Other Necessary Documents. Submit along with Form C-32, the following documents. Be sure to reference on the documents the WCB Case Number for each claim included in the Section 32 Waiver Agreement: ⚫ a signed and notarized Form C-32.1, Claimant Release ⚫ a completed Form OC-400.1 if an attorney fee of over $1000 is requested ⚫ a letter from CMS, if the agreement references CMS's approval of a specified Medicare set-aside ⚫ current evidence that the life insurance carrier providing the annuity is rated A or better by A.M. Best or Standard & Poor, if the agreement references an annuity ⚫ a copy of the guarantee letter from the life insurer backing the assignee, if the agreement references a qualified assignment ⚫ document(s) identifying the proper beneficiaries, if the agreement pertains to benefits payable upon the death of the claimant ⚫ letter of approval from the Administrator of the WTCHP, the National Institute for Occupational Safety and Health (NIOSH), if the agreement is for a claim accepted into the World Trade Center Health Program (WTCHP)
Other Necessary Documents. Submit along with Form C-32, the following documents. Be sure to reference on the documents the WCB Case Number for each claim included in the Section 32 Waiver Agreement: • a signed and notarized Form C-32.1, Claimant Release • a completed Form OC-400.1 if an attorney fee of over $1000 is requested • a letter from CMS, if the agreement references CMS's approval of a specified Medicare set-aside • current evidence that the life insurance carrier providing the annuity is rated A or better by A.M. Best or Standard & Poor, if the agreement references an annuity • a copy of the guarantee letter from the life insurer backing the assignee, if the agreement references a qualified assignment • document(s) identifying the proper beneficiaries, if the agreement pertains to benefits payable upon the death of the claimant • letter of approval from the Administrator of the WTCHP, the National Institute for Occupational Safety and Health (NIOSH), if the agreement is for a claim accepted into the World Trade Center Health Program (WTCHP)
Other Necessary Documents. Provider will sign upon request (and shall cause its Provider Personnel to transfer, grant, convey, and relinquish with retroactive effect to the start date of the Services), all documents necessary to vest title in FIS to any intellectual property rights associated with the Services, deliverables, inventions or works related to the Services. Provider will also sign upon request, any document necessary for the filing and prosecution of patent, trademark or copyright applications in the United States and elsewhere, including divisional, continuation, revival, renewal or reissue application. Provider will cooperate and assist FIS in preparing, filing and prosecuting any and all such patent, trademark and copyright applications during the Term and for two (2) years following its termination. FIS will bear all costs associated with the prosecution of such patent, trademark or copyright applications.
Other Necessary Documents. Submit along with Form W-32R, the following documents. Be sure to reference on the documents the WCB Case Number for each claim included in the settlement agreement. - a signed and notarized Form C-32.1, Claimant Release; - a completed Form OC-400.1 if an attorney fee of over $450 is requested; - a letter from CMS, if the agreement references CMS's approval of a specified Medicare set-aside; - current evidence that the life insurance carrier providing the annuity is rated A or better by A.M. Best or Standard & Poor if the agreement references an annuity; - document(s) identifying the proper beneficiaries if the agreement pertains to benefits payable upon the death of the claimant.
Other Necessary Documents. Consultant will sign upon request (and shall cause its Consultant Personnel to sign upon request with retroactive effect to the start date of the Services), all documents necessary to vest title in FIS to any intellectual property rights associated with the Services, Deliverables, Inventions or works related to the Services or Inventions. Consultant will also sign upon request (and shall cause its Consultant Personnel to sign upon request with retroactive effect to the start date of the Services), any document necessary for the filing and prosecution of patent, trademark or copyright applications in the United States and elsewhere, including divisional, continuation, revival, renewal or reissue application. Consultant will cooperate and assist FIS in preparing, filing and prosecuting any and all such patent, trademark and copyright applications during the Term and for two (2) years following its termination. FIS will bear all costs associated with the prosecution of such patent, trademark or copyright applications.
Other Necessary Documents. Provider will sign upon request (and shall cause its Provider Personnel to transfer, grant, convey, and relinquish with retroactive effect to the start date of the Services), all documents necessary to vest title in Worldpay to any intellectual property rights associated with the Services, deliverables, inventions or works related to the Services. Provider will also sign upon request, any document necessary for the filing and prosecution of patent, trademark or copyright applications in the United States and elsewhere, including divisional, continuation, revival, renewal or reissue application. Provider will cooperate and assist Worldpay in preparing, filing and prosecuting any and all such patent, trademark and copyright applications during the Term and for two (2) years following its termination. Worldpay will bear all costs associated with the prosecution of such patent, trademark or copyright applications.
