Office Telephone Number. Insert the employee's area code, office telephone number and extension.
Office Telephone Number. Registrar's Office e-mail address HOST Institution's Financial Aid Representative's signature indicating acceptance of all terms of this agreement Signature Date
Office Telephone Number. No. Faksimili
Office Telephone Number. No. Faksimili Facsimile Number Swasta Wiraswasta Ibu RT Profesional Peg. Negeri Private Entrepreneur House Wife Professional Civil Servant Peg. BUMN BUMN Employee Mahasiswa Student Lainnya, sebutkan Other, mention it Tahun Kantor Sebelumnya Tahun Year Previous Office Year Kode Pos Post Code Data Keuangan Nasabah/ Customer Financial Data Penghasilan Per Tahun Income per Year Daftar Kekayaan/List of Assets Rumah, Lokasi House, Location Nilai Jual Objek Pajak (NJOP) Selling Value of Tax Object Deposit Bank Bank Deposit Jumlah Amount Lainnya Other aaSn/ Filledpby theeCompacny custiommer only en Khusus diisi untuk nasabah perusah Antara Rp 100 - Rp 250 juta Between IDR 100 – IDR 250 millions Di atas Rp 500 juta Above IDR 500 millions Antara Rp 250 –Rp 500 juta Between IDR 250 – IDR 500 millions Nama Perusahaan Company Name Alamat Perusahaan Company Address Negara Asal Country of Origin No. Telepon
Office Telephone Number. Physician Signature Date □ I am a person employed by the following physician and I request access to the following FHMI IT Systems: NOTE: The supervising physician must also sign this agreement Printed Name of Physician Employee IT Systems Needed Printed Name of Supervising Physician Office Telephone Number Employee Signature Date Physician Signature
Office Telephone Number. No. Faksimili Facsimile Number Swasta Wiraswasta Ibu RT Profesional Peg. Negeri Private Entrepreneur House Wife Professional Civil Servant Peg. BUMN BUMN Employee Mahasiswa Student Lainnya, sebutkan Other, mention it Tahun Kantor Sebelumnya Tahun Year Previous Office Year Kode Pos Post Code Data Keuangan Nasabah/ Customer Financial Data Penghasilan Per Tahun Income per Year Daftar Kekayaan/List of Assets Rumah, Lokasi House, Location Nilai Jual Objek Pajak (NJOP) Selling Value of Tax Object Deposit Bank Bank Deposit Jumlah Amount Lainnya Other aan/ Filled by the Company customer only en Khusus diisi untuk nasabah perusah Nama Perusahaan Company Name Alamat Perusahaan Company Address Antara Rp 100 - Rp 250 juta Between IDR 100 – IDR 250 millions Di atas Rp 500 juta Above IDR 500 millions Antara Rp 250 –Rp 500 juta Between IDR 250 – IDR 500 millions Negara Asal Country of Origin No. Telepon Telephone Number No. Faksimili FacsimileNumber Bidang Usaha Type of Business Tanggal Pendirian Date of Establishment Direktur Utama President Director Direktur Director Komisaris Utama President Commissioner Komisaris Commissioner Izin Usaha Business License Tanggal dikeluarkan Issued Date Nomor Pokok Wajib Pajak (NPWP) Taxpayer Registration Number Kode Pos Post Code PT. EQUITYWORLD FUTURES Data Rekening Bank Nasabah Untuk Penarikan/ Customer Bank Account for Withdrawal Nama Name Nama Bank Bank Name Cabang Branch Nomor A/C Account Number No. Telepon Telephone Number Jenis Rekening Giro Tabungan Lainnya Account Type Current Account Saving Other Nama Name Nama Bank Bank Name Cabang Branch Nomor A/C Account Number No. Telepon Telephone Number Jenis Rekening Account Type Specimen Giro Current Account Tabungan Saving Lainnya Other Pernyataan/ Statement Dengan ini saya menyatakan bahwa semua informasi diatas adalah benar dan tepat. Saya akan bertanggung jawab penuh apabila di kemudian hari terjadi sesuatu hal, sehubungan dengan ketidakbenaran data yang saya berikan. I hereby declare that any information above is true and correct. I will be fully responsible for any consequences occurs in the future related to the data I provided. Mengetahui,Suami/ Istri *) Pemohon, Acknowledged, Husband / Wife Applicant, Nama Xxxxx & Xxxxx Xxxxan Nama Xxxxx & Xxxxx Xxxxan Full Name & Signature Full Name & Signature Dengan menandatangani formulir ini saya melampirkan : / I signed on these forms I enclose with :
Office Telephone Number. ( ) -------------------------------
Office Telephone Number. Mailing Address ______________________________________ City, State, Zip Code ______________________________________ State of Residence ______________________________________ Social Security/Tax ID No. ______________________________________ Date $550 Sales Price per Unit -------------------------------------- ____________________ Number of Units to be sold ======================================== ------- FOR INTERNAL USE ONLY ------- ACCEPTED: KALMIA INVESTORS, LLC By: Smithtown Bay, LLC Its Manager By: Global Capital Management, Inc. Its Manager By: /s/ --------------------- Name: Michael J. Frey Title: Chief Executive Officer =========================================== YOU MUST MAIL EXECUTED ORIGINAL TO THE PURCHASER: Kalmia Investors, LLC 601 Carlson Parkway, Suite 200 Minnetonka, MN 55305 PLEASE CALL XX XX (000) 000-0854 IF YOU HAVE ANY QUESTIONS REGARDING THE SALE OF YOXX XXXXX ================================================================================ INSTRUCTIONS TO COMPLETE AGREEMENT OF SALE
Office Telephone Number. Pursuant to the terms of the MBIA Inc. 2000 Stock Option Plan, I hereby exercise the Option granted to me on for the number of shares listed below subject to the cashless exercise procedures in the Plan.
Office Telephone Number. Cell Telephone Number Email Address Fax Number Tax Identification or Social Security Number ENTITY INVESTORS: Full Name of Entity By: Signature Its: Title Name Printed or Typed Address to which correspondence should be sent: Street Suite/Unit City __________________ State _________ Zip Code __________ Office Telephone Number Cell Telephone Number Email Address Fax Number Tax Identification or Social Security Number If Units are being subscribed for by any entity, the Certificate of Signatory on the last page must also be completed The foregoing subscription is accepted and the Company hereby agrees to be bound by its terms. DIAMONDHEAD CASINO CORPORATION Dated: _________________ By: Xxxxxxx X. Xxxxxx, President CERTIFICATE OF SIGNATORY (To be completed if Units are being subscribed for by an entity) I, , the (name of signatory) (title) of (“Entity”), a (name of entity) (type of entity) hereby certify that I am empowered and duly authorized by the Entity to execute the Subscription Agreement and to purchase the Units and certify further that the Subscription Agreement has been duly and validly executed on behalf of the Entity and constitutes a legal and binding obligation of the Entity.
