Policy Number. If the Beneficiary is covered under any prepaid funeral or burial insurance, please provide the insurer’s name, address, and the policy number. Insurer: Address: Policy Number: Exhibit “C” Proof of Grantor’s Status to Establish Trust on Behalf of Beneficiary Under current law, only the beneficiary’s parents, grandparents, legal guardian, the beneficiary himself or herself, or someone acting at the direction of a court may establish the Trust on behalf of the beneficiary. If you are anyone other than the beneficiary, then please include documents that verify that you fall within one of these permissible categories. ALL GRANTORS MUST PROVIDE A PHOTOCOPY OF THEIR DRIVER’S LICENSE OR OTHER PHOTO IDENTIFICATION In addition to the Grantor’s photo I.D., the list below illustrates the types of documents that must be submitted to establish the Grantor’s relationship to the Beneficiary and/or the status to contribute to the Trust.
Policy Number. If the Beneficiary is covered under any prepaid funeral or burial insurance plan, what is the insurer’s name and address, and what is the policy number? Insurer: Address: Policy Number:
Policy Number. In the event of any change in health insurance, the responsible party is required to notify the opposing party of the change. The responsible party shall inform the Virginia Department of Social Services, if support payments are ordered to be paid through the Virginia Department of Social Services, or the opposing party, if support payments are ordered to be paid directly to the opposing party, of any changes in the availability of the health care coverage for the minor child or children. [ ] The parties agree that “health care coverage” as defined by the statute is not available at “reasonable cost” as defined by statute, and therefore, the parties agree that neither the Respondent nor the Petitioner will be required to provide health care coverage. [ ] Any reasonable and necessary unreimbursed medical and dental expenses for each child covered by this agreement shall be paid in the following manner: ............................................ % Respondent % Petitioner. MEDIATION SUPPORT AGREEMENT Case No. ......................................................................
Policy Number. Are children or vulnerable adults involved with this hiring? Yes/No If Yes, then a protection policy must be in force and a written copy attached. (Excludes private functions)
Policy Number. «POLICY»
Policy Number. ESP1004516-00 Named Insured: City of Garland This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: October 1, 2020
Policy Number. If the Beneficiary is covered under any prepaid funeral or burial insurance, please provide the insurer’s name, address, and the policy number. Insurer: Address: Policy Number: Exhibit “C” Desires of Grantor for Use of Distributions From Trust Sub-Account During Life of Beneficiary Please be as thorough as possible when completing this section. This information is potentially very important when authorizing requests for distributions.
Policy Number. If you’d like to make a claim, please refer to the instructions at xxxxxxxxx.xxxxxxxxxxxxx.xxx.xx/xxxxxxxx Unauthorised Transactions Insurance SG01000008-00 Summary of the key terms of your BusinessVantage Visa Credit Card facility Introduction This is a summary of the key terms of your BusinessVantage Visa Credit Card facility. It doesn’t replace your letter of offer or letter schedule (together, the “offer”) or the BusinessVantage Visa Credit Card Conditions of Use as at 1 July 2019 (“conditions”) nor does it cover all of your obligations. You still need to carefully review these documents and any other document we provide. Cardholders Under the facility, you can nominate cardholders and we’ll issue a BusinessVantage Visa Credit Card (“card”) to them. You’re responsible for all transactions made by cardholders. Security of cards and PINs Cardholders have to protect the security of the card and PIN and have to make every effort to see that the card and PIN aren’t misused, lost or stolen. Lost or stolen cards or PIN revealed or suspected unauthorised transactions A cardholder must tell you and us as soon as possible if a card or PIN record is lost or stolen or they suspect any unauthorised card transactions. If they don’t do this, you may be liable for unauthorised card transactions. Facility limit and credit limit We’ll let you know what the facility limit is when we open the facility. The total of all individual card credit limits may not exceed the facility limit. You can ask us to vary the facility limit, but we have no obligation to do so. When you apply for a card, the credit limit for that card is in your offer. This is the maximum amount of credit the cardholder can normally access on the card, including any accrued fees or interest charges. You must tell each cardholder their credit limit. If the credit limit is exceeded, you have to repay us the excess amount and we can also charge a fee. We can reduce the facility limit or credit limit on a card (or both) and if we do, we’ll tell you in writing. Using the card and daily limits Cardholders must use cards solely for business purposes, and not private or domestic purposes. Cardholders can use the card to obtain goods, services and cash in various ways in Australia and overseas, (including through merchants, ATMs and bank branches displaying the Visa logo). You can also use the card for transactions by mail order, telephone, internet and other remote access. You can place restrictions on the types o...
Policy Number. Assignee: Address: For Value Received, the undersigned hereby assign policy No. issued by Banner Life Insurance Company on the life of to , Assignee. This assignment is collateral security for any and all liabilities of the undersigned or any of them to the Assignee now existing or that may hereafter arise in the ordinary course of business between any of the undersigned and the Assignee. The undersigned expressly agree that the Assignee shall have the sole right to receive all benefits and to exercise all options and privileges described in the said policy or allowed by the Insurance Company except the right to designate and change the beneficiary, or the right to elect any optional mode of settlement permitted by the Policy or allowed by the Insurer or the right to collect from the insurer any disability benefit payable in cash that does not reduce the amount of insurance, but the right of the Assignee to surrender the Policy completely is not impaired and any designation or change of beneficiary shall be subject to this assignment. The Assignee by acceptance of this assignment agrees that any sums received hereunder shall be applied only to the secured liabilities or to pay premiums, and any balance remaining after payment of the secured liabilities in full shall be paid by the Assignee to the persons entitled thereto under the terms of the policies had this assignment not been made; and further, the Assignee agrees not to surrender the Policy unless there has been a default in the secured liabilities, nor until twenty days after mailing to the undersigned at the addresses given below notice of intention to do so. The Insurer is hereby authorized to recognize the Assignee’s claims to rights hereunder without investigating the reason for any action taken by the Assignee, or the validity or the amount of the liabilities or the existence of any default therein, or the application to be made by the Assignee of any amounts to be paid to the Assignee. The sole signature of the Assignee and the sole receipt of the Assignee for any sums received shall be a full discharge and release to the Insurer. The Assignee shall be under no obligation to pay any premium, or the principal of or interest on any loans or advances on the Policy whether or not obtained by the Assignee, or any other charges on the Policy, but any such amounts so paid by the Assignee from its own funds, shall become a part of the liabilities hereby secured, shall be due immediately, and shall dra...
Policy Number. E-mail Address As payments on my policy become due, I authorize Narragansett Bay Insurance Company to electronically debit the bank account listed below. If a payment is dishonored, I will be charged the applicable return transaction fee. I understand this authorization will remain effective until I formally notify Narragansett Bay Insurance Company to cease deductions or if the policy is cancelled for any reason. I understand that Narragansett Bay Insurance Company will notify me of any changes to the deduction amount in advance of the automated draft and reserves the right to terminate this agreement at their discretion. Name as it appears on Bank Account Bank Name Bank Routing Number Bank Account Number Signature/Date I authorize Narragansett Bay Insurance Company to electronically debit the following bank account:
