ADMISSION REQUEST. Before signing this Admission Request, please read the Residence Terms set out in Part 2 on page 8 onwards. (Please ask for an explanation of any areas that you do not understand). Resident’s Name: Resident’s Address: Date of Birth: / / Method of payment: £ Resident Third Party Liability OR Council/other Public Funding £ £ £
ADMISSION REQUEST. Before signing this Admission Request, please read the Residence Terms set out in Part 2 on page 8 onwards. (Please ask for an explanation of any areas that you do not understand). Resident’s Address: Date of Birth: / / Method of payment: Direct Debit Normal annual fee rate change: 1st April
ADMISSION REQUEST. Before signing this Admission Request, please read the Residence Terms set out in Part 2 on page 8 onwards. (Please ask for an explanation of any areas that you do not understand). Resident’s Address: Date of Birth: / / Method of payment: OR Council/other Public Funding £ Name and Address of Guarantor:
ADMISSION REQUEST. Please read the Residence Terms set out in Part 2 below carefully before signing this Agreement (which, together with this Admission Request form part of the contract between us). Please ask for an explanation of any areas that you do not understand. The following details, together with the Residence Terms in Part 2, form the Agreement which applies to the admission of the Resident named below as a Resident of the Care Home. Mr/Mrs/Miss/Ms/Dr/Rev/Other Direct Debit By the time of your admission to the Care Home the Resident and any Third Party Contributor must have a direct debit in place for payment. Liability for funding/sources (weekly) for Residential Fees (including any contributions to Council Funding ) Total net weekly fee (being Resident Fees)
ADMISSION REQUEST. Please read the Residence Terms set out in Part 2 below carefully before signing this Agreement (which, together with this Admission Request form part of the contract between us). Please ask for an explanation of any areas that you do not understand. The following details, together with the Residence Terms in Part 2, form the Agreement which applies to the admission of the Resident named below as a Resident of the Care Home. Mr/Mrs/Miss/Ms/Dr/Rev/Other Direct Debit 4 weeks after your admission to the Care Home the Resident and any Third Party Contributor must have a direct debit in place for payment. Interest is charged on late payments at the rate of 4% above HSBC Bank’s base rate from time to time. Name and Address of Resident’s Attorney under a power of attorney (if any) or Resident’s Representative: Liability for funding/sources (weekly) for Residential Fees (including any contributions to Council Funding )
ADMISSION REQUEST. Before signing this Admission Request, please read the Residence Terms set out in Part 2 on page 8 onwards. (Please ask for an explanation of any areas that you do not understand). Resident’s Address: Date of Birth: / / Method of payment:
