Recipient Information. Company does not wish to receive any confidential information from Recipient, and Company assumes no obligation, either express or implied, with respect to any information disclosed by Recipient.
Recipient Information. Recipient shall provide the information set forth below. PLEASE PRINT OR TYPE THE FOLLOWING INFORMATION Recipient Name (exactly as filed with the IRS: Street Address: City, State, ZIP: Email: Phone: ( ) Fax: ( ) Is Recipient a nonresident alien, as defined in 26 USC § 7701(b)(1)? (Check one box): YES NO
Recipient Information. WorldRemit may, as necessary in providing the Service, store all information required of a Recipient to prove his or her identity or associated with their specific Instruction. Such proofs may include a suitable form of valid, unexpired identification from a list of acceptable papers provided by the Service Provider, and/or a transaction tracking number, a personal identification number (PIN), a "password", a "secret word", or other similar identifiers.
Recipient Information. Legal Services of North Florida, Inc. Pensacola Branch 0000 X. Xxxxxxx Street Pensacola, FL 32501 Phone: 000-000-0000 Attn: Xxxxxx Xxxxxx-Xxxxxxxxx
Recipient Information. Discloser does not wish to receive any confidential information from the Recipient, and Discloser assumes no obligation, either express or implied, with respect to any information disclosed by Recipient.
Recipient Information. 1. Recipient Name California Department of Public Health 0000 Xxxxxxx Xxx Xxxxxxxxxx Department of Public Health Sacramento, CA 95814-5015 (000) 000-0000 2. Congressional District of Recipient 06 3. Payment System Identifier (ID) 1743204993A1 4. Employer Identification Number (EIN) 000000000 5. Data Universal Numbering System (DUNS) 799150615 6. Recipient’s Unique Entity Identifier (UEI) KD2JSY6LNMW7 7. Project Director or Principal Investigator Xx. Xxxxx Xxxxx Volk Assistant Branch Chief XXXXX.XXXX@XXXX.XX.XXX (000) 000-0000 8. Authorized Official Dr. Karen388388 Xxxxx N/A XXXXX.XXXXX@xxxx.xx.xxx 000-000-0000 Federal Agency Information CDC Office of Financial Resources 9. Awarding Agency Contact Information Xxxxxxxx Xxxxxxx GMS xxx0@xxx.xxx 000-000-0000 10.Program Official Contact Information Xxxxxx Xxxxxxxx Public Health Advisor xxx0@xxx.xxx 000-000-0000 11. Award Number 5 NH23IP922612-04-00
Recipient Information. Recipient shall provide the information set forth below.
Recipient Information. You are responsible for ensuring that all information relating to the intended recipient (the “Recipient”) and the bank you have indicated at which the Recipient should receive the Simplii Financial Global Money Transfer (“GMT”) (the “Recipient Bank”) that we or an Intermediary may require, is correct. Neither we nor any Intermediary is responsible for verifying the accuracy of any information you provide, and we and the Recipient Bank may rely solely on an account number or identifying number to complete the GMT. “Intermediary” means any person receiving or handling funds for us or the Recipient including but not limited to other financial institutions (including the Recipient Bank), payment networks and their respective agents and service providers.
Recipient Information. Recipient shall provide the information set forth below. Please print or type the following information Recipient Name (exactly as filed with the IRS): Street address: City, state, zip code: Email address: Telephone: ( ) Facsimile: ( ) Is Recipient a nonresident alien, as defined in 26 USC § 7701(b)(1)? (Check one box): YES NO Recipient Proof of Insurance, as required by Exhibit C, Section 7: All insurance listed must be in effect at the time of provision of services under this Agreement. Professional Liability Insurance Company: Policy #: Expiration Date: Commercial General Liability Insurance Company: Policy #: Expiration Date: Automobile Liability Insurance Company: Policy #: Expiration Date: Workers’ Compensation: Does Recipient have any subject workers, as defined in ORS 656.027? (Check one box): YES NO If YES, provide the following information: Workers’ Compensation Insurance Company: Policy #: Expiration Date: Business Designation: (Check one box): Professional Corporation Nonprofit Corporation Limited Partnership Limited Liability Company Limited Liability Partnership Sole Proprietorship Corporation Partnership Other The above information must be provided prior to Agreement execution. Recipient shall provide proof of Insurance upon request by DHS or DHS designee.
Recipient Information. DWA does not wish to receive any confidential information from Recipient, and DWA assumes no obligation, either express or implied, with respect to any information disclosed by Recipient.
