Family Details Sample Clauses

Family Details. Current occupation: ............................................................................................................... Currently living in Owned/Rented property (please delete as appropriate) FEES I confirm that if my tender is accepted, I agree to pay £300 non-returnable reservation deposit, which will be counted towards the first month’s rent. SIGNED: ........................................................ DATE: ..............................................
Sample 1
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Family Details. Name Relation If, Alive If, Expired Age (Years) Health Cause of Death Year of Death Father Mother Grandfather Grandmother Brother/Sister Brother/Sister Brother/Sister
Sample 1
Family Details. If married, name of your spouse: ........................................................................................................ Surname:............................................................................................................................................... If employed, profession/duty of your spouse: ..................................................................................... Registered trade name of the company your spouse works for:......................................................... Address of the company your spouse works for: ............................................................................... ...............................................................................................................................................................
Sample 1
Family Details. Mother’s Name Address (If different from child) _ Occupation Day time telephone _ Evening telephone _ Mobile Father’s Name _ Address (If different from child) _ Occupation Day time telephone _ Evening telephone _ Mobile Email (For financials and centre information) Emergency Contacts (In addition to parents details) Name Relationship Telephone Name Relationship Telephone _ Is there any person who is prohibited access to your child? Yes  Name No  Custody order on file? Yes  No  Enrolment Details Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: Date: /_ / 20 Hours ECE Details Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Yes  No  Is your child receiving 20 Hours ECE at any other services? Yes  No  I hereby declare that my child is not enrolled at another early childhood institution at the same times that he/she is enrolled at Childsplay Unlimited: Parent/Guardian Signature: _ Date: /_ / _ Privacy Statement We are collecting personal information on this enrolment form for the purposes of providing early childhood education for your child. We will use and disclose your child’s information only in accordance with the Privacy Act 1993. Under that Act you have the right to access and request correction of any personal information we hold about you or your child. Details about your child’s identity will be shared with the Ministry of Education so that it can allocate a national student number for your child. This unique identifier will be used for research, statistics, funding, and the measurement of educational outcomes. You can find more information about national student numbers at: xxx.xxxxxx.xxxx.xx/xxxxxxx * Information about acceptable identity verification documents is available online at xxx.xxxx.xxx.xxxx.xx and xxx.xxxxxx.xxxx.xx/xxxxxxx The Ministry recommends that all services keep a copy of the identity verification document of each child who is enrolled at the service. Declaration Please read and agree to the following before signing the application:
Sample 1
Family Details. Current occupation:................................................................................................................ Currently living in Owned/Rented property (please delete as appropriate) LEGAL FEES I confirm that if my tender is accepted and solicitors instructed, I will pay the agreed proportion of the legal costs in connection with the Tenancy Agreement whether abortive or not. I also agree to pay £200 non-returnable reservation deposit which will be counted towards the first months rent. SIGNED:................................................ DATE:..............................................
Sample 1

Related to Family Details

  • Family Care Employees may use vacation leave for care of family members as required by the Family Care Act, WAC 296-130.

  • Family Planning The MCO must ensure that its network includes sufficient family planning providers to ensure timely access to covered family planning services for enrollees. Although family planning services are included within the MCO’s list of covered benefits, Medicaid enrollees are entitled to obtain all Medicaid covered family planning services without prior authorization through any Medicaid provider, who will bill the MCO and be paid on a FFS basis.4 The MCO must give each enrollee, including adolescents, the opportunity to use his/her own primary care provider or go to any family planning center for family planning services without requiring a referral. The MCO must make a reasonable effort to Subcontract with all local family planning clinics and providers, including those funded by Title X of the Public Health Services Act, and must reimburse providers for all family planning services regardless of whether they are rendered by a participating or non-participating provider. Unless otherwise negotiated, the MCO must reimburse providers of family planning services at the Medicaid rate. The MCO may, however, at its discretion, impose a withhold on a contracted primary care provider for such family planning services. The MCO may require family planning providers to submit claims or reports in specified formats before reimbursing services. MCOs must provide their Medicaid enrollees with sufficient information to allow them to make an informed choice including: the types of family planning services available, their right to access these services in a timely and confidential manner, and their freedom to choose a qualified family planning provider both within and outside the MCO’s network of providers. In addition, MCOs must ensure that network procedures for accessing family planning services are convenient and easily comprehensible to enrollees. MCOs must also educate enrollees regarding the positive impact of coordinated care on their health outcomes, so enrollees will prefer to access in-network services or, if they should decide to see out-of-network providers, they will agree to the exchange of medical information between providers for better coordination of care. In addition, MCOs are required to provide timely reimbursement for out-of-network family planning and related STD services consistent with services covered in their contracts. The reimbursement must be provided at least at the applicable West Virginia Medicaid FFS rate 4 Access to family planning services without prior notification is a federal law. Under OBRA 1987 Section 4113(c)(1)(B), “enrollment of an individual eligible for medical assistance in a primary case management system, a health maintenance organization or a similar entity must not restrict the choice of the qualified person, from whom the individual may receive services under Section 1905(a)(4)(c).” Therefore, Medicaid enrollees must be allowed freedom of choice of family planning providers and may receive such services from any family planning provider, including those outside the MCO’s provider network, without prior authorization. appropriate to the provider type (current family planning services fee schedule available from BMS). The MCO, its staff, contracted providers and its contractors that are providing cost, quality, or medical appropriateness reviews or coordination of benefits or subrogation must keep family planning information and records confidential in favor of the individual patient, even if the patient is a minor. The MCO, its staff, contracted providers and its contractors that are providing cost, quality, or medical appropriateness reviews, or coordination of benefits or subrogation must also keep family planning information and records received from non-participating providers confidential in favor of the individual patient even if the patient is a minor. Maternity services, hysterectomies, and pregnancy terminations are not considered family planning services.

  • Payment Details You will make all Payments due under this Master Agreement by 12:00 P.M., Connecticut time, on the day they are due. You will make all Payments in US Dollars (US$) in immediately available funds. We do not have to make or give "presentment, demand, protest or notice" to get paid. You waive "presentment, demand, protest and notice."

  • Account Details (a) Account for payments to Counterparty: To be provided. Account for delivery of Shares to Counterparty: To be provided.

  • Long Term Care Insurance The University offers full-time faculty the opportunity to purchase Long-Term Care Insurance through a voluntary Long-Term Care Insurance policy. Faculty members are responsible for 100% of the premium, which may be remitted through payroll deduction.

  • Group Life Insurance The Hospital shall contribute one hundred percent (100%) toward the monthly premium of HOOGLIP or other equivalent group life insurance plan in effect for eligible full-time employees in the active employ of the Hospital on the eligibility conditions set out in the existing Agreements.

  • Plagiarism The appropriation of another person's ideas, processes, results, or words without giving appropriate credit.

  • Legal Details All legal details and proceedings in connection with the transactions contemplated by this Agreement and the other Loan Documents shall be in form and substance satisfactory to the Agent and counsel for the Agent, and the Agent shall have received all such other counterpart originals or certified or other copies of such documents and proceedings in connection with such transactions, in form and substance satisfactory to the Agent and said counsel, as the Agent or said counsel may reasonably request.

  • Contact details (a) Except as provided below, the contact details of each Party for all communications in connection with the Finance Documents are those notified by that Party for this purpose to the Facility Agent on or before the date it becomes a Party.

  • Life Insurance No portion of your IRA may be invested in life insurance contracts.

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