ASSIGNMENT AND RELEASE definition

ASSIGNMENT AND RELEASE means the document attached hereto as Exhibit B.
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ASSIGNMENT AND RELEASE. I hereby authorize my benefits to be paid directly to Acupuncture for Pregnancy. I am financially responsible for any balance due. I also authorize the practitioner(s) listed to release any information required for this claim.
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Examples of ASSIGNMENT AND RELEASE in a sentence

  • THE PARTIES ENTER INTO THIS ASSIGNMENT AND RELEASE AGREEMENT on the basis of the following facts, understandings and intentions: A.

  • ASSIGNMENT AND RELEASE: I authorize payment of benefits be made directly to this healthcare provider and I understand that the service(s) listed above may or may not be covered by my insurance, and that I will be responsible for any and all charges related to the service(s) shown.

  • Yes No If yes: Name of Primary Insurance (ie Medicare, Cigna, etc): ASSIGNMENT AND RELEASE I, the undersigned, have insurance coverage with: And assign directly to Pelorus Elder & Behavioral Health all medical benefits, if any, otherwise payable to me for services rendered.

  • NOTARY PUBLIC, STATE OF My Commission Expires: CONSENT TO ASSIGNMENT AND RELEASE Lessor in the above-referenced Lease, hereby acknowledges and consents to the above assignment and agrees to render to Assignee the performance due under the terms of said Lease.

  • Kent Title: ▇▇▇▇▇ ▇▇▇▇▇▇▇ve Officer EXHIBIT A --------- ASSIGNMENT AND RELEASE ---------------------- See attached.

  • Phone # Preferred Pharmacy_ Phone #__ _ ASSIGNMENT AND RELEASE I, the undersigned, have insurance coverage with: And assign directly to Pelorus Elder & Behavioral Health all medical benefits, if any, otherwise payable to me for services rendered.

  • By: Name: Its: CONSENT TO ASSIGNMENT AND RELEASE The Contracting Party hereby acknowledges and consents to the above Assignment and agrees to render to Assignee the performance formerly due the Assignor under the terms of the Contract.

  • THIS ASSIGNMENT AND RELEASE AGREEMENT SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE INTERNAL LAWS OF THE STATE OF NEW YORK.

  • EXHIBIT A ASSIGNMENT AND RELEASE ASSIGNMENT AND ASSUMPTION AGREEMENT, dated as of [___], 2006 (this "Agreement"), among IWG-Philippines, Incorporated, a corporation organized under the laws of the Philippines (the "Company"), International Wire Group, Inc., a Delaware corporation (the "Seller Parent"), and [_______], a [_________] corporation (the "Counterparty").

  • EXHIBIT A ASSIGNMENT AND RELEASE ASSIGNMENT AND ASSUMPTION AGREEMENT, dated as of [___], 2006 (this "Agreement"), among IWG Durango, S.

Related to ASSIGNMENT AND RELEASE

  • Waiver and Release means the Waiver and Release attached hereto as Exhibit A.

  • Release of Claims means the Release of Claims in substantially the same form attached hereto as Exhibit B (as the same may be revised from time to time by the Company upon the advice of counsel).

  • Release Agreement means an agreement, substantially in a form approved by the Company, pursuant to which Executive releases all current or future claims, known or unknown, arising on or before the date of the release against the Company, its subsidiaries and its officers.

  • General Release has the meaning stated in Section 6.03.

  • Assignment and Conveyance An assignment and conveyance of the Mortgage Loans purchased on a Closing Date in the form annexed hereto as Exhibit 4.