Signature and Certification. Sign in ink, in the space provided. This is your promise to pay. DO NOT COMPLETE: Xxxxxxxx, retain this copy for your records The Alaska Commission on Postsecondary Education (ACPE) services the education loans owned by the Alaska Student Loan Corporation (ASLC).
SECTION A: Borrower Information Print Neatly in Black Ink or Type Read the Instructions on Page 4
1. Last Name First Name Middle Name 2. Social Security Number
Signature and Certification. REQUIRED The adult household member who fills out the application must sign below. If Part 4 is completed, the adult signing the form must also list the last four digits of his/her Social Security Number (SSN) or check the box if no SSN. See Privacy Act Statement on the back of this page. If you have listed a case number in Part 2 or are applying on behalf of a xxxxxx child, or have checked the box that your child(ren) will not qualify for Free/Reduced- Price meals, the last four digits of the SSN is not needed. “I certify (promise) that all information on this application is true and that all income is reported. I understand that this information is given in connection with the receipt of Federal funds, and that CACFP officials may verify (check) the information. I am aware that if I purposely give false information, the participant/center may lose meal benefits, and I may be prosecuted under applicable State and Federal laws.” Signature of Adult Today’s Date X Print Name of Adult Signing Social Security Number (SSN) (last four digits) XXX-XX- Check if no SSN OSPI CNS (Rev. 1/19) Page 1 of 2 White Native Hawaiian or Pacific Islander Multi-Racial Black or African American Asian Not Hispanic or Latino We are required to ask for information about your children’s race and ethnicity. This information is important and helps to make sure we are fully serving our community. Responding to this section is optional and does not affect your children’s eligibility for receiving meals during care.
Signature and Certification. All baseline monitoring reports must be signed and certified in accordance with Section 7 of this Division.
Signature and Certification. Sign in ink, in the space provided. This is your promise to pay.
Signature and Certification. ✔ I certify that I have established an IRA with the TCW Funds, Inc. of which U.S. Bank, NA, is the Custodian. I agree to contact my present Custodian from whom I am transferring to determine if specific documentation or a signature guarantee is required. I understand that I am responsible for determining my eligibility for all transfers or direct rollovers. I agree to hold the Custodian harmless against any and all situations arising from an ineligible transfer or direct rollover. I acknowledge that the Custodian or its agent cannot provide legal advice and I agree to consult with my own tax professional for advice. I authorize U.S. Bancorp Fund Services, LLC, to act on my behalf in contacting the current custodian or plan administrator to facilitate the transfer of assets. Signature of Owner (or Guardian if IRA owner is a minor) Date (MM/DD/YYYY) Signature Guarantee* (for transfers from another Custodian) IMPORTANT: Please contact your current Custodian to determine if a signature guarantee* is required. * A signature guarantee may be obtained from any eligible guarantor institution, as defined by the Securities and Exchange Commission. These institutions include banks, saving associations, credit unions, and brokerage firms. The words “SIGNATURE GUARANTEED” must be stamped or typed near your signature. The guarantee must appear with the printed name, title, and signature of an officer and the name of the guarantor institution. Please note that a Notary Public Seal or Stamp is not acceptable.
Signature and Certification. I understand and agree that:
(a) I received and have in my possession a copy of my employer’s original Form 5304-SIMPLE or prototype plan agreement. I also certify that I meet the eligibility requirements.
(b) If I change employers and my new employer sponsors a SIMPLE IRA plan, I will notify Pacific Funds.
(c) If I am making employee salary deferrals, I have completed a salary reduction agreement authorizing my employer to send salary deferrals to Pacific Funds. Pacific Funds will allocate my salary deferrals according to instructions I provide on the application. I can change these allocations at any time by submitting a letter of instruction. Any allocation changes must be submitted prior to my next salary deferral being sent to Pacific Funds.
(d) If I am providing this form to Pacific Funds by fax, it is as valid as the original.
(e) I certify that this information is true and correct. Participant’s Signature Date Pacific Funds P.O. Box 9768 Providence, RI 02940-9768 Pacific Funds Attn: Work Management 0000 Xxxxxxxx Xxxxx Website: xxx.XxxxxxxXxxxx.xxx Use this form to request a transfer of SIMPLE IRA assets held with another custodian to your Pacific Funds SIMPLE IRA. Based on your instructions, BNY Mellon Investment Servicing Trust Company will initiate the transfer for you. If you are over 70 ½, you are responsible for distributing any required minimum distribution amounts from your current SIMPLE IRA in advance of the transfer. Please remember the transfer of assets can only occur between SIMPLE IRAs. Incomplete information will result in processing delays on your request. If you require assistance completing this form, please contact Shareholder Services at (000) 000-0000, Option 2.
1. Account Information
Signature and Certification. The signing of this document by authorized officials forms a binding commitment between LPC and SFC. The parties are obligated to perform in accordance with the terms and conditions identified in this MOU. All Appendices attached hereto are hereby incorporated into this MOU and made a part hereof. Authorized Treasury Official Title Date Authorized Treasury Official Title Date (41 CFR 102-73.155 (p)) (41 CFR 102-73.80) San Francisco Regional Financial Center 0000 00xx Xxxxxx, Xxxxx X, Xxxxxxxxxx XX 00000 . a. Xxxxxx Xxxxxxx, Director Work Phone 000-000-0000 Cell Phone 000-000-0000
b. Xxxxx Xxxxxx, Deputy Director Work Phone 000-000-0000 Cell Phone 000-000-0000
c. Xxxxxxx Xxxxxx, COOP Officer Work Phone 000-000-0000 Cell Phone 000-000-0000
d. Xxxxx Xxxxxxxxx, Manager, Administrative Management Branch Work Phone 000-000-0000 Cell Phone 000-000-0000
e. Xxx Xxxxx, Manager, Electronic Operations Branch Work Phone 000-000-0000 Cell Phone 000-000-0000
f. Xxxxxxxx Xxxx, Manager, Debt Management Support and Testing Branch Work Phone 000-000-0000 Cell Phone 000-000-0000
g. Xxxxxx Xxxxxx, Manager, Payment Facilities Branch Work Phone 000-000-0000 Cell Phone 000-000-0000
h. Xxxxxx Xxxxx, Manager, Special Payments & Claims Branch Work Phone 000-000-0000 Cell Phone 000-000-0000 San Francisco Regional Financial Center 0000 00xx Xxxxxx, Xxxxx X, Xxxxxxxxxx XX 00000 Xxx O’Dell ADP / ISSO Xxxxxxx Xxxxxx COOP Officer Xxxxxx Xxxxxx ADP / ISSO – Backup Xxxxxx Xxxxxxxx IT Specialist Xxxx Xxxxxxx Super Programmer Xxxxxx Xxx Super Programmer Xxxxx Xxxx Control Room Lead Xxxx Xxxxx EOB Supervisor Xxxxx Xxxx EOB Supervisor Xxxxxx Xxxxx EOB Supervisor Xxxx Xxxxxx PFB Supv Xxxxxx Xxxxx PFB Supv Xxxxxx Xxxxxxx PFB Supv
Signature and Certification. SCSC has the right to determine when provisions of this agreement are violated and to determine the appropriate course of action. If any section or subsection of this contract is ruled to be illegal or invalid, this will not affect the validity or enforceability of the remaining provisions of the contract.
Signature and Certification. I certify under penalty of perjury, under the laws of the State of California, that I have read and understand the aforementioned statements and agree to comply with the requirements contained therein. City County State BY: DATE: Signature Print Name: TITLE:
Signature and Certification. This Annual Audit Compliance Report may only be signed by a person(s) with legal authority to sign it. The ways in which the Annual Audit Compliance Report must be signed and certified and the people who may sign the statement, are set out below. Please tick the box next to the category that describes how this Annual Audit Compliance Report is being signed. If you are uncertain about who is entitled to sign or which category to tick, please contact the licensing officer for your premises. If the licence holder is The Annual Audit Compliance Report must be signed and certified: an individual □□ by the individual licence holder, or by a person approved in writing by the Chief Executive Officer of the Department of Environment Regulation to sign on the licensee's behalf. A firm or other unincorporated company □ □ by the principal executive officer of the licensee; or by a person with authority to sign on the licensee's behalf who is approved in writing by the Chief Executive Officer of the Department of Environment Regulation. □ by affixing the common seal of the licensee in accordance with the Corporations Act 2001; or □ by two directors of the licensee; or □ by a director and a company secretary of the licensee, or A corporation □ if the licensee is a proprietary company that has a sole director who is also the sole company secretary – by that director, or □ by the principal executive officer of the licensee; or □ by a person with authority to sign on the licensee's behalf who is approved in writing by the Chief Executive Officer of the Department of Environment Regulation. □ by the principal executive officer of the licensee; or A public authority (other than a local government) □ by a person with authority to sign on the licensee's behalf who is approved in writing by the Chief Executive Officer of the Department of Environment Regulation. □ by the chief executive officer of the licensee; or
