Certification, Authorization, and Signature Sample Clauses

Certification, Authorization, and Signature. (s) Authorization I/we hereby apply for membership in Merck Sharp & Dohme Federal Credit Union and agree to conform to its laws and amendments and to subscribe to at least one share. I/we agree to the terms and conditions printed on the reverse side of this form, as well as the Membership and Account Agreement, Truth-in-Savings Rate and Fee Schedule, Funds Availability Policy Disclosure, if applicable, and to any amendment the credit union makes from time to time which are incorporated herein. I/we acknowledge receipt of the copy of the Agreement and Disclosures applicable to the accounts and services requested herein made available on our website at xxx.xxxxxx.xxx or upon request. If a Visa® Debit Card or EFT service is requested and provided, I/we agree to the terms and acknowledge receipt of the Electronic Funds Transfer Agreement. Certification of Taxpayer Identification Number and Backup Withholding Under penalties of perjury, I/we certify that (1) the number(s) shown on this form is my/our correct taxpayer identification number, (2) I am/we are not subject to backup withholding because: (a) I am/we are exempt from backup withholding, or (b) I/we have not been notified by the Internal Revenue Service (IRS) that I am/ we are subject to backup withholding as a result of failure to report all interest or dividends, or (c) the IRS has notified me/us that I am/we are no longer subject to backup withholding, and (3) I am/we are a U.S. person (including a U.S. resident alien). Instructions: Cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you failed to report all interest and dividends on your tax return. Complete a W-8 BEN if you are not a U.S. person. Joint Owner Account Agreement MSDFCU is hereby authorized to recognize any of the signatures subscribed hereto in payment of funds or the transaction of business for this account. The joint owners of this account hereby agree with each other and with said credit union that all sums now paid in on savings, heretofore or hereafter paid in on savings by any or all said joint owners to their credit as such joint owners with all accumulations thereon, are and shall be owned by them jointly with right of survivorship and be subject to the withdrawal or receipt of any of them, and payment to any of them or the survivor(s) shall be valid and discharge said credit union from any liability for such payment. Any or all of said joint owners may pledg...
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Certification, Authorization, and Signature. By submitting this Claim Form, I agree to be bound by the terms of the Agreement and the jurisdiction of the Special Master, and the court presiding over MDL No. 1964, the federal multi-district litigation venued in the United States District Court for the Eastern District of Missouri (the “MDL Court”) (or the New Jersey Coordinated Proceeding Court, should the MDL Court lack subject matter jurisdiction), with regard to all matters pertaining to the Agreement and the Program contained therein. I agree that the Special Master will hea motions to dismiss claims that fail to comply with the Agreement and make recommendations to the court in which my case is pending. I also agree that appeals of determinations by the Claims Administrator as to whether a Claimant is eligible for payment under the terms of the Master Settlement Agreement will be resolved by the Special Master, and that the Special Master’s decisions will be binding on the parties. I acknowledge that the Special Master’s rulings on these appeals are separate from recommendations he makes as a Special Master on appointment from the MDL Court, New Jersey Coordinated Proceeding Court, or other court. By executing this form, I acknowledge that I have been fully advised of my rights under the Agreement and elect to participate in the Program, and that such election is irrevocable. I declare under penalty of perjury subject to 28 U.S.C. § 1746 that all of the information provided in this Claim Form is true and correct. Claimant’s Signature Date / / (month) (day) (year) Printed Name First MI Last Authorization to Release Records and Other Information IN RE NUVARING® PRODUCTS LIABILITY41L5I3T8IGATION APPENDIX E-2 Authorization to Release Records and Other Information Patient Name First Middle Initial Last Date of Birth: / / (Month/Day/Year) Social Security No. | | | | - | | | - | | | | | Provider’s Name (or Class of Providers): Recipient: Provider Address: Recipient Address:
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Certification, Authorization, and Signature. Dominion Energy Virginia will treat all information, including financial statements, provided pursuant to the Shared Solar Subscriber Organization’s registration in a confidential manner. The Company, however, may be required to disclose some or all of such information to the Virginia State Corporation Commission or pursuant to a court order. Applicant will notify Dominion Energy Virginia’s Shared Solar Program’s administrator if any license, financial or other information changes. Applicant acknowledges that this Shared Solar Program Subscriber Organization Registration Agreement is the initial registration process and the SO will be required to enter into a Subscriber Organization Coordination Agreement. Applicant acknowledges that only complete registration forms with required attachments will be considered complete in order for SO to be considered for the program capacity queue. Applicant acknowledges that when notified by Dominion Energy Virginia that the SO’s Shared Solar Facility is awarded capacity in the program queue, the SO shall pay Dominion Energy Virginia a security deposit of $50 per kilowatt (kW) of alternating-current rated capacity of the Shared Solar Facility within 10 days (unless exempt if SO deemed bona fide nonprofit). The Company will accept a bond on the Company's bond form in lieu of the cash deposit. Applicant acknowledges that if a project fails to reach mechanical completion within 24 months of the date it was awarded capacity, the project will be removed from the program queue unless the SO provides an additional deposit of $25 per kW for the project to maintain its position in the program queue. The Company will accept a bond on the Company’s bond form in lieu of the cash deposit. The Applicant also acknowledges that if, after paying the additional deposit or submitting the Supplemental bond, the project still fails to reach mechanical completion within an additional 12 months, Dominion Energy Virginia will remove the project from the program queue. Applicant certifies that the information herein is complete and accurate to the best of the Applicant's knowledge, information, and belief, and that the individual signing below is an authorized representative of the Subscriber Organization. Applicant hereby authorizes Dominion Energy Virginia to obtain any information that may be required relative to the Applicant from any source, including Applicant's financial and trade references. Applicant also hereby authorizes each source t...
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Related to Certification, Authorization, and Signature

  • Representation on Authority of Parties/Signatories Each person signing this Agreement represents and warrants that he or she is duly authorized and has legal capacity to execute and deliver this Agreement. Each Party represents and warrants to the other that the execution and delivery of this Agreement and the performance of such Party’s obligations hereunder have been duly authorized and that this Agreement is a valid and legal agreement binding on such Party and enforceable in accordance with its terms.

  • Information Authorization Your enrollment in the applicable Service may not be fulfilled if we cannot verify your identity or other necessary information. Through your enrollment in or use of each Service, you agree that we reserve the right to request a review of your credit rating at our own expense through an authorized bureau. In addition, and in accordance with our Privacy Policy, you agree that we reserve the right to obtain personal information about you, including without limitation, financial information and transaction history regarding your Eligible Transaction Account. You further understand and agree that we reserve the right to use personal information about you for our and our Service Providers’ everyday business purposes, such as to maintain your ability to access the Service, to authenticate you when you log in, to send you information about the Service, to perform fraud screening, to verify your identity, to determine your transaction limits, to perform collections, to comply with laws, regulations, court orders and lawful instructions from government agencies, to protect the personal safety of subscribers or the public, to defend claims, to resolve disputes, to troubleshoot problems, to enforce this Agreement, to protect our rights and property, and to customize, measure, and improve the Service and the content and layout of the Site. Additionally, we and our Service Providers may use your information for risk management purposes and may use, store and disclose your information acquired in connection with this Agreement as permitted by law, including (without limitation) any use to effect, administer or enforce a transaction or to protect against or prevent actual or potential fraud, unauthorized transactions, claims or other liability. We and our Service Providers shall have the right to retain such data even after termination or expiration of this Agreement for risk management, regulatory compliance, or audit reasons, and as permitted by applicable law for everyday business purposes. In addition, we and our Service Providers may use, store and disclose such information acquired in connection with the Service in statistical form for pattern recognition, modeling, enhancement and improvement, system analysis and to analyze the performance of the Service. The following provisions in this Section apply to certain Services:

  • Deduction Authorization The Employer agrees to deduct an amount equal to the membership dues from the salary of employees who authorize such deduction within thirty (30) days of the receipt of written notice from the Union that the employee has authorized dues deductions. The Employer will honor the terms and conditions of each employee’s signed membership card. The Employer will provide payments for the deductions to the account directed by the Union each pay period.

  • Execution Authority With respect to any limited liability company, corporation, partnership, trust, estate or any other entity other than an individual or group of individuals (“Entity”) identified on the Signature Page as a party to this Agreement (or as a partner, member, manager or fiduciary signing on behalf of a party to this Agreement), such Entity and each individual and/or Entity purporting to sign this Agreement on behalf of such Entity jointly and severally promise, represent and warrant that: (a) such Entity has full power and authority to execute this Agreement; (b) all action has been taken and all approvals and consents have been obtained which may be required to properly authorize the execution of this Agreement on behalf of such Entity; (c) the individual(s) purporting to sign this Agreement on behalf of such Entity has/have full power and authority to execute this Agreement on behalf of (and as the binding act of) such Entity; and (d) this Agreement has been properly executed on behalf of (and as the binding act of) such Entity.

  • Notification to Union The Hospital will provide the union with a list, monthly of all hirings, lay-offs, recalls and terminations within the bargaining unit where such information is available or becomes readily available through the Hospital's payroll system."

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