Language Preference. All documents must be in French or English if you applying in Quebec or New Brunswick, and in English if you are applying in all other provinces/regions. I understand and can speak and write in: English French Both English and French
Language Preference. The parties have asked to have the Cardholder Agreement and all related documents drawn up and executed in English. Les parties exigent que cette convention et tous documents qui s’y rattachent soient rédigés en anglais.
Language Preference. The Residential Property Tribunal welcomes receiving correspondence in Welsh or English. Any correspondence received in Welsh will be answered in Welsh and corresponding in Welsh will not lead to a delay in responding. The Tribunal also welcomes phone calls in Welsh or English. You may submit forms, documents and make written representations to the tribunal in Welsh or English. Please inform the tribunal of your language preference by completing box 3 below. It is important that you read the notes above carefully before you complete this form. Please write clearly in BLACK ink. MH9
Language Preference. The Customer expressly requires that all contracts, correspondence and documentation concerning any accounts of the Customer and the latter’s dealings with First Nations Bank of Canada and its affiliates (“the Bank”) be drawn up in English and the Bank, because of the Customer’s request and by making such contracts, correspondence and documentation available to the Customer, in the English language, expresses the same requirement. The Customer and the Bank confirm that the foregoing requirement has been in effect throughout their dealings and since August 26, 1977, if their relations commenced on or after such a date”. "Le client requiert expressément que tous les contrats, correspondance ou documents relatifs à tous comptes du client et ses transactions avec Banque dés Premières Nations du Canada et les membres de son groupe (la « Banque ») soient rédigés en anglais et la Banque, à cause de cette exigence du client, fait sienne cette volonté en faisant en sorte que les susdits contrats, correspondance ou documents rédigés en anglais soient à la disposition du client. Le client et la banque confirment que l'exigence qui précède s'applique depuis le début de leurs relations contractuelles et depuis le 26 août 1977 si leurs relations ont commencé à cette date ou postérieurement". Foreign and Domestic Politically Exposed Persons and Heads of an International Organization (PEFP/DPEP/HIO) – Under the Proceeds of Crime (Money Laundering) and Terrorist Financing Act and Regulations we are required by law to collect information related to Politically Exposed Persons (both domestic and foreign) and Heads of International Organizations, either as self-declared individuals, Prescribed Family Members and Close Associates. A Politically Exposed Foreign Person (PEFP) is a person who holds or has held one of the following offices or positions in or on behalf of a foreign state: • Head of state or head of government; • Member of the executive council of government or member of a legislature; • Deputy minister or equivalent rank; • Ambassador or attaché or counsellor of an ambassador; • Military officer with a rank of general or above; • President of a state-owned company or state-owned bank; • Head of a government agency; • Judge of a supreme court, constitutional court or other court of last resort; • Leader or president of a political party represented in a legislature; or • Holder of any prescribed office or position. A Domestic Politically Exposed Person (DPEP) is a p...
Language Preference. This Agreement has been drawn up in the English language at the request of all parties. SCHEDULE “A”- STANDARD TERMS AND CONDITIONS Schedule “A” sets out the Standard Terms and Conditions (“Standard Terms and Conditions”) which apply to these credit facilities. The Standard Terms and Conditions, including the defined terms set out therein, form part of this Agreement, unless this letter states specifically that one or more of the Standard Terms and Conditions do not apply or are modified.
Language Preference. Select the language for notices. English
Language Preference. □English □Spanish □Other Race □White □American Indian / Alaskan Native □Asian or Asian American □Black / African American □Hawaiian or Pacific Islander □Other Ethnicity □Hispanic or Latino □ NOT Hispanic or Latino Xxxxx X. Xxxxxxxxx, M.D., P.C., & Associates 000 Xxxxxxxxxxxx Xxxxxx • Suite 105 • Xxxx Xxxxxxxxxx, Xxxxxxxxxxxx 00000 Phone: (215) 000-0000 • Fax: (000) 000-0000 FINANCIAL POLICY AGREEMENT Patient (print) Date of Birth CANCELLATION / MISSED APPOINTMENT FEE Any missed appointment or canceled appointment with less than 48 HOURS NOTICE may be subject to a $75.00 cancellation fee. Our office utilizes an auto-call service that will issue a reminder 72 hours or more prior to your appointment, but it is your responsibility to remember your appointment. Unlike other types of doctor appointments, Xx. Xxxxxxxxx and his associates set aside a block of time just for your appointment. You can cancel your appointment up until 48 hours prior to your appointment by calling the main office at 000-000-0000 and press option 6 to reach the appointment hotline. The time of your call will be marked by our system. If there is an emergency and you cannot make your appointment and cannot cancel with 48 hours’ notice, if you call, you may be given the option of participating in a telephone session with your clinician ($75.00, in lieu of the cancellation fee) that cannot be billed to the insurance company and must be paid by credit card prior to the phone session. Please help us serve you better by keeping scheduled appointments. PRESCRIPTION REFILL FEE Our clinicians are very happy to write necessary prescriptions for our patients at the time of their appointment that will carry them through until their next appointment. Patients are encouraged to bring a list of medications needed to their appointment. However, if you require a prescription before your next appointment or if you forgot to request a refill at the time of your appointment, please note that you may be charged a fee of $30.00 for this refill. You are invited to make a short appointment to have your prescriptions renewed if you do not wish to pay the $30.00 prescription refill fee. You can leave a refill request or make a short appointment by calling the main office at 000-000-0000 and press option 7 to reach the prescription hotline or press 6 to schedule an appointment. BOUNCED OR RETURNED CHECKS There will be a $25.00 fee assessed for bounced or returned checks.
