Acknowledgement and Signature. I certify that the information set forth within this application is complete, true, and correct, to the best of my knowledge and belief, and that I will comply with the information set forth within this application. Acceptance of the application should in no way be construed as final approval or confirmation of the request. The Town of Xxxxxxxxx reserves the right to deny the application and it is revocable if deemed in the best interest of the Town of Xxxxxxxxx. Responsible Party (please print): Signature: Date: Xxxxxxxxx Xxxxxxx Patio Rental Fee Schedule Fees to be submitted with Special Event Application
Acknowledgement and Signature. The undersigned hereby attest(s) and agree(s) that the above application is for the purpose of opening an account with Noor Capital PSC, operating under the trade license No. 1003525, having its principal address at Xx-Xxxxxxxx Xxxxx X, Xxxxxx 000/000, Xxxxxx Xxxxx, Xxxxx the First Street, Khalidiyah, Abu Dhabi, UAE and/or any of its affiliates and/or subsidiaries (hereinafter referred to as "NOOR") and that such an account will be governed by the terms and conditions set forth within NOOR's Client Agreement. The undersigned further certifies that he/she/it has received a copy of NOOR's Client Agreement, Online Services and Electronic Trading Agreement, Risk Disclosure Statement and Terms of Business and has read, understands and agrees that all terms and conditions contained therein shall govern his/her/its business relationship with NOOR. The undersigned agrees and understands that NOOR retains the right to amend any and all Agreements at any time by means of proper notification. The undersigned hereby attest(s) and agree(s) that the above information is complete and accurate and certifies that the signature is genuine and that any photocopies, including copies of the verification of identity documents supplied are unaltered, exact copies of the corresponding originals. The undersigned hereby authorizes NOOR to verify any or all of the foregoing information through any means deemed proper by NOOR. Further, the undersigned hereby represent that he/she/it is age 21 years or older and that the information provided on this account application is true and accurate. He/she/it further represent to notify NOOR of any material changes to this application in writing. He/she/it can confirm not breaching any regulations of his/her/its country of residence in trading with NOOR. NOOR reserves the right, but has no duty, to verify the accuracy of information provided, and to contact any banks, agencies or others referenced on this application as it deems necessary. TRADER Name : Signature :
Acknowledgement and Signature. (All account owners/trustees must sign on the following page) By signing below: • I certify that I have received and read the current Prospectus, Statement of Additional Information, Declaration of Trust, By-Laws and Privacy Policy of the Fund in which I am investing and agree to be bound by its terms and conditions. I certify that I have the authority and legal capacity to make this purchase and that I am of legal age in my state of residence. • I authorize the Fund and its agents to act upon instructions (by phone, in writing or other means) believed to be genuine and in accordance with the procedures described in the Prospectus for this account. I agree that neither the Fund nor the Fund’s transfer agent will be liable for any loss, cost or expense for acting on such instructions. • I certify that I am not a Foreign Financial Institution as defined in the USA Patriot Act. AN INVESTMENT IN THE FUND IS SPECULATIVE WITH A SUBSTANTIAL RISK OF LOSS. THE FUND DOES NOT GUARANTEE ANY LEVEL OF RETURN OR RISK ON INVESTMENTS AND THERE CAN BE NO ASSURANCE THAT THE FUND’S INVESTMENT OBJECTIVE WILL BE ACHIEVED. AN INVESTMENT IN THE FUND ENTAILS SUBSTANTIAL RISKS, INCLUDING BUT NOT LIMITED TO: • LOSS OF CAPITAL, UP TO THE ENTIRE AMOUNT OF A SHAREHOLDER’S INVESTMENT. • THE FUND’S SHARES ARE ILLIQUID SECURITIES AND AN INVESTMENT IN THE FUND IS APPROPRIATE ONLY FOR THOSE INVESTORS WHO DO NOT REQUIRE A LIQUID INVESTMENT. • SHARES WILL NOT BE LISTED ON ANY NATIONAL OR OTHER SECURITIES EXCHANGE AND NO SECONDARY MARKET IS EXPECTED TO DEVELOP FOR SHARES OF THE FUND. • SHARES ARE SUBJECT TO SUBSTANTIAL RESTRICTIONS ON TRANSFERABILITY, AND LIQUIDITY, IF ANY, MAY BE PROVIDED BY THE FUND ONLY THROUGH REPURCHASE OFFERS, WHICH MAY, BUT ARE NOT REQUIRED TO, BE MADE FROM TIME TO TIME BY THE FUND AS DETERMINED BY THE FUND’S BOARD OF TRUSTEES IN ITS SOLE DISCRETION. • AN INVESTMENT IN THE FUND IS APPROPRIATE ONLY FOR THOSE INVESTORS WHO CAN TOLERATE A HIGH DEGREE OF RISK AND DO NOT REQUIRE A LIQUID INVESTMENT AND FOR WHOM AN INVESTMENT IN THE FUND DOES NOT CONSTITUTE A COMPLETE INVESTMENT PROGRAM. YOU SHOULD CAREFULLY CONSIDER THESE RISKS TOGETHER WITH ALL OF THE OTHER INFORMATION CONTAINED IN THE PROSPECTUS BEFORE MAKING A DECISION TO INVEST IN THE FUND. Under penalty of perjury, I certify that:
Acknowledgement and Signature. I understand that conversions from a Traditional IRA to a Roth IRA will be treated as a distribution and may be considered ordinary income for tax purposes. I have been advised to consult a tax professional and assume full responsibility for this conversion transaction and will not hold Computershare Trust Company, N.A. and its agents are not liable for any adverse consequences that may result. I understand that the resigning custodian will remit any income tax which has been withheld to the Internal Revenue Service on my behalf and I have made my election directly with them. I also understand that if I recharacterize, amounts previously withheld may only be refunded by the Internal Revenue Service. Amounts withheld may be subject to a 10% early withdrawal penalty in addition to income tax. By signing this IRA Transfer/Conversion Request Form, I certify that the information I have provided is true and correct. I authorize the current IRA Trustee/Custodian to transfer/convert the IRA assets as instructed above. I understand that I am responsible for ensuring I am eligible to authorize this transfer/conversion and I assume all responsibilities for any consequences that arise as a result of my actions. I agree to indemnify and hold the IRA Trustee/Custodian harmless from any consequences related to executing my directions. I have been advised to seek competent legal and tax advice, and have not been provided any such advice from the IRA Trustee/Custodian. Signature Date
Acknowledgement and Signature. By applying for and/or using the electronic banking services indicated above, I agree to the Terms and Conditions described above and certify that all information I furnish now and hereafter is true and complete; I authorize and consent to: (a.) investigation and verification of my application and account information, (b.) the Credit Union sharing such information with others including credit and check reporting agencies as well as Credit Union affiliates. I agree to be responsible for all charges, advances and other fees and to abide by all of the terms governing the services and my accounts. I understand that this application will remain the property of the Credit Union. By selecting the Online Banking service I understand and acknowledge that I have authorized The Bank Employees’ Credit Union (BECU) to provide electronic services as previously indicated. Use of the Online Banking service or other banking products shall be deemed to be my written authorization to charge, debit, or credit my account(s) for the amount and type of transaction(s) indicate at the time of use. Signature FOR OFFICIAL USE ONLY: Date Date Rec’d ID Verification Date Appv’d
Acknowledgement and Signature. By signing this Xxxxxxxxx ESA Transfer Request Form, I certify that I am the Responsible Individual, the information provided is true, correct and complete, and the Trustee/Custodian may rely on what I have provided. I understand that I am responsible for ensuring I am eligible to authorize this transfer and I assume all responsibilities for any consequences as a result of my actions. I have been advised to seek competent legal and tax advice and have not been provided any such advice from the Trustee/Custodian. I will indemnify and hold the Trustee/Custodian harmless from any consequences related to executing my directions. The Trustee/Xxxxxxxxx agrees to accept this transfer as instructed above. Responsible Individual Complete for Transfers (for internal use only): – Computershare Trust Company, N.A., agrees to serve as the new Custodian for the Xxxxxxxxx Education Savings Account of the above-named individual, and as Custodian we agree to accept the assets being transferred.
Acknowledgement and Signature. Prior to receipt of the Shares exercised in accordance with this Notice, I acknowledge that I have received a copy of the Plan and the prospectus for the Plan. Signature: Date: FOR COMPANY USE ONLY: Received by the Company on .
Acknowledgement and Signature. By my signature below, I verify that I have read, understand, and will abide by the requirements outlined here and I agree to provide the additional information required to complete my Housing Accommodation Request under the University’s Emotional Support Animal Policy. I have read and understand the Emotional Support Animal Policy and Agreement and I agree to abide by the requirements applicable to Emotional Support Animals. I understand that if I fail to meet the requirements set forth in the Policy, Indiana Tech has the right to remove the Emotional Support Animal and I will be nonetheless required to fulfill my housing, academic, and all other obligations for the remainder of the housing contract. I furthermore give permission to the Disability Services Office to disclose to others impacted by the presence of my Emotional Support Animal (e.g., Residence Life staff, Counseling Services staff, potential and/or actual roommate(s)/neighbor(s)) that I will be living with an animal as an accommodation. I understand that this information will be shared with the intent of preparing for the presence of the Emotional Support Animal and/or resolving any potential issues associated with the presence of the Emotional Support Animal. I further recognize that the presence of the Emotional Support Animal may be noticed by others visiting or residing in University Housing and agree that staff may acknowledge the presence of the animal and explain that under certain circumstances Emotional Support Animals are permitted for persons with disabilities. Student Printed Name Student Signature Date
Acknowledgement and Signature. I UNDERSTAND THAT THIS IS A LEGAL AGREEMENT that is binding upon myself and my heirs, executors, administrators, successors and assigns. I HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT and I ACKNOWLEDGE THAT by signing this agreement voluntarily, I am agreeing to abide by its terms and I am waiving certain legal rights that my child or I may have. This Consent, Authorization and Acknowledgment shall be effective from and including September 1, 2018 through August 31, 2019 or until cancelled in writing by the parents. Signature of Parent or Guardian (Under 18 years) Date Signature of Participant Date
Acknowledgement and Signature. I have read, understood, and agreed to all of the provisions in this Participation Agreement, including the Release and Hold Harmless and the Release of Information from Campus Health Services sections. This the day of , of 20 Club PID# Status: Student Faculty/Staff Community Sex: M F Participant's Name (Please Print) Participant's Signature Parent/Guardian Name (Please Print) Parent/Guardian Signature (if participant is under 18 years old) (if participant is under 18 years old) Participant’s Email Address Participant’s Phone Number
