Disclosure AgreementDisclosure Agreement • March 14th, 2024
Introduction: This Agreement is a contract between you and Carter Bank & Trust , ) that outlines and governs the terms and conditions for accessing your Account(s) at CB&T through Carter on the GO, an Internet banking service. You must have at least one eligible checking account, savings account, certificate of deposit or loan account at Carter in order to have access to Carter on the GO. Carter on the GO can be accessed through your personal computer, through your Mobile device, or through a portable Tablet.
Application No. / Nombor PermohonanDisclosure Agreement • May 23rd, 2022
Foreign Account Tax Compliance Act (FATCA) Pengisytiharan oleh orang Amerika Syarikat di bawah Akta Cukai Pematuhan Akaun Asing (FATCA)
ContractDisclosure Agreement • September 11th, 2021
DISCLOSURE AGREEMENTDisclosure Agreement • March 15th, 2012
This Disclosure Statement is issued by Lucror Capital Markets LP (“LCM”). This is an important document and should be read in its entirety.
Disclosure Agreement. RespondeesDisclosure Agreement • May 6th, 2023
Name of Committee: National Institute of Neurological Disorders and Stroke Initial Review Group (Neurological Sciences and Disorders B).
Attachment M813-B DEPARTMENT OF VETERANS AFFAIRS DISCLOSURE AGREEMENT FOR NON- COMPETITIVE REQUIREMENTS {Insert project name and solicitation number}Disclosure Agreement • June 7th, 2022
This disclosure agreement is required for all awards over the Simplified Acquisition Threshold (SAT) made on a non-competitive basis to be completed by staff involved in the procurement (program sponsor, contracting officer’s representative, etc.) as appropriate. Prior to any discussion involving this requirement, all persons involved in the procurement must disclose any personal or professional relationship between such staff and offeror’s personnel.
DISCLOSURE AGREEMENT --------------------------------------------Disclosure Agreement • December 2nd, 2009 • Wecosign, Inc. • Surety insurance
DISCLOSUREDisclosure Agreement • May 18th, 2022
I, the above patient, parent or legal guardian of the patient, or policyholder as applicable hereby contract with Connecticut Physical Therapy Specialists, LLC (CTPTS) to render physical therapy as prescribed by my physical therapist and/or my referring physician. I understand and agree that CTPTS will first seek reimbursement from my insurers and I direct my insurance to pay all benefits or coverage to which I am entitled to CTPTS and I hereby assign any benefits or coverage to which I am entitled to CTPTS for their services. I understand and agree I am responsible for all co-pays, co-insurance, deductibles or any fee, charge or service my insurer does not pay. If an insurer reimburses me directly, or my portion of a settlement, I will immediately remit to CTPTS the share of reimbursement they are entitled for their services. If I have no insurance I understand and agree I am responsible for all fees, charges or services rendered by CTPTS.
Disclosure AgreementDisclosure Agreement • February 13th, 2024
BPP is committed to promoting disclosure and supporting students with learning difficulties, disabilities, sensory impairments and medical conditions. This is one of our duties under the Equality Act 2010. We therefore encourage disability disclosure to ensure that all students receive a high level of support.
Live Work Play: Disclosure Agreement Homeownership IncentiveDisclosure Agreement • January 30th, 2019
I/we, , have applied for or are currently applying for assistance from Near West Side Partners, Inc. in order to facilitate my/our purchase of a home (the “Property”) pursuant to the Live Work Play Homeownership Incentive Program (“Program”).
Blue Cross/Blue Shield Disclosure Agreement Waiver of Coverage SelectionDisclosure Agreement • September 7th, 2010 • Kansas
If you are a benefits-eligible active employee and are declining medical coverage for yourself or your dependents (including your spouse) because of other group coverage, you or your dependents may in the future be able to enroll in this plan, provided that you request enrollment within 31 days after your other group coverage ends. In addition, you may be able to enroll yourself and your dependent(s), provided that you request enrollment within 31 days after a marriage, birth, adoption or placement for adoption. If you are declining medical and/or dental coverage for any other reason, or if you fail to complete this form, you may be limited to enrolling only during the annual enrollment period and a pre-existing condition exclusion period may apply. To request a special enrollment for medical and/or dental coverage, please contact our Member Services Department at (816) 395-2950.
STATE OF CALIFORNIA • STATE AND CONSUMER SERVICES AGENCYDisclosure Agreement • April 2nd, 2014
DISCLOSURE AGREEMENTDisclosure Agreement • February 7th, 2011
Coghlan’s Ltd. (hereinafter referred to collectively as “Company”) are anxious to take every opportunity to improve their products and add profitable ones to their product lines. However, we have found certain precautions necessary in accepting disclosures of information, ideas or inventions. For example, our employees have varied and numerous ideas of their own that have been developed in the past or are currently in development. Some of these ideas, might by chance, be similar to your own. Hence, in order to avoid any possible future confusion between your ideas and our own, and to prevent any misunderstanding as to the respective rights and obligations of the Company and the person making the submission, the Company’s policies as to considering submitted ideas are set forth below:
DISCLOSURE AGREEMENT INCLUDING WAIVER OF CONFIDENTIALITYDisclosure Agreement • May 20th, 2011
The undersigned ("Submitter") hereby submits to FGX International Inc. ("Company") a disclosure of certain suggestions, inventions and/or ideas relating to (the “Disclosure”). Submitter submits the Disclosure to the Company upon the following express conditions:
JSC Federal Credit UnionDisclosure Agreement • February 16th, 2010
By completing and signing the STAR/STAR-PC application, I apply for a JSC Federal Credit Union confidential Personal Identification Number (PIN) for use with the STAR Audio Response System, and STAR-PC Home Banking System.
DISCLOSURE AGREEMENTDisclosure Agreement • July 28th, 2021
GHS FEDERAL CREDIT UNION DISCLOSURE AGREEMENT FOR INTERNET BILL PAY SERVICEDisclosure Agreement • November 6th, 2018 • New York
This Terms and Conditions Agreement is also referred to as “the Agreement”. GHS Federal Credit Union is also referred to as “GHS FCU,” “the credit union,” and “the financial institution.”
ContractDisclosure Agreement • January 14th, 2014
Disclosure Request: A Quick Note from the MJW EA & Company LLC Staff We are providing the following form that we would need filled out and signed by you (the taxpayer) and a separate one from spouse (if applicable) in order to directly supply copies of your returns to anyone else. This usually applies to banks, family members, insurance companies, etc. If you do not wish to sign the disclosure agreement, you have the option of having us supply you with the information you require and then you can forward it as needed. Keep in mind, we are happy to provide one paper copy and one PDF with your filing; however, additional copies in either format are available at $25 each. Thank you!
DISCLOSURE AGREEMENTDisclosure Agreement • March 6th, 2009
Ear, Nose, and Throat Assessment in ChildrenChristina LandinoRN, BSN, CPN Victoria AlbanoMSN, CPNP Disclosure Agreement:We have no relevant financial or non-financial relationships to disclose. Contact Information:...Disclosure Agreement • August 2nd, 2017
Overview I. Nose and Sinus Assessmenta. Anatomy of the Nose and Sinus Cavitiesb. Common Diagnoses of the Nose and SinusesII. Mouth and Throat Assessmenta. Anatomy of the Mouth and Throatb. Common diagnoses of the Mouth and ThroatIII. Ear Assessmenta. Anatomy of the Earb. Common Diagnoses of the EarIV. Hearing lossa. Conductive vs. sensorineuralb. Music-induced hearing lossc. Treatment
Disclosure Agreement for Midwest Community's Internet Bill Pay ServiceDisclosure Agreement • January 30th, 2017 • Ohio
Note: All references within this document to the terms "Payment Service" and/or "the Service" reflect the Internet Bill Pay Service offered by Midwest Community Federal Credit Union (Midwest Community).
Disclosure AgreementDisclosure Agreement • July 9th, 2003
By clicking on Continue below, you agree to receive your monthly and quarterly Dort Federal Account Activity statements electronically (you will no longer receive printed versions of these statements in the mail).
DISCLOSURE AGREEMENTDisclosure Agreement • November 8th, 2011
IN CONSIDERATION of The FND Enterprise Co-operative Credit Union Limited, a private small business development organization with its Head Office in the Town of Basseterre, in the Federation of Saint Christopher-Nevis (hereafter called ‘The FNDECCU”) considering all or any of My/Our financial or commercial transacts whatsoever with the FNDECCU, I/We:
7th Grade Disclosure AgreementDisclosure Agreement • August 19th, 2020
Parents/Guardians, please use the “DPMS 7th Grade Information Page” and online content disclosures to complete this form with your 7th grade student. If you need clarification or see an issue with one of the 7th grade documents, please contact the 7th grade Assistant Principal, Jodi Roberts at jodi.roberts@canyonsdistrict.org or 801-826-6912 before completing the form.
PROTOTYPE AGREEMENT AGREEMENT for DISCLOSURE OF FREE AND REDUCED PRICE INFORMATIONDisclosure Agreement • May 5th, 2020
[Insert the Name of the Determining Agency] and [Insert the Name of the Receiving Agency] acknowledge and agree that children’s free and reduced price meal and free milk eligibility information obtained under provisions of the Richard B. Russell National School Lunch Act (42 USC 1751 et seq.) (NSLA) or Child Nutrition Act of 1966 (42 USC 1771 et seq.) (CNA) and the regulations implementing these Acts is confidential information. This Agreement is intended to ensure that any information disclosed by the [Insert name of the Determining Agency] to the [Insert Name of the Receiving Agency] about children eligibility for free and reduced price meals or free milk will be used for purposes specified in this Agreement and that the [Insert name of the Determining Agency] and [Insert Name of the Receiving Agency] recognize that there are penalties for unauthorized disclosures of this eligibility information.
THIS AGREEMENT made and entered into between , “Landlord" and ,Disclosure Agreement • May 2nd, 2021
The following parties have reviewed the information above and certify, to the best of their knowledge, that the information they have provided is true and accurate.
Disclosure Agreement. RespondeesDisclosure Agreement • April 15th, 2016
Name of Committee: National Institute of Neurological Disorders and Stroke Initial Review Group (Neurological Sciences and Disorders B).
Disclosure Agreement For Writers And AuthorsDisclosure Agreement • July 29th, 2022
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Disclosure Agreement Form for JOHN MACDisclosure Agreement • August 20th, 2013
In the increasingly complex world of scientific publication, concerns about commercial influence and other possible conflicts make it important for authors to disclose all potential sources of bias. Our system aligns with the policies of the AAN and allows the readers to judge whether bias exists. All Authors (not Co-investigators or Contributors) will be required to complete the following form upon provisional acceptance of a manuscript. Please refer to the definitions at the beginning of the form regarding commercial entities, compensation, expert witness, and "immediate family member." At first glance, this task may seem onerous, but will likely take less than 10 minutes.
DISCLOSURE AGREEMENT FORMDisclosure Agreement • May 13th, 2021
THIS AGREEMENT is made and entered into as of the below signed date (“Effective Date”) by and between The Bahamas Development Bank (“the Bank”) having its principal place of business on Robinson Road and Key West Street in the Central District of the Island of New Providence, being one of the Islands of the Commonwealth of The Bahamas and , (“the Borrower”).
ContractDisclosure Agreement • September 26th, 2014
Excerpt of the agreement notified to Consob, insofar as necessary, pursuant to art. 122 of Legislative Decree February 24, 1998, no. 58, as subsequently amended and supplemented (“TUF”) and pursuant to the applicable provisions of the Regulation adopted by Consob with resolution no. 11971 on May 14, 1999, as subsequently amended and supplemented (“RE”).
DISCLOSURE ON BED BUGSDisclosure Agreement • May 19th, 2021
The following parties have reviewed the information above and certify, to the best of their knowledge, that the information they have provided is true and accurate.
DISCLOSURE AGREEMENTDisclosure Agreement • November 9th, 2018
This agreement shall be a binding contract between NATIONAL COMMERCIAL BANK OF ANGUILLA LTD, (hereinafter referred to as the "Bank" which term shall include its successors in title and/or assigns) and
ContractDisclosure Agreement • June 19th, 2024
Excerpt pertaining to the agreements entered into on June 14, 2024, by Retex S.p.A. – Benefit Corporation (“Società Benefit”) and separately each of Claudio Benasso, Silvia Bosani, Luca Bosco, Federica Busino, Paolo Cederle, Guido Cuzzocrea, Paolo Fontana, Enrico Meacci, Alberto Saccardi and Oscar Zoggia, containing provisions relevant under Article 122 of Legislative Decree dated February 24, 1998, no. 58 (“CFA”) and Article 129 of CONSOB Regulation dated May 14, 1999, no. 11971 (“CONSOB Regulation”)
TASC ™ Disclosure AgreementDisclosure Agreement • July 23rd, 2019
This company is a Member of The Association of Settlement Companies and as such has agreed to publicly disclose the following on each of our websites and as part of ou r contract with
