Common use of Agreement to Provide Clause in Contracts

Agreement to Provide. Flu vaccination service to eligible patients between 5th September 2022 and 31st March 2023. AAH Account Number: To allow AAH to release stock Contractor/Contractor Representative Name: (Please print) Signature: …………………………………………. Date: ………………….. Counter Fraud Declaration: I accept that the information provided on this form may be used to verify any claim associated with this service and may be shared with other bodies/agencies for the purposes of prevention and detection of crime. In signing this form, I consent to this use and acknowledge that if I provide false information then I may be liable to criminal prosecution, referral to my professional body and/or recovery proceedings. Please sign this document and retain for their own records. Please submit a copy as above. Signed on behalf of NHS Greater Glasgow & Xxxxx:

Agreement to Provide. Flu vaccination service to eligible patients between 5th September 1st February 2022 and 31st March 20232022. AAH Account Number: To allow AAH to release stock Contractor/Contractor Representative Name: (Please print) Signature: …………………………………………. Date: ………………….. Counter Fraud Declaration: I accept that the information provided on this form may be used to verify any claim associated with this service and may be shared with other bodies/agencies for the purposes of prevention and detection of crime. In signing this form, I consent to this use and acknowledge that if I provide false information then I may be liable to criminal prosecution, referral to my professional body and/or recovery proceedings. Please sign this document and retain for their own records. Please submit a copy as above. Signed on behalf of NHS Greater Glasgow & Xxxxx:

Agreement to Provide. Flu vaccination service to eligible patients between 5th September 2022 and 31st March 2023. AAH Account Number: To allow AAH to release stock Contractor/Contractor Representative Name: ……………………………….. (Please print) Signature: …………………………………………. Date: ………………….. Counter Fraud Declaration: I accept that the information provided on this form may be used to verify any claim associated with this service and may be shared with other bodies/agencies for the purposes of prevention and detection of crime. In signing this form, I consent to this use and acknowledge that if I provide false information then I may be liable to criminal prosecution, referral to my professional body and/or recovery proceedings. Please sign this document and retain for their own records. Please submit a copy as above. Signed on behalf of NHS Greater Glasgow & Xxxxx: