Country. [insert country where ITT is issued]
Country. Risk – shall have the meaning set forth in the Custodian Agreement.
Country. Primary Phone Number Secondary Phone Number Primary Email Address* Secondary Email Address Receive email notifications?* q Yes q No If not a U.S. Citizen, enter country of citizenship Employment Status: q Employed q Self Employed q Not Employed/Retired Employer Name Health Plan Type: q Single q Family Effective Date of Qualified Health Insurance (mm|dd|yyyy) / / Health Insurance Carrier *By providing an email address and checking the “Yes” box, the account holder represents and warrants that he/she consents and has the ability to receive the electronic delivery of all investment-related, account-related information and notices at the provided email address. Electronic delivery may include, but is not limited to, emailed copies of or internet links to documents in PDF format. Investment-related and account-related information and notices may include, but is not limited to fund prospectuses, tax notices, account statements, confirmations of statements, account access passwords, etc. Account holder’s consent will be in effect until revoked. Account holder may request no-cost written copies of any electronically delivered documents and/or may revoke his/her consent to electronic delivery by contacting Customer Service.
Country. 2d. SEE INSTRUCTIONS ADD’L INFO RE ORGANIZATION DEBTOR 2e. TYPE OF ORGANIZATION 2f. JURISDICTION OF ORGANIZATION 2g. ORGANIZATIONAL ID #, if any NONE
Country. [Click here and enter Host Country name]
Country. Student with: ☐ a financial support from Erasmus+ EU funds ☐ a zero-grant The financial support includes (if applicable): Special needs support ☐ The student receives financial support other than Erasmus+ EU funds Institution to complete the following box for all participants receiving financial support from Erasmus+ EU funds. Bank account where the financial support should be paid: Bank account holder (if different than student): Bank name: Clearing/BIC/SWIFT number: Account/IBAN number: Called hereafter “the participant”, of the other part, Have agreed to the Special Conditions and Annexes below which form an integral part of this agreement ("the agreement"): Xxxxx X (b) i: Learning Agreement for Erasmus+ mobility for studies Xxxxx X (b) ii: Learning Agreement for Erasmus+ mobility for Traineeships Learning Agreement for Erasmus+ mobility for Studies combined with a Traineeship Xxxxx X (b) iii: General Conditions Xxxxx X (b) iv: Erasmus+ Student Charter The terms set out in the Special Conditions shall take precedence over those set out in the annexes. It is not compulsory to circulate papers with original signatures for Xxxxx X (b) i and (b) ii of this document: scanned copies of signatures and electronic signatures may be accepted, depending on the national legislation.
Country. AREA CODE AND TELEPHONE NUMBER AREA CODE AND TELEPHONE NUMBER POSTAL CODE POSTAL CODE TEXT MESSAGE - CELL NUMBER EMAIL EMAIL PERMANENT ADDRESS VALID FROM TO WHAT IS THIS PERSON’S RELATIONSHIP WITH YOU (YOUR FATHER, YOUR SPOUSE, YOUR FRIEND, ETC.)? YEAR MONTH DAY YEAR MONTH DAY AS A TEMPORARY OCCUPANT, YOU MUST BE A STUDENT REGISTERED AT A POST SECONDARY INSTITUTION. ARE YOU A UNIVERSITY OF OTTAWA STUDENT? OTHER POSTSECONDARY INSTITUTION (Specify) YES STUDENT NO. (U.O.) NO STUDENT NO. AT THAT INSTITUTION UNDERGRADUATE STUDIES GRADUATE STUDIES ARE YOU REGISTERED IN A CO-OP PROGRAM? YES NO SPECIFY MR. SURNAME IDENTIFICATION DU RÉSIDENT GIVEN NAMES STUDENT NUMBER MRS. MS. MISS 1 PERMANENT HOME ADDRESS 2 PERSON TO CONTACT FOR EMERGENCIES NUMBER AND STREET APT. 45 XXXX OU ANNEXE OU XXXXX XXXXXXX CITY UNIT NUMBER ROOM NUMBER PROVINCE AREA CODE & TELEPHONE NUMBER AREA CODE & TELEPHONE NUMBER POSTAL CODE EMAIL EMAIL MAILING ADDRESS VALID FROM TO YEAR MONTH DAY YEAR MONTH DAY SUBLET DETAILS NO EXCEPTION: SUMMER SUBLET PERIOD STARTS NO EARLIER THAN APRIL 30, 2022 AND ENDS NO LATER THAN AUGUST 26, 2022. SUBLET PERIOD FROM TO OCCUPATION FEES $ PER WEEK PER MONTH DEPOSIT $ ( TO ENSURE THE RESERVATION ) YEAR MONTH DAY YEAR MONTH DAY ITEMS ROOM LIVING AND DINING ROOM KITCHEN SIGNATURES OF RESIDENTS As the resident being replaced, you must obtain the signature of all residents living in the unit (i.e. residents holding a Resident Agreement.). RESIDENT LIVING IN ROOM A DATE RESIDENT LIVING IN ROOM B DATE RESIDENT LIVING IN ROOM C DATE RESIDENT LIVING IN ROOM D DATE RESIDENT LIVING IN ROOM E DATE With the University’s permission, the resident authorizes the temporary occupant to use the assigned room for the entire sublet period, provided he or she pays the agreed-upon monthly charges to the resident. The refundable deposit may be kept by the resident beyond the sublet period only to compensate for the costs incurred by the temporary occupant’s conduct or actions or that of his or her guests. The occupant and the resident agree that all clauses on the back of this form are binding terms and condition. DATE SIGNATURE (REPLACED RESIDENT) DATE SIGNATURE (TEMPORARY OCCUPANT) HOUSING SERVICE (HS) 00 Xxxxxxxxxx Xxx, Xxxx 000, Xxxxxx XX Xxxxxx X0X 0X0 Tel. 000-000-0000
Country. The information provided in the Student Agreement applies also for the second-year studies.
Country. 2.3 The participant shall receive a financial support from Erasmus+ EU funds for _______ months and ______ days [if the participant receives a financial support from Erasmus+ EU funds: the number of months and extra days shall be equal to the duration of the mobility period. If the participant receives a financial support from Erasmus+ EU funds combined with a zero-grant period: the number of months and extra days shall correspond to the period covered by financial support from Erasmus+ EU funds, which shall be provided at least for the minimum duration of the period abroad (2 months for traineeships and 3 months or 1 academic term or trimester for studies)]; [If the participant receives a zero-grant for the entire period: this number of months and extra days should be 0].
Country. For correspondence (Please quote on all correspondence and invoices) Contract No. (Cosoft No): Project Processing No.: Date:
