PLEASE CHECK BELOW. 1. No: ☐ or Yes ☒ : ( if ‘No’, do not proceed further ) Do you use and/or store hazardous materials beyond typical household cleaning products?
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Please (a) Issue a check payable to Borrower or
Check One o (1) This Note is being transferred to a “qualified institutional buyer” in compliance with Rule 144A under the Securities Act of 1933, as amended and certification in the form of Exhibit F to the Indenture is being furnished herewith.
PLEASE READ YOUR CONTRACT CAREFULLY It is a legal Contract between you, the Owner, and us, SBL. The Contract's table of contents is on page 2. FREE LOOK PERIOD-RIGHT TO CANCEL YOU MAY RETURN THIS CONTRACT WITHIN 10 DAYS AFTER YOU RECEIVE IT. YOU MAY RETURN THE CONTRACT BY DELIVERING OR MAILING IT TO SBL. THIS CONTRACT WILL THEN BE DEEMED VOID FROM THE BEGINNING. NO WITHDRAWAL CHARGE WILL BE IMPOSED, AND WE WILL REFUND YOUR CONTRACT VALUE, INCLUDING ANY FEES AND/OR CHARGES FOR PREMIUM TAX THAT WERE DEDUCTED FROM THAT CONTRACT VALUE, LESS THE VALUE OF ANY CREDIT ENHANCEMENTS MADE INTO THE CONTRACT, AS OF THE DATE WE RECEIVE THE RETURNED CONTRACT. Signed for Security Benefit Life Insurance Company on the Contract Date. XXXXX X. XXXXX XXXX X. XXXXXXX Secretary President A BRIEF DESCRIPTION OF THIS CONTRACT This is a FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT. * Investment Experience is Reflected in Benefits * Variable and Fixed Accumulation Before the Annuity Start Date; Variable and Fixed Annuity Payments Thereafter * Death Benefit Proceeds are Payable Before the Annuity Start Date * This Contract is Non-Participating BENEFITS AND VALUES PROVIDED BY THIS CONTRACT MAY BE ON A VARIABLE BASIS. AMOUNTS DIRECTED INTO ONE OR MORE OF THE SUBACCOUNTS WILL REFLECT THE INVESTMENT EXPERIENCE OF THOSE SUBACCOUNTS. THESE AMOUNTS MAY INCREASE OR DECREASE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. (SEE "CONTRACT VALUE AND EXPENSE PROVISIONS" AND "ANNUITY PAYMENT PROVISIONS" FOR DETAILS.) [SBL LOGO] SECURITY BENEFIT LIFE INSURANCE COMPANY A Member of The Security Benefit Group of Companies 000 XX Xxxxxxxx Street, Topeka, KS 66636-0001 0-000-000-0000 The variable annuity covered by this Contract is the subject of a pending patent application in the United States Patent and Trademark Office. V6029 (8-00) -------------------------------------------------------------------------------- TABLE OF CONTENTS -------------------------------------------------------------------------------- Page CONTRACT DATA PAGE........................................................ 3 DEFINITIONS............................................................... 4
Account Verification Attorney in Fact Proxy 6.1Account Verification. The Administrative Agent may at any time, in the Administrative Agent’s own name, in the name of a nominee of the Administrative Agent, or in the name of any Grantor communicate (by mail, telephone, facsimile or otherwise) with the Account Debtors of any such Grantor, parties to contracts with any such Grantor and obligors in respect of Instruments of any such Grantor to verify with such Persons, to the Administrative Agent’s reasonable satisfaction, the existence, amount, terms of, and any other matter relating to, Accounts, Instruments, Chattel Paper, payment intangibles and/or other Receivables.
CHECK-OFF The Company agrees that on the 1st day of the 2nd month following each anniversary of this Agreement, the Company will include on the Dues Pre-Billing Report submitted to the Local Union, the current hourly wage rate for each employee who is a member of the Union. Upon receipt of a written authorization from the employee, the Company agrees to deduct initiation fees and monthly dues from the pay of each such employee in the amount and manner prescribed by the Union in accordance with the International’s Constitution and the Local 743 By-Laws. Such deductions must be deducted on the first pay period of each month and must be submitted to the Union no later than the fifteenth (I5th) of the month in which the money is deducted; except that the withdrawal fees shall be held by the Company and forwarded to the Union only as required by Union procedure. In the event the amounts cannot be forwarded by the 15th of the month, the amounts deducted shall be submitted to the Union no later than ten (10) working day from the date of deduction. These authorizations for deduction shall be in the following form: HEALTH CARE, PROFESSIONAL, TECHNICAL, OFFICE, WAREHOUSE, AND MAIL ORDER EMPLOYEES UNION Local 743, I.B. of T. 0000 X. Xxxxx Ave., Chicago, Illinois 60632 Phone: (000) 000-0000 APPLICATION AND AUTHORIZATION Although I am aware that I am not required to sign any dues check-off assignment, or any membership application card, or any other Union form, and I further realize that under the provisions of the Labor-Management Relations Act of 1947, as amended, and the contract between the above Local Union and the Company, I am not required, as a condition of employment, to become a member of said Union until the thirtieth (30th) day following the beginning of my employment or the effective date of such contract, whichever is the later, nevertheless, I desire, voluntarily, to sign this form. I, the undersigned, hereby apply for membership in the above Union. EMPLOYEE’S SIGNATURE: I, the undersigned, authorized and irrevocably direct Innophos, Inc. to deduct from my wages each and every month dues and initiation fees which may be charged against me by Local 743 which is required to maintain me as a member in good standing in said Union, in accordance with the By-Laws of the Union and in compliance with the Labor-Management Relations Act of 1947. The amount deducted each month shall be forwarded to Local 743. The authorization and direction shall be irrevocable for the period of one (1) year, or until the termination of the collective agreement between the Company and Local 743, whichever occurs sooner; and I agree and direct that this authorization and direction shall be automatically renewed, and shall be irrevocable for successive periods of one (1) year each or for the period of each succeeding applicable collective agreement between the Company and Local 743, whichever shall be shorter, unless written notice is given by me to the Company not more than twenty (20) days and not less than ten (10) days prior to the expiration of each period of one (1) year, or of each applicable collective agreement between the Company and Local 743, whichever occurs sooner. EMPLOYEE’S SIGNATURE: Male Female Address: Zip Code: City: Starting Date: Home Phone: Date of Birth: Dept.: Clock No. Beneficiary: Relationship: Soc. Sec. No.: Date: Such deductions shall be forwarded to the Union before the fifteenth (15th) of the month in which the money is deducted. When any employee for whom a written authorization has been submitted to the Company completes his first thirty (30) days of employment, the monthly dues and initiation fees shall be deducted beginning with the first day of the month following that month in which such thirtieth (30) days falls.
Yes You can participate in a SEP (other than a model SEP) even though you participate in another plan of the same employer. However, the combined contribution limits are subject to certain limitations described in section 415 of the Internal Revenue Code. Also, if you work for several employers, you may be covered by the SEP of one employer and a pension or profit-sharing plan of another employer.
Name of Company The name of the Company shall be as set forth in the Certificate.
Name; Address Unless you have promptly notified the Manager In Writing otherwise, your name as it should appear in the Registration Statement, Prospectus or Offering Circular and any advertisement, if different, and your address, are as set forth on the signature pages hereof.
Name and Address OF THE PERSON TO WHOM SUCH COMMON SHARES ARE TO BE ISSUED AND DELIVERED: ----------------------------------------------------------------------- ----------------------------------------------------------------------- ----------------------------------------------------------------------- ----------------------------------------------------------------------- -----------------------------------------------------------------------
Account Number 2. This authorization shall remain in effect until revoked or until a subsequent Notice of Account Designation is provided to the Administrative Agent.
