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Print full name: Date: Signed by the Guarantor: Signature:................................................................ Print full name: Date: in the presence of: Independent witness sign: ...................................... Print full name: Date: A1.1 We will provide you with Residential Care and services at the Facility based on your assessed care needs and our capacity to meet those needs from the Agreed Entry Date for the remainder of your lifetime or until this Agreement is terminated in accordance with clause C9.

Print full name: RESIDENT Date: in the presence of: Witness: .................................................................. Print full name: Date: Signed by an authorised officer of the Provider: Signature:................................................................ Print full name: Capacity: Date: in the presence of: Witness: .................................................................. Print full name: Date: I have the right to:

Examples of Print full in a sentence

• Signature Guaranteed (Signature of Warrantholder) Print full name Print full address The signature on this Transfer Form must correspond in every particular with the name shown on the face of the Warrant Certificate without alteration or any change whatsoever or this Subscription Form must be signed by a duly authorized signing officer of the Holder.

• Print full name in the presence of: ............................................................................

• Print full name ............................................................................

• Signature of Authorised Person Print full name of Authorised Person Dated Executive Director – Rural Fire Division Department of Fire and Emergency Services .

• Dated: [insert] Executed by Director Director/Secretary (if applicable) Print full name of Director Print full name of Director/Secretary engage:BDR Limited ACN 621 160 585 (Company) proposes to enter into an agreement with Ayrton Capital LLC on or about [insert date] (Agreement).

• Signature of Authorised Person Print full name of Authorised Person Click or tap here to enter text.

• Print full name: Date: 07/12/2022 Signed by an authorised officer of the Provider: Signature:................................................................

• We recommend you obtain the help of a qualified lawyer to complete SIGNED for and on behalf of [INSERT NAME OF COMPANY] by: ) ) Signature of authorised signatory Print full name INTERPRETATION Term Meaning Agreement this Agreement, including the Schedules attached to it.

• Sign here: /s/ ▇▇▇▇▇▇▇ ▇▇▇▇▇ Print full legal name here: ▇▇▇▇▇▇▇ ▇.

• I understand that I remain responsible for fees as per Conditions of Enrolment Signed: Date: Print full name: Name: Billing email: I request for tuition fees and charges to be billed to me at the shared portion of % for the student listed above.

More Definitions of Print full

Print full name: RESIDENT Date: in the presence of: Witness Signature:.................................................. Print full name: Date: Signed by an authorised officer of the Provider: Signature:................................................................ Print full name: Position: Date: in the presence of: Witness Signature:.................................................. Print full name: Date: Part A:Charter of Aged Care Rights‌ I have the right to:

Print full name: Capacity: Date: in the presence of: Witness: .................................................................. Print full name: Date: I have the right to: 1. safe and high quality care and services; 2. be treated with dignity and respect; 3. have my identity, culture and diversity valued and supported; 4. live without abuse and neglect; 5. be informed about my care and services in a way I understand; 6. access all information about myself, including information about my rights, care and services; 7. have control over and make choices about my care, and personal and social life, including where the choices involve personal risk;

Print full name: ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ Capacity: Facility Manager Date: 07/03/2023 in the presence of: I have the right to: 1. safe and high quality care and services; 2. be treated with dignity and respect; 3. have my identity, culture and diversity valued and supported; 4. live without abuse and neglect; 5. be informed about my care and services in a way I understand; 6. access all information about myself, including information about my rights, care and services; 7. have control over and make choices about my care, and personal and social life, including where the choices involve personal risk;

Print full. NAME:………………………………………………………………………………………….. Date of Birth (required for credit search):………………....…………..