Please attach. 1. Copy/Scan of your personal ID CARD or PASSPORT (driving licenses are not valid)
Please attach. 1) A copy of your most recent transcript of marks (from either high school, college or university), and,
Please attach a copy of a recent bank statement.Please note that the bank statement must provide all the information indicated above under “BANK ACCOUNT NAME” and “BANK”. In this case, the bank’s stamp and the signature of its representative are not required. The signature of the account holder is obligatory in all cases.
Please attach. Copy Of Voided Check To This Form If Funds Are To Be Sent To A Bank * The above services cannot be established without a pre-printed voided check. For electronic funds transfers, signatures of bank account owners are required exactly as they appear on the bank records. If the registration at the bank differs from that on this Subscription Agreement, all parties must sign below. Attach Xxxxx Bankrate 000 Xxxxxxxx Xxxxxxxxx Xxx Xxxx, XX 00000 000-000-0000 Date: 1111 Check Here Pay to the order of: $ DOLLARS Generic Bank and Trust Contains Security Features. Details on Back Memo: |:123456789 |:10987654321 |:1111 Routing Number Account Number Check Number For help completing this form, please call Investor Services at 855.422.3223.
Please attach a certified copy of South African identity document (must be certified by a Commissioner of Oaths)
Please attach a photocopy of your passport details page or a certified copy of your birth certificate. Father’s Details: (Name must be as it appears on your passport) Title: Mr Dr Date of Birth: Family name: First name: Street Address: Home Phone: Business phone: Mobile: Email: First language: Country of citizenship: Passport number: Expiry date: Do you speak or read English? Speak: Yes No Read: Yes No Mother’s Details: (Name must be as it appears on your passport) Title: Mrs Miss Ms Dr Date of birth: Family name: First name: Street address: Home Phone: Business phone: Mobile: Email: First language: Country of citizenship: Passport number: Expiry date: Do you speak or read English? Speak: Yes No Read: Yes No Legal Guardian (if applicable) Title: Mr Mrs Miss Ms Dr Date of birth: Family name: First name: Street address: Home Phone: Business phone: Mobile: Email: First language: Country of citizenship: Passport number: Expiry date: Do you speak or read English? Speak: Yes No Read: Yes No Emergency Contact (English speaking in New Zealand): Contact's name: Mobile phone: Home phone: Email address: Emergency Contact (English speaking in home country, other than parents): Contact's name: Mobile phone: Home phone: Email address: Agent Information (If using an agent) Agency name: Agent name: Agent email address: Phone: Street address: New Zealand based Advisor or Counsellor contact details (if applicable) Please note that an advisor or counsellor is not compulsory but recommended for students under 18 Name: Address: Home phone: Mobile Phone: Work phone: Email: Important: All international students must have appropriate and current medical and travel insurance while studying in New Zealand. Pre-paid insurance is from Southern Cross. It is medical and travel insurance. Please check the website xxxxx://xxx.xxxx.xx.xx/our-products/international-student/insurance/ We recommend insurance cover that covers the loss or theft of personal belongings. If you choose to use an alternative insurance company, the school must sight the policy BEFORE the student buys it and before he/she leaves his/her home country. Otherwise Southern Cross must be pre-paid to the school. If we do not see an alternative policy, the default policy will be Southern Cross. Insurance Details Do you wish to purchase Southern Cross insurance through the school? Yes No If you are providing your own insurance please provide the name of your insurer: Policy number: Insura...
Please attach a summary of exemptions for the provision of goods and services that cannot practically be performed by the New York State supply chain at this time as Appendix D.5 to this report. Please attach a list of hosted Supplier Forums for New York State firms including proof of planning activities, event venues, date selection and attendance as Appendix D.6 to this report. The Status of Specific Industry Growth Activities Including Industry Event Dates and Attendees, Negotiating of Contracts, Establishment of Facilities, Steering Members and Board Members, Hiring of Employees, Establishment of Funds, Dollars Spent, Submitted and Awarded Proposals, Launch Dates, and Workers Trained Please attach a summary related to the specific industry growth activities committed to the project as Appendix E.1 to this report. Updates With Respect to Expenditures on Community Benefit Funds, Grants, Apprenticeships and Internships, Educational Cooperative Efforts, and/or Training Initiatives Please attach a list of dollars per quarter spent (not budgeted or allocated) in pursuit of community benefit funds, grants, apprenticeship and internships, educational cooperative efforts, or training as Appendix F.1 to this report. Activities Undertaken Pursuant to Seller’s Stakeholder Engagement Plan, Including How Seller Has Taken into Account the Interests of Disadvantaged Communities, Updates on Seller’s Consultations with the Consulting State Agencies, Timely Notice of Upcoming Meetings and Known Outreach Events and Activities for the Next Quarter that Representatives of NYSERDA May Attend Using elements from the Project’s Stakeholder Engagement Plan, please provide specific details on tracking Stakeholder Engagement for the current Quarter and for the upcoming quarterly reporting period as Appendix G.1 to this report. Please attach a list of completed meetings, outreach activities, and outcomes including Consultations with New York State Agencies and Technical Working Group (TWG) Participation for the previous quarter including outcomes as Appendix G.2 to this report. Using elements from the Project’s Stakeholder Engagement Plan, please provide specific details on tracking Stakeholder Marketing Efforts for the current Quarter and for the upcoming quarterly reporting period as Appendix G.3 to this report. Disadvantaged Community Benefits
Please attach a copy of a voided check — not your deposit slip — for verification purposes. (See check facsimile below.) Please Note: • Savings accounts can have different routing numbers than checking accounts. To ensure this information is correct and there are no delays in processing your reimbursement, please contact your institution directly for the proper information. • Credit union, money market or brokerage accounts often use account and routing numbers for automatic transfers that are different from the one printed on your checks. To ensure this information is correct and there are no delays in processing your reimbursement, please contact your institution directly for the proper information. Invalid/Returned Direct Deposit Transmission: I understand and agree to pay $25.00 for any invalid or returned deposit transmissions due to incorrect bank information supplied by me. Your Name 000 Any Street Any City, USA 00000 1234 DATE PAY TO THE ORDER OF $ DOLLARS MEMO |: 2 4 6 8 2 4 6 8 2 :| 088394827 1234 Retiree Signature: Joint Account Signature: Date: Date: *BANK ROUTING NUMBER Attach copy of voided check here. MAIL TO: Blue Cross Blue Shield of Delaware QUESTIONS? Flexible Benefits Department Visit: xxxxxx.xxx (select Flexible Benefits) P.O. Box 8737 Email: XXXXX@xxxxxx.xxx Wilmington, DE 00000-0000 Call: 000.000.XXXX (3539) or 302.421.8970
Please attach a copy of a voided check for a checking account or savings deposit slip for a savings account.
Please attach a copy of the RA’s passport, UAE visa (if applicable), and CV.
