Investigator Request Form and Payment Instructions Sample Clauses

Investigator Request Form and Payment Instructions. F ormulář pro zkoušejícího a platební pokyny. 8.1. CRO shall send, via e-mail transmission, an electronic version of the Investigator Request Form to the Institution to the e-mail address . This e-mail will also contain details of where to return the completed version of the electronic format CRO zašle poskytovateli zdravotních služeb e-mailem elektronickou verzi formuláře pro zkoušející (IRF) na e- mailovou adresu . Tento e-mail bude obsahovat údaje o tom, kam se má vyplněný formulář v elektronickém formátu odeslat. 8.2. The Institution shall complete the electronic version of the Poskytovatel zdravotních služeb vyplní elektronickou verzi Investigator Request Form and return it to CRO via e-mail transmission, at the email address specified in the e-mail referred to in Section 8.1 above. formuláře pro zkoušející (IRF) a vrátí jej CRO e-mailem, na adresu uvedenou v e-mailu popsaném v odstavci 8.1 výše. 8.3. Payments shall be made by CRO and shall be paid within sixty (60) days of receipt, review and approval of an original invoice in the form shown in Exhibit C. Výplata odměny bude provedena CRO, a to do šedesáti (60) dnů od obdržení, zkontrolování a schválení originálu faktury ve formátu uvedeném v Příloze C. 8.4. To expedite faster payment turnaround, please electronically email invoices in the format shown in Exhibit C to CRO at the following email address: Pro urychlení plateb, zasílejte prosím faktury CRO e-mailem ve formátu uvedeném v Příloze C, a to na následující e- mailovou adresu If for some reason electronic e-mail transmission is not possible then please send invoices in the format shown in Exhibit C to the following postal address: PAREXEL International (IRL) Limited One Xxxxxxxxxx Xxxxxx Xxxxxxxxx Xxxx Xxxxxxxxxx Xxxxxx 0 Ireland Pokud není z nějakého důvodu zaslání elektronickou poštou možné, zašlete prosím faktury ve formátu uvedeném v Příloze C na následující poštovní adresu: PAREXEL International (IRL) Limited One Xxxxxxxxxx Xxxxxx Xxxxxxxxx Xxxx Xxxxxxxxxx Xxxxxx 0 Ireland Invoices submitted for Services performed and expenses incurred in an EU jurisdiction must not have VAT applied (unless the payee is established in the Republic of Ireland). Na fakturách za poskytnuté služby a vyúčtování nákladů vzniklých v některé z členských zemí Evropské unie nesmí být účtována DPH (daň z přidané hodnoty) (toto neplatí, pokud je plátce společností se sídlem na území Irské republiky). Please note that invoices, preferably in English to facilitate fast...
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Investigator Request Form and Payment Instructions. 7.1 CRO shall send, via e-mail transmission, an electronic version of the Investigator Request Form to the Institution. This e-mail will also contain details of where to return the completed version of the electronic format. 7.2 The Institution shall complete the electronic version of the Investigator Request Form and return it to CRO, via e-mail transmission, at the email address specified in the e-mail referred to in Section 7.1 above. 7.3 Payments shall be made by CRO on behalf of SPONSOR and shall be paid within sixty (60) days of receipt, review and approval of an original invoice* submitted to the following address:
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Investigator Request Form and Payment Instructions. 7.1 PAREXEL shall send, via e-mail transmission, an electronic version of the Investigator Request Form to the Institution. This e-mail will also contain details of where to return the completed version of the electronic form. 7.2 T he Institution shall complete the electronic version of the Investigator Request Form and return it to CRO, via e-mail transmission, at the email address specified in the e-mail referred to in Section 1.) above. 7.3 PAREXEL shall insert a paper copy of the completed Investigator Request form as Attachment 1. 7.4 Payments shall be made by PAREXEL on behalf of SPONSOR and shall be paid within sixty (60) days of receipt, review and approval of an original invoice* submitted to the following address: PAREXEL International Czech Republic s.r.o. Sokolovská 651/136 a 186 00 Praha 8 Czech Republic 208695 DEX-TRA-04 SVK 42102 CSA KopcanB Bilingual 20130528 0,3 Slovakia_Inst_PI_CSA_V2.6_Bilingual Please note that invoices* must contain the following information: (a) Protocol Number; and
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Investigator Request Form and Payment Instructions. PAREXEL shall send, via e-mail transmission, an electronic version of the Investigator Request Form to the Institution. This e-mail will also contain details of where to return the completed version of the electronic form.
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Investigator Request Form and Payment Instructions. 6.1 TFS shall send, via e-mail transmission, an electronic version of the Investigator Request Form to the Institution. This e-mail will also contain details of where to return the completed version of the electronic format. 6.2 The Institution shall complete the electronic version of the Investigator Request Form and return it to TFS, at the address specified in the Section 6.4 below. 6.3 TFS shall insert a paper copy of the Investigator Request form as Attachment 1 6.4 Payments shall be made by TFS on behalf of SPONSOR and shall be paid within thirty (30) days of receipt, review and approval of an original invoice* submitted to the following address:
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Investigator Request Form and Payment Instructions. 7.1 TFS shall send, via e-mail transmission, an electronic version of the Investigator Request Form to the Institution and Investigator . This e-mail will also contain details of where to return the completed version of the electronic format. 7.2 The Institution and Investigator shall complete the electronic version of the Investigator Request Form and return it to TFS, via e-mail transmission, at the email address specified in the e-mail referred to in Section 7.1 above. 7.3 TFS shall insert a paper copy of the Investigator Request form as Attachment 1. 7.4 Payments shall be made by TFS on behalf of SPONSOR and shall be paid within sixty (60) days of receipt, review and approval of an original invoice* submitted to the following address:
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Investigator Request Form and Payment Instructions. Formulár žiadosti skúšajúceho a pokyny týkajúce sa 8.1. CRO shall send, via e-mail transmission, an electronic version of the Investigator Request Form to the Institution. This e-mail will also contain details of where to return the completed version of the electronic format 8.2. The Institution shall complete the electronic version of the Investigator Request Form and return it to CRO via e-mail transmission, at the email address specified in the e-mail referred to in Section 8.1 above. 8.3. Payments shall be made by CRO and shall be paid within sixty (60) days of receipt, review and approval of an original invoice in the form shown in Exhibit C. 8.4. To expedite faster payment turnaround, please electronically email invoices in the format shown in Exhibit C to CRO at the following email address: Invoices submitted for Services performed and expenses incurred in an EU jurisdiction must not have VAT applied (unless the payee is established in the Republic of Ireland). (a) Protocol Number; and číslo protokolu, (b) Invoice Number; and číslo faktúry, (c) Invoice Date; and dátum vystavenia faktúry, (d) Date & Description of Services Provided; and dátum a opis poskytovaných služieb, (e) CRO Project Number; and číslo projektu CRO; a (f) Total amount payable; and celkovú sumu na zaplatenie, (g) Exchange rate used (where applicable); and použitý výmenný kurz (v prípade potreby), (h) Investigator Name; and meno skúšajúceho, (i) Site Number; and číslo pracoviska, (j) Payee Name and Address (per this Agreement); and meno príjemcu a adresa (za tejto zmluvy), (k) CRO Address listed above vyššie uvedenú adresu CRO. Invoices and associated documentation should be de- identified of patient personal information (e.g. name, date of birth, initials, etc.) prior to being submitted to CRO. Where the payee is VAT/GST registered then the following information should also be provided: (a) VAT / GST registration number of the supplier (payee), prefixed with their country code (if applicable); and (b) Name, address and Irish VAT registration number of the customer (CRO) (unless the payee is established in the Republic of Ireland); (c) On the face of the invoice the words “Reverse Charge” (unless the payee is established in the Republic of Ireland) Form of Invoice is set forth in Exhibit C (unless the payee is established in the Republic of Ireland). Faktúry a súvisiaca dokumentácia nesmú obsahovať identifikačné osobné údaje pacienta (napr. meno, dátum narodenia, iniciály atď.) a až...
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Related to Investigator Request Form and Payment Instructions

  • Payment Instructions Agent shall have received written instructions from Borrowing Agent directing the application of proceeds of the initial Advances made pursuant to this Agreement;

  • Disbursement Instructions Xxxxxxxx understands that no loan proceeds will be disbursed until all of Xxxxxx’s conditions for making the loan have been satisfied. Please disburse the loan proceeds of $479,984.97 as follows: Other Disbursements: $ 479,984.97 $479,984.97 CURRENT BALANCE AFTER $150,000.00 PRINCIPAL PAYDOWN Note Principal: $ 479,984.97 CHARGES PAID IN CASH. Xxxxxxxx has paid or will pay in cash as agreed the following charges: Prepaid Finance Charges Paid in Cash: $ 0.00 Other Charges Paid in Cash: $ 154,919.90 $1,000.00 LOAN FEE $3,919.90 INTEREST DUE MARCH 3, 2010 $150,000.00 PRINCIPAL PAYDOWN Total Charges Paid in Cash $ 154,919.90 FINANCIAL CONDITION. BY SIGNING THIS AUTHORIZATION, XXXXXX REPRESENTS AND WARRANTS TO THE LENDER THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT AND THAT THERE HAS BEEN NO MATERIAL ADVERSE CHANGE IN BORROWER’S FINANCIAL CONDITION AS DISCLOSED IN BORROWER’S MOST RECENT FINANCIAL STATEMENT TO LENDER. THIS AUTHORIZATION IS DATED MARCH 3, 2010 ICOP DIGITAL, INC By: /s/ Xxxxx X. Xxxx XXXXX X. XXXX, Chairman & CEO of ICOP DIGITAL, INC DESCRIPTION OF EXISTING INDEBTEDNESS. PROMISSORY NOTE DATED MARCH 3, 2008 IN THE AMOUNT OF $780,000.00 TOGETHER WITH ANY AND ALL RENEWALS/MODIFICATIONS THEREOF (“NOTE”). DESCRIPTION OF CHANGE IN TERMS. EXTEND THE MATURITY DATE FROM MARCH 3, 2010 TO MARCH 3, 2011; DECREASE CURRENT PRINCIPAL BALANCE FROM $629,985.97 TO $479,984.97. PROMISE TO PAY. ICOP DIGITAL, INC (“Borrower”) promises to pay to Bank of Blue Valley (“lender”), or order, in lawful money of the United States of America, the principal amount of Four Hundred Seventy~nine Thousand Nine Hundred Eighty~four & 97/100 Dollars ($479,984.97), together with interest on the unpaid principal balance from March 3, 2010, calculated as described in the “INTEREST CALCULATION METHOD” paragraph using an interest rate of 8.000% per annum based on a year of 360 days, until paid in full. The interest rate may change under the terms and conditions of the “INTEREST AFTER DEFAULT” section.

  • Suspension or Debarment Instructions Instructions for Certification 1. By answering yes to the next Attribute question below, the vendor and prospective lower tier participant is providing the certification set out herein in accordance with these instructions.

  • Form instructions This form does not mandate the use of a specific font size or style but the font must be legible.

  • SETTLEMENT INSTRUCTIONS The undersigned Holder directs that a certificate for shares of Common Stock deliverable upon settlement on or after the Stock Purchase Date of the Purchase Contracts underlying the number of Normal Units evidenced by this Normal Units Certificate (after taking into account all Units then held by such Holder) be registered in the name of, and delivered, together with a check in payment for any fractional share, to the undersigned at the address indicated below unless a different name and address have been indicated below. If shares are to be registered in the name of a Person other than the undersigned, the undersigned will pay any transfer tax payable incident thereto. Dated: ------------------ ----------------------------------------- Signature Signature Guarantee: --------------------- Signatures must be guaranteed by an "eligible guarantor institution" meeting the requirements of the Registrar, which requirements include membership or participation in the Security Transfer Agent Medallion Program ("STAMP") or such other "signature guarantee program" as may be determined by the Registrar in addition to, or in substitution for, STAMP, all in accordance with the Securities Exchange Act of 1934, as amended. If shares are to be registered in the REGISTERED HOLDER name of and delivered to a Person other than the Holder, please (i) print such Person's name and address and (ii) provide a guarantee of your signature: PLEASE PRINT NAME AND ADDRESS OF REGISTERED HOLDER: --------------------------- ----------------------------- Name Name --------------------------- ----------------------------- --------------------------- ----------------------------- --------------------------- ----------------------------- Address Address -------------------------------------------------------------------------------- Social Security or other Taxpayer Identification Number, if any ELECTION TO SETTLE EARLY The undersigned Holder of this Normal Units Certificate hereby irrevocably exercises the option to effect Early Settlement in accordance with the terms of the Purchase Contract Agreement with respect to the Purchase Contracts underlying the number of Normal Units evidenced by this Normal Units Certificate specified below. The option to effect Early Settlement may be exercised only with respect to Purchase Contracts underlying Normal Units with an aggregate Stated Amount equal to $1,000 or an integral multiple thereof. The undersigned Holder directs that a certificate for shares of Common Stock deliverable upon such Early Settlement (after taking into account all Units then held by such Holder) be registered in the name of, and delivered, together with a check in payment for any fractional share and any Normal Units Certificate representing any Normal Units evidenced hereby as to which Early Settlement of the related Purchase Contracts is not effected, to the undersigned at the address indicated below unless a different name and address have been indicated below. Pledged Notes, Pledged Treasury Consideration or the Pledged Applicable Ownership Interest in the Treasury Portfolio, as the case may be, deliverable upon such Early Settlement will be transferred in accordance with the transfer instructions set forth below. If shares are to be registered in the name of a Person other than the undersigned, the undersigned will pay any transfer tax payable incident thereto. Dated: ------------------ ----------------------------------------- Signature Signature Guarantee: --------------------- Number of Units evidenced hereby as to which Early Settlement of the related Purchase Contracts is being elected: If shares of Common Stock or Normal Units REGISTERED HOLDER Certificates are to be registered in the name of and delivered to and Pledged Notes, Pledged Treasury Consideration or Pledged Applicable Ownership Interest in the Treasury Portfolio, as the case may be, are to be transferred to a Person other than the Holder, please print such Person's name and address: PLEASE PRINT NAME AND ADDRESS OF REGISTERED HOLDER: --------------------------- ----------------------------- Name Name --------------------------- ----------------------------- --------------------------- ----------------------------- --------------------------- ----------------------------- Address Address -------------------------------------------------------------------------------- Social Security or other Taxpayer Identification Number, if any Transfer instructions for Pledged Notes, Pledged Treasury Consideration or the Pledged Applicable Ownership Interest in the Treasury Portfolio, as the case may be, transferable upon Early Settlement or a Termination Event: -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- [TO BE ATTACHED TO GLOBAL CERTIFICATES] SCHEDULE OF INCREASES OR DECREASES IN GLOBAL CERTIFICATE The following increases or decreases in this Global Certificate have been made: ------------------------- ---------------------- ----------------------- ---------------------- ---------------------- DATE AMOUNT OF DECREASE AMOUNT OF INCREASE IN STATED AMOUNT OF THE SIGNATURE OF IN STATED STATED AMOUNT GLOBAL CERTIFICATE AUTHORIZED AMOUNT OF OF FOLLOWING OFFICER THE GLOBAL THE SUCH DECREASE OF CERTIFICATE GLOBAL CERTIFICATE OR INCREASE AGENT ------------------------- ---------------------- ----------------------- ---------------------- ---------------------- ------------------------- ---------------------- ----------------------- ---------------------- ---------------------- ------------------------- ---------------------- ----------------------- ---------------------- ---------------------- ------------------------- ---------------------- ----------------------- ---------------------- ---------------------- ------------------------- ---------------------- ----------------------- ---------------------- ---------------------- ------------------------- ---------------------- ----------------------- ---------------------- ---------------------- ------------------------- ---------------------- ----------------------- ---------------------- ---------------------- EXHIBIT B FORM OF STRIPPED UNITS CERTIFICATE (Form of Global Certificate Legend) [THIS CERTIFICATE IS A GLOBAL CERTIFICATE WITHIN THE MEANING OF THE PURCHASE CONTRACT AGREEMENT (AS HEREINAFTER DEFINED) AND IS REGISTERED IN THE NAME OF THE CLEARING AGENCY OR A NOMINEE THEREOF. THIS CERTIFICATE MAY NOT BE EXCHANGED IN WHOLE OR IN PART FOR A CERTIFICATE REGISTERED, AND NO TRANSFER OF THIS CERTIFICATE IN WHOLE OR IN PART MAY BE REGISTERED, IN THE NAME OF ANY PERSON OTHER THAN SUCH CLEARING AGENCY OR A NOMINEE THEREOF, EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE PURCHASE CONTRACT AGREEMENT. Unless this Certificate is presented by an authorized representative of The Depository Trust Company (55 Water Street, New York, New York) to the Company or its agent for regxxxxxxxxx xx xxxxxxxx, xxxxxxxx or payment, and any Certificate issued is registered in the name of Cede & Co., or such other name as requested by an authorized representative of The Depository Trust Company, and any payment hereon is made to Cede & Co., ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY A PERSON IS WRONGFUL since the registered owner hereof, Cede & Co., has an interest herein.] AMEREN CORPORATION (Form of Face of Stripped Units Certificate) ($25 Stated Amount)

  • Reporting and Payment Procedures The Sub-recipient shall report at least quarterly all expenses incurred and associated project activities carried out with CDBG and non-CDBG funds. The Sub-recipient shall follow the reimbursement request process as set forth by the County and CDBG program administrator. Reimbursements are subject to the following but not limited to: eligibility of expenses, proper reporting and expense documentation, availability of funds, and authorization by the County and CDBG program administrator. DocuSign Envelope ID: E4D55B2A-BBB1-48FF-A259-0798F37C0F0E

  • Irrevocable Transfer Agent Instructions The Company shall issue irrevocable instructions to its transfer agent, and any subsequent transfer agent, in the form of Exhibit E attached hereto (the “Irrevocable Transfer Agent Instructions”). The Company represents and warrants that no instruction other than the Irrevocable Transfer Agent Instructions referred to in this Section 4.1(d) (or instructions that are consistent therewith) will be given by the Company to its transfer agent in connection with this Agreement, and that the Securities shall otherwise be freely transferable on the books and records of the Company as and to the extent provided in this Agreement and the other Transaction Documents and applicable law. The Company acknowledges that a breach by it of its obligations under this Section 4.1(d) will cause irreparable harm to a Purchaser. Accordingly, the Company acknowledges that the remedy at law for a breach of its obligations under this Section 4.1(d) will be inadequate and agrees, in the event of a breach or threatened breach by the Company of the provisions of this Section 4.1(d), that a Purchaser shall be entitled, in addition to all other available remedies, to an order and/or injunction restraining any breach and requiring immediate issuance and transfer, without the necessity of showing economic loss and without any bond or other security being required.

  • Instruction; Etc The Underwriters, for and on behalf of each of the Investors, hereby irrevocably instruct the Escrow Agent, and the Escrow Agent agrees: (a) to enter into the Deposit Agreement, and, if applicable, in accordance with Section 5 of the Note Purchase Agreement, to enter into a Replacement Deposit Agreement with the Replacement Depositary; (b) to appoint the Paying Agent as provided in this Agreement; (c) upon receipt at any time and from time to time prior to the Termination Date (as defined below) of a certificate substantially in the form of Exhibit B hereto (a “Withdrawal Certificate”) executed by the Pass Through Trustee, together with an attached Notice of Purchase Withdrawal in substantially the form of Exhibit A to the Deposit Agreement duly completed by the Pass Through Trustee (the “Applicable Notice of Purchase Withdrawal” and the withdrawal to which it relates, a “Purchase Withdrawal”), immediately to execute the Applicable Notice of Purchase Withdrawal as Escrow Agent and transmit it to the Depositary by facsimile transmission in accordance with the Deposit Agreement; provided that, upon the request of the Pass Through Trustee after such transmission, the Escrow Agent shall cancel such Applicable Notice of Purchase Withdrawal; (d) upon receipt of a Withdrawal Certificate executed by the Pass Through Trustee, together with an attached Notice of Replacement Withdrawal (as such term is defined in the Deposit Agreement) in substantially the form of Exhibit C to the Deposit Agreement duly completed by the Pass Through Trustee, to:

  • Exhibit D - Debarment Certification By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below.

  • Form of Instructions Instructions to restrict or prohibit trading must include the TIN, ITIN, or GII, if known, and the specific restriction(s) to be executed. If the TIN, ITIN, or GII is not known, the instructions must include an equivalent identifying number of the Shareholder(s) or account(s) or other agreed upon information to which the instruction relates.

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