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Tick one Sample Clauses

Tick one. The boarding room which the tenant is renting is not shared by other tenants. The boarding room which the tenant is renting is shared by other tenants and the maximum number of other tenants who may occupy the room is .
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Tick one. This boarding house tenancy is a joint tenancy with . This boarding house tenancy is not a joint tenancy.
Tick one. ❑ Yes as a first treatment If yes, how many times? (not more than 9) ❑ Yes only if other treatments have not worked If yes, how many times? (not more than 9) ❑ No Signature: Date: Name: Signature: Date: Name: Signature: Date: Name: ❑ I am satisfied that the person has decision-making capacity to fill in this form and that the matters discussed and agreed to in the form are within my professional scope of practice. Signature: Date: Contact details: Name: Signature: Date: Name: Signature: Date: Did you sign this form? Nominated person – signature on Page 4 Yes / No Advance Agreement – signatures on Page 10 Yes / No Advance Consent Direction – signatures on Page 15 Yes / No Once your Form Kit is signed, you must give a copy to: You Yes / No Your Nominated Person, if you have one Yes / No Your Guardian, if you have one Yes / No Your Power of Attorney, if you have one Yes / No Any clinician who can access your health information Yes / No Any clinician who can’t access your health information Yes / No You may want to give the Form Kit to: Your Carer, if you have one Yes / No Other people who are helping you Yes / No If you are not a patient at Canberra Health Services Mental Health, Justice Health and Alcohol and Drugs Service (MHJHADS), you can email it to XxxxxxxxXxxxxxx@xxx.xxx.xx. They will add it to Canberra Health Services system. Yes / No Other – Name: Yes / No Other – Name: Yes / No Other – Name: Yes / No Your Nominated Person, Advance Agreement or Advance Consent Direction is legal until it is cancelled or changed. This Form Kit has your views, wishes and decisions. Read this Form Kit at least once a year to see if you want to change it.
Tick one. ✔ The boarding room which the tenant is renting is not shared by other tenants.
Tick one. Will you be using subcontractors for any part of your contracted work? ☐ Yes ☐ No Write the business name of any subcontractors being used by PCBU2.                         As evidence of due diligence, attach a copy of your Subcontractor’s SSSP Agreement section, to the back of this SSSP either now or when the Subcontractor begins work on this site. Kākāriki (Green) Agreement SSSP Form 1 3 Outline of work being undertaken Write a brief outline of the scope of work this SSSP relates to.  

Related to Tick one

  • Check one I am a United States citizen or legal permanent resident. ▪ A valid Colorado driver's license or a Colorado identification card;

  • CHECK-OFF 9.01 Subject to this Article, the Employer will, as a condition of employment, deduct an amount equal to the monthly membership dues from the monthly pay of all employees in the bargaining unit. Where an employee does not have sufficient earnings in respect of any month to permit deductions made under this Article, the Employer shall not be obliged to make such deduction from subsequent salary. 9.02 The Association shall inform the Employer in writing of the authorized monthly deduction to be checked off for each employee. 9.03 For the purpose of applying clause 9.01, deductions from pay for each employee in respect of each calendar month will start with the first full calendar month of employment to the extent that earnings are available. 9.04 No employee organization, as defined in Section 3 of the Parliamentary Employment and Staff Relations Act, other than the Association, shall be permitted to have membership dues and/or other monies deducted by the Employer from the pay of employees in the bargaining unit. 9.05 The amounts deducted in accordance with clause 9.01 shall be remitted to the Association by cheque in the month following that in which their deductions were made and shall be accompanied by particulars identifying each employee and the deductions made on his/her behalf. 9.06 The Employer agrees to make deductions for other purposes on the basis of the production of appropriate documentation. 9.07 The Association agrees to indemnify and save the Employer harmless against any claim or liability arising out of the application of this Article, except for any claim of liability arising out of an error committed by the Employer limited to the amount actually involved in the error. 9.08 An employee who satisfies the Employer to the extent that he/she declares in an affidavit that he/she is a member of a religious organization, registered pursuant to the Income Tax Act, whose doctrine prevents him/her, as a matter of conscience, from making financial contributions to an employee organization and that he/she will make contributions to a charitable organization equal to dues, shall not be subject to this Article, provided that the affidavit submitted by the employee shows the registered number of the religious organization and is countersigned by an official representative of the religious organization involved. A copy of the affidavit will be provided to the Association.

  • Instructions for Certification - Lower Tier Participants (Applicable to all subcontracts, purchase orders and other lower tier transactions requiring prior FHWA approval or estimated to cost $25,000 or more - 2 CFR Parts 180 and 1200) a. By signing and submitting this proposal, the prospective lower tier is providing the certification set out below. b. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department, or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. c. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous by reason of changed circumstances. d. The terms "covered transaction," "debarred," "suspended," "ineligible," "participant," "person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 CFR Parts 180 and 1200. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. “First Tier Covered Transactions” refers to any covered transaction between a grantee or subgrantee of Federal funds and a participant (such as the prime or general contract). “Lower Tier Covered Transactions” refers to any covered transaction under a First Tier Covered Transaction (such as subcontracts). “First Tier Participant” refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). “Lower Tier Participant” refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers).

  • Limit on Number of Partners Unless otherwise permitted by the General Partner in its sole and absolute discretion, no Person shall be admitted to the Partnership as an Additional Limited Partner if the effect of such admission would be to cause the Partnership to have a number of Partners that would cause the Partnership to become a reporting company under the Exchange Act.

  • CHECK-OFF OF UNION DUES 22.01 The Company shall deduct on the payroll for the last applicable pay period of each month from wages due and owing to each Employee under this Agreement such sum as may be uniformly assessed under the Union Constitution for monthly dues and initiation fees. 22.02 The amount to be deducted shall not be changed except to conform with a change in the Union's Constitution. 22.03 Membership in the Union shall be available to any Employee eligible under the Constitution of the Union on payment of the initiation or reinstatement fees uniformly required of all other such applicants. Membership shall not be denied for reasons of race, national origin, colour or religion. 22.04 Deductions shall commence on the payroll for the last applicable pay period of the first full calendar month of service. 22.05 If the wages of an Employee payable on the payroll for the last applicable pay period of any month are insufficient to permit the deduction of the full amount of dues, no such deduction shall be made from the wages of such Employee by the Company in such month. The Company shall not, because the Employee did not have sufficient wages payable to him on the designated payroll, carry forward and deduct from any subsequent wages the dues not deducted in an earlier month. 22.06 Only payroll deductions now or hereafter required by law, deductions of monies due or owing the Company, pension deductions and deduction for provident funds shall be made from wages prior to the deduction of dues. 22.07 The amount of dues so deducted from wages accompanied by a statement of monthly dues check-off list including additions, deductions, employee's name and number and location shall be remitted by the Company to the Union. 22.08 The Company shall not be responsible financially or otherwise, either to the Union or to any Employee, for any failure to make deductions or for making improper or inaccurate deductions or remittances; however, in any instance in which an error occurs in the amount of any deduction of dues from an Employee's wages, the Company shall adjust it directly with the Employee. In the event of any mistake by the Company in the amount of its remittance to the Union, the Company shall adjust the amount in a subsequent remittance. The Company's liability for any and all amounts deducted pursuant to the provisions of this Article shall terminate at the time it remits the amounts payable to the Union. 22.09 In the event of any action at law against the parties hereto resulting from any deduction or deductions made from payrolls, or to be made by the Company pursuant to the first paragraph of this Article, both parties shall cooperate fully in the defence of such action. Each party shall bear its own cost of such defence except that if, at the request of the Union, counsel fees are incurred these shall be borne by the Union. Save as aforesaid, the Union shall indemnify and save harmless the Company from any losses, damages, costs, liabilities or expenses suffered or sustained by the Company as a result of any such deduction or deductions from payrolls.

  • Multi-Year Planning The CAPS will be in a form acceptable to the LHIN and may be required to incorporate (1) prudent multi-year financial forecasts; (2) plans for the achievement of performance targets; and (3) realistic risk management strategies. It will be aligned with the LHIN’s then current Integrated Health Service Plan and will reflect local LHIN priorities and initiatives. If the LHIN has provided multi-year planning targets for the HSP, the CAPS will reflect the planning targets.

  • Please see the current Washtenaw Community College catalog for up-to-date program requirements Conditions & Requirements

  • Education Allowance Provisions in existing Collective Agreements providing for educational allowances shall be continued in effect.

  • Are There Penalties for Early Distribution from a Xxxx XXX As indicated above, earnings on your contributions, as well as amounts contributed to a Xxxx XXX as a rollover from a Traditional IRA, that are distributed before certain events are subject to various taxes. Please see IRS Publication 590 for further information about Xxxx XXX rules and restrictions.

  • Estimated Number of Participating Households Approximately 6,460. This figure is based on loans with unpaid principal balances ranging from $200,000 to $400,000 with an average funding of $5,000.00.

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