Authorization and Signature Sample Clauses

Authorization and Signature. If more than one Owner is signing below, each of these Owners confirms having the power and authority to sign the Agreement on behalf of the Applicant and to legally bind the Applicant. If only one Owner is signing below, such Owner confirms having the power and authority to sign the Agreement on behalf of the Applicant and to legally bind the Applicant, in each case, acting alone. Signed as of the day of Month Year (PRINT) Applicant’s legal business name (Name of the sole proprietor, partnership or corporation) Signature: * Name of Owner: Title: Signature: * Name of Owner: Title: Signature: * Name of Owner: Title: * I/WE agree to be jointly and severally (in Quebec, solidarily) liable with the Applicant and the Owner(s) for all Debt charged to the Account. ® / ™ Trademark(s) of Royal Bank of Canada. RBC and Royal Bank are registered trademarks of Royal Bank of Canada. ‡ All other trademarks are the property of their respective owner(s).
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Authorization and Signature. The applicant warrants and represents that it has the authority to enter into the PLA and perform all its obligations provided thereunder and that it has obtained the appropriate consents or approvals from the Owner/Developer and further warrants that the execution of this application and the PLA applied for will not result in any conflict or violation under any material contract to which the applicant is party. I declare under penalty of perjury under the laws of the United States of America that the information in this Application is true and correct. Applicant’s Signature Print Name, Title Date Submitted
Authorization and Signature. I authorize QualChoice to initiate credit entries to my account at the financial institution indicated above. This authority is to remain in full force and effect until QualChoice has received written notification from me of its termination in such time and such manner as to afford QualChoice and the financial institution a reasonable opportunity to act on it, or until the bank has sent me ten (10) days’ written notice of the bank’s termination of this agreement. In order to initiate direct deposit, I understand that I must sign this form and submit to QualChoice with a VOIDED check attached. Employee Signature x Date Signed MAIL or FAX with VOIDED CHECK QualChoice, ATTN: FSA Department, P.O. Box 25610 • Little Rock, AR 72221 • (F) 501.228.0135 (P) 501.228.7111 OR 800.235.7111 • xxx.xxxxxxxxxx.xxx
Authorization and Signature. By completing and executing this Election Agreement, Employee authorizes the Company to defer or not defer, as applicable, the issuance of the shares subject to the RSU award. Employee acknowledges that the Company has not made any representations concerning future performance of the Company’s Common Stock. Further, Employee has not relied upon advice from the Company in making Employee’s election. By executing this Election Agreement, the Employee hereby acknowledges his or her understanding of and agreement with all the terms and provisions set forth herein. Employee Neurocrine Biosciences, Inc. By: Name: Title: Date: Date: EXHIBIT B Deferred Compensation Plan Deferral Election Agreement (RSU Awards) Please complete this Deferred Compensation Plan Deferral Election Agreement (“Election Agreement”) and return a signed copy to Sxxxx Xxx no later than the thirtieth (30th) day following the Effective Date as indicated on your Restricted Stock Unit Agreement (“RSU Agreement”). Defined terms not explicitly defined in this Election Agreement but defined in the Company’s 2003 Incentive Stock Plan (“Plan”), the Company’s Amended and Restated Nonqualified Deferred Compensation Plan (“Deferred Compensation Plan”), or your RSU Agreement shall have the same definitions as in such documents.
Authorization and Signature. By completing and executing this Election Agreement, Employee authorizes the Company to defer or not defer, as applicable, the issuance of the shares subject to the RSU award. Employee acknowledges that the Company has not made any representations concerning future performance of the Company’s Common Stock. Further, Employee has not relied upon advice from the Company in making Employee’s election. Additionally, Employee acknowledges that the terms of the Deferred Compensation Plan document, as reasonably interpreted by the Company, governs all aspects of this election. By executing this Election Agreement, the Employee hereby acknowledges his or her understanding of and agreement with all the terms and provisions set forth herein. • Signature of Employee Date Exhibit C Beneficiary Designation Personal Information
Authorization and Signature. By signing below, the Adopting Employer, by its duly authorized officer or other representative, hereby agrees to the provisions of the Plan, including the provisions set forth in this Adoption Agreement on this day of , 20 ADOPTING EMPLOYER Name (please print) Title Signature Please return a copy of the completed, signed Adoption Agreement to EPC Benefit Resources, Inc. Scan and email to xxxxxxxx@xxx.xxx, fax to (000) 000-0000, or mail to: EPC Benefits Resources, Inc. 0000 X.X. Xxx Blvd., Suite 510 Orlando, FL 32822
Authorization and Signature. If more than one Signing Authority is signing below, each of these Signing Authorities confirms having the power and authority to sign the Agreement on behalf of the Applicant and to legally bind the Applicant. If only one Signing Authority is signing below, such Signing Authority confirms having the power and authority to sign the Agreement on behalf of the Applicant and to legally bind the Applicant, in each case, acting alone. Signed as of the day of , Month Year Applicant’s legal business name Signature: Name: Title: Signature: Name: Title: Signature: Name: Title: Signature: Name: Title: ® / ™ Trademark(s) of Royal Bank of Canada. RBC and Royal Bank are registered trademarks of Royal Bank of Canada. ‡ All other trademarks are the property of their respective owner(s).
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Authorization and Signature. I authorize QualChoice to initiate credit entries to my account at the financial institution indicated above. This authority is to remain in full force and effect until QualChoice has received written notification from me of its termination in such time and such manner as to afford QualChoice and the financial institution a reasonable opportunity to act on it, or until the bank has sent me ten (10) days’ written notice of the bank’s termination of this agreement. In order to initiate direct deposit, I understand that I must sign this form and submit to QualChoice with a VOIDED check attached. Employee Signature x Date Signed MAIL or FAX with VOIDED CHECK QualChoice | ATTN: FSA Department | P.O. Box 25610 | Little Rock, AR 72221 | F: 501.707.6845 or 855.800.0938 | XxxxXxxxxx.xxx 0911CL026A_02 (11/14) Non-Discrimination and Accessibility Notice QualChoice complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. QualChoice does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. QualChoice:  Provides free aids and services to people with disabilities to communicate effectively with us, such as: o Qualified sign language interpreters o Written information in other formats (large print, audio, accessible electronic formats, other formats)  Provides free language services to people whose primary language is not English, such as: o Qualified interpreters o Information written in other languages If you need these services, contact Customer Service at (000) 000-0000. If you believe that QualChoice has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: QualChoice Civil Rights Coordinator QualChoice P.O. Box 25610 Little Rock, AR 72221-5610 (000) 000-0000 Fax #: 000-000-0000 XXX_XXX@xxxxxxxxxx.xxx You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the QualChoice Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 000 Xxxxxxxxxxxx Xxxxxx XX., ...
Authorization and Signature. Employer hereby adopts and agrees to the provisions of the RCA Plan Document, as well as any provisions regarding the RCA Plan Document that may be set forth in this Adoption Agreement. (Print Name of Employer) By: (Print Name and Apply Signature of Employer’s Authorized Officer or Agent) Title: (Print Title of Employer’s Authorized Officer or Agent) Date: To be completed by Board staff: Church ID #: Division Code #: RETURNING THE APPLICATION The Employer should retain a copy of this Adoption Agreement, along with a copy of the RCA Plan Document. Send the fully completed and signed Adoption Agreement to the address below: U.S. Mail Board of Benefits Services Reformed Church in America 000 Xxxxxxxxx Xxxxx, Xxxxx 0000 Xxx Xxxx, XX 00000 000-000-0000 (telephone) 000-000-0000 (fax) xxxxxxxxxx@xxx.xxx (email) 403(B)(9) PLAN ADMINISTRATIVE APPENDIX
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