ACCEPTED AND AGREED TO BY. Xxxxxx Xxxxx
ACCEPTED AND AGREED TO BY. LICENSEE:
ACCEPTED AND AGREED TO BY. Reseller’s Full Legal Name
ACCEPTED AND AGREED TO BY. SOUTHERN NEVADA ANTHROPOMORPHIC EVENTS ALEXIS PARK ALL SUITE RESORT Xxxxxx Xxxxx Xxxxxxxxx Xxxxxx Convention Chair Sales Manager Signature Signature Date Date ALEXIS PARK ALL SUITE RESORT Xxxxxx Xxxxxxx Director of Sales Signature Date
ACCEPTED AND AGREED TO BY. SPONSOR THE CLEVELAND CLINIC FLORIDA
ACCEPTED AND AGREED TO BY. AEP Span, a Division of ASC Profiles Inc. Original Owner:
ACCEPTED AND AGREED TO BY. “you” or “Customer”
ACCEPTED AND AGREED TO BY. (Telephone Company Authorized Representative) ---------------------------- (Name of Telephone Company) EXHIBIT D State Administrators -------------------- California Department of Corporations ---------- 0000 Xxxxxxxx Xxxxxxxxx Xxxxx 000 Xxx Xxxxxxx, XX 00000 000-000-0000 Hawaii Director of Commerce and Consumer Affairs ------ 0000 Xxxxxxxx Xxxxxx Honolulu, HI 96813 000-000-0000 Illinois Illinois Attorney General's Office -------- 000 Xxxxx Xxxxxx Xxxxxx Xxxxxxxxxxx, XX 00000 000-000-0000 Indiana Indiana Secretary of State ------- 302 X. Xxxxxxxxxx Street, Room E-111 Xxxxxxxxxxxx, XX 00000 000-000-0000 Maryland Office of the Attorney General -------- Division of Securities 000 Xx. Xxxx Xxxxxx, 20th Floor Baltimore, MD 21202-2020 000-000-0000 Michigan Department of the Attorney General -------- Consumer Protection Division Franchise Section 000 Xxx Xxxxxxxx Xxxxxxx, XX 00000 000-000-0000 Minnesota Office of the Commissioner of Commerce --------- Department of Commerce 000 X Xxxxxxx Xxxxxx Xx. Xxxx, MN 55101 000-000-0000 New York New York State Department of Law -------- Bureau of Investor Protection and Securities 000 Xxxxxxxx, 00xx Xxxxx Xxx Xxxx, XX 00000 000-000-0000 State Administrators --------------------- (continued) ----------- North Dakota Securities Commissioner ------------ 000 Xxxx Xxxxxxxxx, 0xx Xxxxx Xxxxxxxx, XX 00000 000-000-0000 Oregon Department of Consumer and Business Services ------ Division of Finance and Corporate Securities Labor and Industries Xxxxxxxx Xxxxx, XX 00000 Rhode Island Department of Business Regulation ------------ Xxxxx 000, 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000-0000 000-000-0000 South Dakota Division of Securities ------------ 000 Xxxx Xxxxxxx Xxxxxx, XX 00000 000-000-0000 Virginia Division of Securities and Retail Franchising -------- Director, State Corporation Commission 0000 X. Xxxx Xxxxxx, 0xx Xxxxx Xxxxxxxx, XX 00000 000-000-0000 Washington Department of Financial Institutions ----------- Securities Division X.X. Xxx 0000 Xxxxxxx, XX 00000-0000 000-000-0000 Wisconsin Office of the Commissioner of Securities --------- X.X. Xxx 0000 Xxxxxxx, XX 00000 000-000-0000 EXHIBIT E Agents Authorized to Receive Service of Process ----------------------------------------------- California Commissioner of Corporations ---------- Department of Corporations 0000 Xxxxxxxx Xxxx., 0xx Xxxxx Xxx Xxxxxxx, XX 00000 Hawaii Director of Department of Commerce and Consumer Affairs ------ 0000 Xxxxxxxx Xxxxxx Honolulu, HI 96813 Illinois...
ACCEPTED AND AGREED TO BY. Oncternal Therapeutics, Inc. The University of Texas M. D. Xxxxxxxx Cancer Center
ACCEPTED AND AGREED TO BY. Name of Agent - Business Entity or Individual Name (please print) Signature of Agent or Authorized Officer, if Bueiness Entity Date Name of Upline - Business Entity or Indiviudal Name (please print) Title Signature of Upline or Authorized Officer, if Bueiness Entity Date Prosperity Life Group is a trade name representing various affiliates of the Prosperity Life Insurance Group, LLC, including the operating members listed above. Members not licensed in all states. Only SBLI USA Life Insurance Company, Inc. is licensed in New York. Each member is solely responsible for its financial condition and contractual obligations. APTCAAECW16 Page 1 of 1 7/2016 SBLI USA Life Insurance Company, Inc. S.USA Life Insurance Company, Inc. Shenandoah Life Insurance Company (Each the “Company”) This form is used to enable the Agent to designate a beneficiary to receive money due the Agent from the Company after the death of the Agent. Unless this form is completed and received by the Company prior to the Agent’s death, money due the Agent posthumously under the contract shall be paid in the following order of preference:
