Applicant Acknowledgement. The applicant hereby acknowledges to pay an application fee of $200 dollars an that all further costs incurred by the Municipality in processing the application shall be borne by the applicant. Date Applicant signature(s)
Applicant Acknowledgement. By signing below, the applicant acknowledges and agrees that, when signed and accepted by the Rust Foundation, this application represents a binding contract between the parties and commits the applicant to (i) payment of annual Membership dues and fees as determined from time to time by the Board of Directors, and (ii) comply with all the terms and conditions of Rust Foundation’s Certificate of Incorporation and By-laws (the applicant hereby acknowledging its access to these documents) and such rules and policies as the Board of Directors and/or committees may from time to time adopt. If applying for Silver membership, the applicant certifies that it has accurately stated its total, consolidated headcount in calculating the fees payable with respect to the Membership class, which it has selected above. The Rust Foundation may elect to avail itself of certain protections offered by the National Cooperative Research and Production Act of 1993, as amended, which requires disclosure of the names of all members of Rust Foundation. Accordingly, the undersigned hereby appoints such person who shall be the Chairperson or acting Chairperson of the Rust Foundation as the undersigned's true and lawful attorney-in-fact and authorizes him or her to (1) notify government agencies of the undersigned's membership in Rust Foundation, (2) make, approve the form of, execute and deliver filings with government agencies on behalf of Rust Foundation and on behalf of the undersigned as a member of Rust Foundation indicating such membership, (3) receive notifications, including without limitation, notifications pursuant to the National Cooperative Research and Production Act on behalf of Rust Foundation and on behalf of the undersigned as a member of Rust Foundation, and (4) authorize and direct other officers of, and/or counsel to Rust Foundation, to do any of the foregoing acts. Rust Foundation will forward to the undersigned any notifications that it receives which are other than normal confirmations of filings and other administrative notices relating to all members. Applicant Authorization: Accepted: RUST FOUNDATION (Company Name – Print) Signature Signature Name: Name: Title: Title:
Applicant Acknowledgement. The personal information collected on this form is collected in accordance with the Freedom of Information and Protection of Privacy Act. The City has authority to collect your information for the purposes of administering the Planning and Land Use Management process in accordance with Part 15 of the Local Government Act. Applicants are advised that all Planning and Land Use Management processes are public and any materials submitted become part of the public record. All information submitted may be used for reports to Council, available to the public upon request and distributed on the City’s website. Should you have any questions or concerns about the collection and/or release of your personal information please call the Supervisor of Development Services at 604.927.3430. By signing this application form, the applicant/owner attests that the information provided on this and supplemental application forms for land use permits from the City of Coquitlam is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application may result in an issued permit becoming null and void. I, the applicant/owner, certify that this application is being made with the full knowledge and consent of all owners of the property in question. Applicant Or Authorized Representative Name (Print) Signature Date Authorization of Applicant I hereby designate to act as my agent in matters related to this application. Owners Name (Printed): Owners Signature: Note: A letter of applicant authorization with the signatures of all owners will also be accepted. City of Coquitlam Heritage Revitalization Agreement Checklist This checklist must be followed and submitted with your application form. If the application is incomplete it will affect the processing time of the pending application. Please complete the application by initialling under “Copies Attached” to verify completion of each submittal requirement. City staff will review the checklist and application package. Only complete applications will be accepted and assigned to a file manager for review. Project Address: Forms, Fees and Technical Reports Document Copies Required Details Notes Copies Attached Accepted (Staff) Application Form 1 • A Heritage Revitalization Agreement application form must be completed and signed at time of submission. • Where the owner is a company, the signature required is from a representative with signing a...
Applicant Acknowledgement. By completing and signing this Application Form, I: • confirm that I have received, read and understood the JBWere Client Agreement, which includes the JBWere Agreement and the Broker Agreement, the associated documents referred to in the JBWere Client Agreement and the JBWere Financial Services Guide, WealthHub Securities Financial Services Guide and Best Execution Policy and agree to be bound by the provisions of the documents set out therein upon acceptance by JBWere and WealthHub Securities; • understand that failure to provide information required in this application may affect the success of this application or any further application I may make to JBWere; • agree that JBWere may act on instructions given on my behalf by my JBWere Advisor or my Authorised Person; and if I have a Margin Lending Facility, JBWere:
Applicant Acknowledgement. I have read and understand all of the provisions of this Enrollment Agreement and accept all such provisions and have been given a copy of the Enrollment Agreement for my records. I have also received and read a copy of the School Catalog and understand and accept all of the terms of that Catalog. I acknowledge that no verbal promises or statements contrary to the terms of the Enrollment Agreement or the School Catalog have been made to me by any employee or representative of the School.
Applicant Acknowledgement. I have read, understand and agree to all terms of this agreement. I have received, understand and will abide by information outlined in document titled “Propane Safety & Use Information Document”. I have been informed and acknowledge where to find sources of propane safety information. I also understand that it is my duty to inform and pass said safety information sources to anyone that may come in contact, use, repair, or participate with appliances, gas, materials, parts or piping related to the services and products provided by Ormonds. If I violate, disobey or do not act in accordance to one or any of the information listed in any of the sources for propane safety provided to me, or information within this application, I nor my affiliates cannot and will not hold Ormonds or its affiliates liable of any wrong doing or negligence.
