Participant Certification. My signature on this form acknowledges that I have read, understand and agree to the SDO participation requirements above. I recognize that there may be changes to these requirements in the future. I will be notified of any major changes, and it is my responsibility to read and be aware of these. I have been provided and read the applicable brochures, available upon request, regarding the SDO and understand this information.
Participant Certification. I certify that the contribution described above is an eligible IRA rollover contribution. I certify that this contribution is being rolled over within 60 calendar days of the date that I received the distribution, or is being rolled directly from my employer’s plan or current custodian, and meets the tax rollover requirements described above. I certify that the rollover is not part of a series of payments over my life expectancy, or over a period of 10 years or more. I certify that the rollover does not include any required minimum distribution, hardship distribution, corrective distribution, or deemed distribution from the employer’s qualified retirement plan. I understand that this rollover contribution is irrevocable and involves important tax considerations. Specifically, I understand that a rollover contribution from a pre-tax qualified retirement plan will no longer be eligible for the special averaging, capital gains and separate tax treatment that may be available under my employer’s plan. I agree that I am solely responsible for all tax consequences. I also agree that neither the Custodian, Virtus Mutual Funds, nor their transfer agent, their agents, officers, trustees, directors or employees shall have responsibility for any such tax consequences or any consequences resulting from this amount being ineligible for rollover. (Rules regarding rollovers, and their tax implications, are complex. Please refer to IRS Publication 590-b or a tax professional for more information.) No information provided by the Virtus Mutual Funds shall be considered to be or is advice on which I may rely as the primary basis for my investment decisions. I agree that I need to make my own decisions, with whatever third-party advice I wish to obtain, and I agree that I am not to rely on any information Virtus Mutual Funds is providing as advice that is a primary basis for my decisions. I expressly confirm, and by signing below, I acknowledge, that none of Virtus Mutual Funds, their distributor, their transfer agent, and their affiliates, has made or is making a recommendation, or has provided or is providing investment advice of any kind whatsoever (whether impartial or otherwise), or is giving any advice in a fiduciary capacity with any decision I may make to invest or otherwise proceed with Virtus Mutual Funds. I have read this form and understand and agree to be legally bound by the terms of this form. I also understand that the Custodian will rely on my instructions wi...
Participant Certification. I affirm that the information I have provided on this form is complete and accurate and is of my own free will.
Participant Certification. By signing below, I certify that the following are true and correct: • The investment is an eligible SIMPLE IRA rollover contribution being rolled over within 60 days. • The rollover does not include required minimum distribution amounts or corrective distribution amounts. I understand that this rollover contribution is irrevocable. I agree that I am solely responsible for all tax consequences. I also agree that neither the Custodian nor Pacific Funds shall have responsibility for any such tax consequences or any consequences resulting from this amount being ineligible for rollover. Rules regarding rollovers, and their tax implications, are complex. Please refer to IRS Publication 560 and 590 or a professional tax advisor for more information. I have read and understand and agree to be legally bound by the terms of this form. I also understand that the Custodian will rely of my certification when accepting my rollover contribution. Participant’s Signature Date The maximum allowable contribution to your SIMPLE IRA for tax year 2019 is 100% of your salary up to $13,000 as deferred compensation. This limit is in addition to your employer’s matching or non-elective contributions. In the case of an eligible employee who will be age 50 or older before the end of the calendar year, the above limitation is $16,000 for 2019. For tax years after 2019, the above limits may be subject to Internal Revenue Service (IRS) cost- of-living adjustments, if any. Please read the SIMPLE Individual Retirement Account Disclosure Statement carefully or consult IRS Publications 560 or consult a professional tax advisor for more information about eligibility requirements and contribution restrictions. The following information is the disclosure statement required by federal tax regulations. You should read this Disclosure Statement, the Custodial Account Agreement and prospectuses for the mutual funds in which your Savings Incentive Match Plan for Employees of Small Employers Individual Retirement Account (“SIMPLE IRA”) contributions will be invested. The rules governing IRAs are subject to change. You should consult Internal Revenue Service (“IRS”) Publications 560 and 590 or the IRS web site xxx.xxx.xxx for updated rules and requirements. BNY Mellon Investment Servicing Trust Company (“we”, or “us”), provides custodial and administrative services for your retirement or savings account. As a result of this role, persons who open a retirement or savings account are considered ‘custo...
Participant Certification. By signing this Agreement below, Participant hereby certifies that, to the best of Participant’s knowledge, all of the information provided in the Application for Operation of
Participant Certification. By signing this Agreement below, Participant hereby certifies that, to the best of Participant’s knowledge, all of the information provided in the Application for Operation of Customer‐Owned Generation is true and correct, the Generator will comply with the Interconnection Agreement, and that Participant has received and reviewed this Agreement.
Participant Certification. My signature on this form acknowledges that I have read, understand and agree to the SDO participation requirements above. I recognize that there may be changes to these requirements in the future. I will be notified of any major changes in the MCDC quarterly newsletter, and it is my responsibility to read and be aware of these. I have been provided and read the applicable brochures, available upon request, regarding the SDO and understand this information.
Participant Certification. I certify that check/voucher number __________ for $_______ has been issued on my behalf and that I have no other resources upon which to draw to pay for this/these item/s.
Participant Certification. The Participant certifies that (a) it has complied with all information in the Application, including all attached documentation, is true and complete; (b) it agrees that the estimated Participant Incentive calculated in this Application is an estimate only and will be adjusted on completion of the Energy Audit in accordance with the Participation Agreement; (c) the Facility (ies) where the Energy Audits will be implemented is/are customer(s) of the LDC (or the Lead LDC and the Satellite LDCs); (d) it would not otherwise have undertaken the Energy Audits without the financial support and participation of the LDC; and (e) it understands and agrees to the terms and conditions as set forth in the Application and the Participant Agreement. The Participant understands and agrees that by submitting the Application, whether or not the Application is accepted:
a) it hereby consents to the collection, use, disclosure and other handling of any information it provides to the LDC (or the Lead LDC and the Satellite LDCs) or the IESO or their respective service providers, and their heirs, successors and assigns (collectively, the “Program Operators”), including personal information and records showing past and current energy usage (the “Participant Information”) by the Program Operators for purposes relating to the operation, administration or assessment of the Audit Funding Program, and in connection with any reporting activities, follow-up surveys, studies and audits relating to the Audit Funding Program, which shall include, without limitation:
i) sharing of Participant Information among the Program Operators;
ii) use by the Program Operators of the Participant Information provided by the Participant to conduct, analyze and report on the results of surveys and modify the Audit Funding Program based on such surveys; and
iii) disclosure to the Ontario Energy Board, the Ontario Ministry of Energy or the Ontario Environmental Commissioner or their respective successors; and iv) for purposes of reporting, surveys, studies and audits, future conservation programs, and the provision to the Program Operators, the Participants past and current energy usage for such purposes. The Participant hereby consents to the Program Operators contacting the Participant directly for such purposes including by email The Participant may withdraw this consent at any time by contacting the LDC at xxxxxxxxxxx@xxxxxxxxxxxxx.xxx or the IESO at xxxxxxxx.xxxxxxxxx@xxxx.xx;
b) it will indemnify and...
Participant Certification. Each Participant issued a Card shall certify upon issuance and each plan year thereafter that the card shall only be used for Health Care Expenses. The Participant shall also certify that any expense paid with the Card has not already been reimbursed by any other plan or source, and that the Participant will not seek reimbursement under any other plan covering health benefits.
