Additional Information Required. If additional information is required, a Service representative will generally contact the Plan Sponsor or the Plan Sponsor's representative and explain what is needed to complete the submission. The Plan Sponsor will have 21 calendar days from the date of this contact to provide the requested information. If the information is not received within 21 days, the matter will be closed, the compliance fee will not be returned, and the case may be referred to Employee Plans Examinations. Any request for an extension of the 21-day time period must be made in writing within the 21-day time period and must be approved by the Service (by the applicable group manager).
Additional Information Required. OWNERSHIP (%): Male Female RACE: (Voluntary) American Indian or Alaska Native Asian Black or African-American Native Hawaiian or Pacific Islander White ETHNICITY (Voluntary) Hispanic or Latino VETERAN STATUS: Veteran Non-Veteran Primary Business Activity: NAICS Annual Sales in Last Fiscal Year: Year Business Established: Total Full Time Employees (2 half time employees equals 1 full time employee): Estimated Jobs Created by this Loan over next 3 years: Estimated Jobs Retained by this Loan over next 3 years: Does the Borrower, including any parent or subsidiary or affiliated entity, in Virginia: have 250 or fewer employees? Yes No Current # OR have less than $10,000,000 in annual gross revenues over each of the last three (3) fiscal years? Yes No OR have less than $2,000,000 in net worth? Yes No If the answer to any of the following questions is “yes”, please furnish details on an attached sheet. Have any owners, officers, directors, guarantors, general partners, stockholders or limited partners owning 20% or more of the Borrower ever been charged with, or convicted of, any criminal offense, other than minor motor vehicle violations? Yes No Has the Borrower or management of the Borrower been informed of any current or on-going investigation of the Borrower with respect to possible violations of state or federal securities laws? Yes No Has the Borrower or any owners, officers, directors, guarantors, general partners, stockholders of limited partners owning 20% or more of the Borrower been in receivership or adjudicated as bankrupt? Yes No Is the Borrower or any of its owners, officers, directors, guarantors, general partners, stockholders or limited partners owning 20% or more of the Borrower involved in any pending lawsuits? Yes No Does the Borrower or any guarantors owe past due federal, state or local taxes of any nature? Yes No
Additional Information Required. Does the student require any special accommodations to participate in the classroom phase (i.e., test being read to him/her, an interpreter, seating arrangements, etc.)? Yes No If Yes, please explain:
Additional Information Required. Emergency Contact:
Additional Information Required. Student Gender: Male Female
Additional Information Required. The Participant must provide the following additional information to the Administrator demonstrating that no portion of the rollover contribution contains after-tax contributions or earnings:
(1) A statement signed under penalty of perjury by the Participant certifying that the rollover contribution contains no after-tax contributions or earnings; or
(2) A signed certification from the transferring plan's administrator or the Participant’s accountant or tax advisor that the rollover contribution contains no after-tax contributions or earnings; If an Eligible Participant does not provide such information, the Plan will not accept the rollover. The Administrator has final discretionary authority to determine whether any required information or documentation is satisfactory and whether the Plan will accept a Participant’s rollover contribution.
Additional Information Required. Family Doctor: Telephone:
Additional Information Required. The parties acknowledge that associated with Level "B" and/or Level "C" Plan approvals more detailed information will be provided to the City to make an accurate determination of the long-term cumulative impacts of the development of the Level "A" Property, as well as to make a determination of the adequacy of basic services necessary to serve the future residents of the Level "A" Property.
Additional Information Required. If you are requesting multiple dates and times includes multiple days and/or varying times, please attach a schedule.
Additional Information Required. Applicant shall complete the official LEDC Building Improvement Loan/Grant application, sign and approve the loan/grant agreement, submit a $50 application fee and submit the following required documents with the application:
