Witness Signature 4. PARENT/GUARDIAN CONSENT: (for applicants under 18 years) – I hereby certify and decree that all the information contained in the declarations above is true and accurate Print Name:................................................................... Signature …………………………………………....……... Relationship to applicant ……………………………… Phone Contact ……………………................................... Address …………………………………………………………………….....................................................................
Signature Signature For the participant For the institution Xxxxxx Xxxxx prof. Ing. arch. Xxxxxx Xxxxxxx, PhD. Vice-xxxxxx for International Relations and Public Relations, based on the procuration Annex I
SIGNATURE PAGE This Account Pledge Agreement has been entered into on the date stated at the beginning by SIG Information Technology GmbH as Pledgor By: /s/ Xxxxx Xxxxx Name: Xxxxx Xxxxx Title: Authorised Signatory The Bank of New York Mellon as Collateral Agent and Pledgee By: /s/ Xxxxxxxxx X. Xxxxxxx Name: Xxxxxxxxx X. Xxxxxxx Title: Vice President SCHEDULE 1
Student Signature By signing this contract, Resident agrees to pay the contract amount (room, board and association fees) in accordance with Addendum B: Rate and Payment Schedule. Resident may pay the full amount due prior to the due date, at the Resident’s election.
Employee Signature Employee ID: Telephone No: Employee Address: Work Location:
Contract Signature If the Original Form of Contract is not returned to the Contract Officer (as identified in Section 4) duly completed, signed and dated on behalf of the Supplier within 30 days of the date of signature on behalf of DFID, DFID will be entitled, at its sole discretion, to declare this Contract void. No payment will be made to the Supplier under this Contract until a copy of the Form of Contract, signed on behalf of the Supplier, is returned to the Contract Officer.
Signature of witness Address of Witness
Signature of Director Name of director (block letters) ) ) ) ) ) ) ) ) ) ) ) ) ............................................................... Signature of director/company secretary* *delete whichever is not applicable ............................................................... Name of director/company secretary* (block letters) *delete whichever is not applicable
Signature Date PLEASE INITIAL PAGE 2 Please retain a photocopy of this form for your own records. Terms and Conditions on Reverse Side TERMS AND CONDITIONS
SIGNED For and on behalf of the Hospital For and on behalf of the Company By: ...................................................... By:...................................................