certifies that the information and disclosures provided in this Application Agreement are true, correct and complete to the best of his/her/their knowledge and belief. Any false information, misrepresentation of information or lack of disclosure in this Application Agreement may result in the rejection of the Applicant’s application and/or the termination of the Admission Agreement and/or legal proceedings, at any time Xxxxxx Manor Nursing Home learns of the false information, misrepresentation, or lack of disclosure. Copies of the following documents must be provided upon request to have this Application Agreement considered complete:
