Policy Number. If the Beneficiary is covered under any prepaid funeral or burial insurance, please provide the insurer’s name, address, and the policy number. Insurer: Address: Policy Number: Exhibit “C” Proof of Grantor’s Status to Establish Trust on Behalf of Beneficiary Under current law, only the beneficiary’s parents, grandparents, legal guardian, the beneficiary himself or herself, or someone acting at the direction of a court may establish the Trust on behalf of the beneficiary. If you are anyone other than the beneficiary, then please include documents that verify that you fall within one of these permissible categories. ALL GRANTORS MUST PROVIDE A PHOTOCOPY OF THEIR DRIVER’S LICENSE OR OTHER PHOTO IDENTIFICATION In addition to the Grantor’s photo I.D., the list below illustrates the types of documents that must be submitted to establish the Grantor’s relationship to the Beneficiary and/or the status to contribute to the Trust.
Policy Number. If the Beneficiary is covered under any prepaid funeral or burial insurance plan, what is the insurer’s name and address, and what is the policy number? Insurer: Address: Policy Number:
Policy Number. In the event of any change in health insurance, the responsible party is required to notify the opposing party of the change. The responsible party shall inform the Virginia Department of Social Services, if support payments are ordered to be paid through the Virginia Department of Social Services, or the opposing party, if support payments are ordered to be paid directly to the opposing party, of any changes in the availability of the health care coverage for the minor child or children. [ ] The parties agree that “health care coverage” as defined by the statute is not available at “reasonable cost” as defined by statute, and therefore, the parties agree that neither the Respondent nor the Petitioner will be required to provide health care coverage. [ ] Any reasonable and necessary unreimbursed medical and dental expenses for each child covered by this agreement shall be paid in the following manner: ............................................ % Respondent % Petitioner. MEDIATION SUPPORT AGREEMENT Case No. ......................................................................
Policy Number. «POLICY»
Policy Number. Are children or vulnerable adults involved with this hiring? Yes/No If Yes, then a protection policy must be in force and a written copy attached. (Excludes private functions)
Policy Number. ESP1004516-00 Named Insured: City of Garland This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: October 1, 2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ELECTRONIC DATA LOSS OR DAMAGE - EXCLUSION This endorsement modifies insurance provided under this policy.
Policy Number. If you’d like to make a claim, please refer to the instructions at xxxxxxxxx.xxxxxxxxxxxxx.xxx.xx/xxxxxxxx Unauthorised Transactions Insurance SG01000008-00 Summary of the key terms of your BusinessVantage Visa Credit Card facility Introduction This is a summary of the key terms of your BusinessVantage Visa Credit Card facility. It doesn’t replace your letter of offer or letter schedule (together, the “offer”) or the BusinessVantage Visa Credit Card Conditions of Use as at 1 July 2019 (“conditions”) nor does it cover all of your obligations. You still need to carefully review these documents and any other document we provide. Cardholders Under the facility, you can nominate cardholders and we’ll issue a BusinessVantage Visa Credit Card (“card”) to them. You’re responsible for all transactions made by cardholders. Security of cards and PINs Cardholders have to protect the security of the card and PIN and have to make every effort to see that the card and PIN aren’t misused, lost or stolen. Lost or stolen cards or PIN revealed or suspected unauthorised transactions A cardholder must tell you and us as soon as possible if a card or PIN record is lost or stolen or they suspect any unauthorised card transactions. If they don’t do this, you may be liable for unauthorised card transactions. Facility limit and credit limit We’ll let you know what the facility limit is when we open the facility. The total of all individual card credit limits may not exceed the facility limit. You can ask us to vary the facility limit, but we have no obligation to do so. When you apply for a card, the credit limit for that card is in your offer. This is the maximum amount of credit the cardholder can normally access on the card, including any accrued fees or interest charges. You must tell each cardholder their credit limit. If the credit limit is exceeded, you have to repay us the excess amount and we can also charge a fee. We can reduce the facility limit or credit limit on a card (or both) and if we do, we’ll tell you in writing. Using the card and daily limits Cardholders must use cards solely for business purposes, and not private or domestic purposes. Cardholders can use the card to obtain goods, services and cash in various ways in Australia and overseas, (including through merchants, ATMs and bank branches displaying the Visa logo). You can also use the card for transactions by mail order, telephone, internet and other remote access. You can place restrictions on the types o...
Policy Number. If the Beneficiary is covered under any prepaid funeral or burial insurance, please provide the insurer’s name, address, and the policy number. Insurer: Address: Policy Number: Exhibit “C” Desires of Grantor for Use of Distributions From Trust Sub-Account During Life of Beneficiary Please be as thorough as possible when completing this section. This information is potentially very important when authorizing requests for distributions.
Policy Number. XX0000000.
Policy Number. For the period (dates) from..................................................... to......................................
