Common use of Responsible Party Clause in Contracts

Responsible Party. Signature: ............................................................................................. Name: ................................................................................................. Date: .................................................................................................. Us Signature: ............................................................................................. Signed for and on behalf of: ........................................................................... Name: ................................................................................................. Position: General Manager / Deputy General Manager / Regional Director Date: .................................................................................................. Schedule 1 Admission Form and Fees Resident Details Name Date of Birth National Insurance Number Date of Occupation Type of Care Residential Care Nursing Care Type of Residency Permanent Respite Neighbourhood Residential Memory Care Room details For Respite Residents Days / Night Departure Date Respite Fee For Permanent Residents Service Fee (comprising a daily fee of £ x 7 Days) £ Nursing Service Fee, if any (comprising a daily fee of £ x 7 Days) £ Total Weekly Fee including nursing fee (comprising a daily fee of £ x 7 Days) £ Care Level Complete if applicable Your Payment £ Funding Authority Payment £ Responsible Party Payment £ Third Party Payment £ Responsible Party Name Address Contact Telephone Number Schedule 2 Services The Services to be provided under the terms of this Agreement include the following:

Responsible Party. Signature: ............................................................................................. Name: ................................................................................................. Date: .................................................................................................. Us Signature: ............................................................................................. Signed for and on behalf of: ........................................................................... Name: ................................................................................................. Position: General Manager / Deputy General Manager / Regional Director Date: .................................................................................................. Schedule 1 Admission Form and Fees Resident Details Name Date of Birth National Insurance Number Date of Occupation Type of Care Residential Care Nursing Care Type of Residency Permanent Respite Neighbourhood Residential Memory Care Room details For Respite Residents Days / Night Departure Date Respite Fee For Permanent Residents Service Total Weekly Fee (comprising a daily fee of £ x 7 Days) £ Nursing Service Fee, if any (comprising a daily fee of £ x 7 Days) £ Total Weekly Fee including nursing fee (comprising a daily fee of £ x 7 Days) £ Care Level Complete if applicable Your Payment £ Funding Authority Payment £ Responsible Party Payment £ Third Party Payment £ Responsible Party Name Address Contact Telephone Number Schedule 2 Services The Services to be provided under the terms of this Agreement include the following:2

Responsible Party. Signature: ............................................................................................. ................................................................................... Name: ................................................................................................. :. .. ......... .. ...... ..... .... .... ..... .... .... ................. ..... .... .... ..... .... . Date: .................................................................................................. .. .. ................ ..... .... .... ..... .... .... .... .................. .... .... ..... .... .. Us Signature: ............................................................................................. . .. .. .. .. .. ...... ..... .... .... ..... ................. .... .... ..... .... .... ..... .... Signed for and on behalf of: ........................................................................... of by Name: ................................................................................................. :......... .. .. ...... ..... .... .... ..... .... .... ................. ..... .... .... ..... .... .. Position: h General Manager / h Deputy General Manager / h Regional Director Date: .................................................................................................. ....................................................................................... Schedule 1 Admission Form and Fees Resident Details Name Date of Birth National Insurance Number Date of Occupation Type of Care h Residential Care h Nursing Care Type of Residency h Permanent h Respite Neighbourhood h Residential h Memory Care Room details For Respite Residents Days / Night Departure Date Respite Fee For Permanent Residents Service Daily Accommodation Services Fee (comprising a daily fee of £ x 7 Days) Daily Care Services Fee £ Daily Nursing Service Fee, if any (comprising a daily fee of £ x 7 Days) Services Fee £ Total Weekly Fee including nursing fee (comprising a daily fee of £ x 7 Days) £ Care Level Complete if applicable Your Payment £ Funding Authority Payment £ Responsible Party Payment £ Third Party Payment £ Responsible Party Name Address Contact Telephone Number Schedule 2 Services The Services to be provided under the terms of this Agreement include the following:2