Green Form definition

Green Form means the statutory Certificate for Burial or Cremation, unless the coroner has already issued an Order for Burial or a Certificate for Cremation.
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Green Form shall have the meaning set forth in Section 4.3(a).
Sample 1

Examples of Green Form in a sentence

  • Check the appropriate box below: [ ] This is an original Green Form.

  • Considering the types of Green Form claims now on file with the existing Trust and assumptions about how many claims will pass medical review and be found payable by the Alternate Facility, we have attempted to project the potential payments by the Alternate Facility to eligible Class Members in Category One.

  • GREEN FORM - 3 NOTE: If this Green Form is used to supplement a prior claim, the entire Claim Form does not have to be completed again in full.

  • As the single Echocardiogram on which the Class Member has based a claim that a Diet Drug Recipient had the Matrix Level condition claimed by the Attesting Physician in Part II of the Green Form submitted in support of the Matrix Claim.

  • To seek additional payment based on a worsened medical condition, you must complete another Green Form.

  • If Wyeth disputes the payability of a claim because it disagrees with the medical condition claimed on the Green Form, or disagrees with the evaluability of a tape as provided in Section 11(b)(1) of these Procedures, Wyeth shall specify which question(s) in Part II of the Green Form it disagrees with, and this question(s) will be the only question(s) submitted to the Auditing Cardiologist for review during Audit (the "Audit Question(s)").

  • You have NOT received a letter from the Trust advising you POST-AUDIT You have NOT received a letter from the Trust that a cardiologist working for the Trust has reviewed or DETERMINATION advising you that a cardiologist working for the audited your pending Green Form claim and that a decision LETTER Trust has reviewed or audited your claim and that a was made either denying Matrix benefits or finding you decision was made finding you eligible for Matrix eligible for Matrix benefits.

  • DETERMINING CATEGORY TWO CATEGORY ONE FACTORS YOU ARE NOT IN CATEGORY ONE, AND: ------------------------------------------------------------------------------------------------------------------------------------ You filed a Pink, Blue or Green Form with the Trust on or REGISTRATION You filed a Pink, Blue, Green, and/or Gray Form with before May 3, 2003.

  • With respect to each claim designated by Wyeth as payable, the Trust shall, as soon as possible, but no later than 30 days after the date of Wyeth's designation, perform a review of the claim to verify that the Class Member filed a Green Form and has the name and claim number of the claim included in Wyeth's designation.

  • If you have previously submitted a Green Form and your medical condition worsens and your change places you on a higher Matrix Level, then you have a right to receive incremental payments.

Related to Green Form

  • Bid Declaration Form means a declaration by the Bidders in form as specified inAnnexure III of this E-Auction Process Information Document;

  • Bid Application Form means the form as specified in Annexure II of this E-Auction Process Information Document;

  • Application Form means any application form to be completed by subscribers for Shares as prescribed by the Company from time to time.

  • Special Instruction Form means a standardized form prescribed by the Management Company to be duly filled by the investor to change his/her particulars and will be stated in this Offering Document.

  • Letter of Transmittal and Election Form means the letter of transmittal and election form(s) to be delivered by Company to the Company Shareholders and Company RSU Holders and providing for the Company Shareholder’s and Company RSU Holders election with respect to the Consideration;

  • Beneficiary Designation Form means the form established from time to time by the Plan Administrator that the Executive completes, signs, and returns to the Plan Administrator to designate one or more Beneficiaries.

  • Account Application Form means the Personal Account Application Form for International Personal Banking or Wealth and Investment as applicable;

  • Authorization Form means a form specified in s. 440.73.

  • Enrollment Form means an agreement pursuant to which an Eligible Employee may elect to enroll in the Plan, to authorize a new level of payroll deductions, or to stop payroll deductions and withdraw from an Offering Period.

  • FACE Form means the Funding Authorization and Certificate of Expenditure Form attached to this Agreement. The FACE Form is used for (i) requests for cash advances, direct payments or reimbursements and (ii) financial reporting by the Partner.

  • Subscription Form means the form of subscription annexed hereto as Schedule “A”;

  • Policy form means the form on which the policy is delivered or issued for delivery by the issuer.

  • Opt-Out Form means the form through which Eligible Employees may note their decision to opt out of participation in the Program.

  • Election Form means the form established from time to time by the Committee that a Participant completes, signs and returns to the Committee to make an election under the Plan.

  • Pledge Form means a standardized form prescribed by the Management Company to be duly filled by the investor to Pledge his/her Units and will be stated in this Offering Document.

  • Enrollment Agreement means an agreement between the Company and an employee, in such form as may be established by the Company from time to time, pursuant to which the employee elects to participate in this Plan, or elects changes with respect to such participation as permitted under the Plan.

  • Variation Form means the form that will be completed and signed by the Parties to effect a Variation which shall be in the form set out in Framework Schedule 19 (Variation Form);

  • Registration Form means a book voter registration form and a by-mail voter

  • Bid Form means the bid form required to be submitted by an Interested Bidder, as per Annexure I;

  • Distribution Election Form means the form established from time to time by the Plan Administrator that the Director completes, signs and returns to the Plan Administrator to designate the time and form of distribution.

  • Beneficiary designation means the naming in a governing instrument of a beneficiary of an insurance or annuity policy, of an account with POD designation, of a security registered in beneficiary form (TOD), of a pension, profit-sharing, retirement, or similar benefit plan, or of another nonprobate transfer at death.

  • National Instrument 51-102 means National Instrument 51-102 Continuous Disclosure Obligations;

  • Deferral Election Form means the form established from time to time by the Plan Administrator that the Director completes, signs and returns to the Plan Administrator to designate the amount of the Deferrals.

  • Account Opening Application Form means the application form/questionnaire completed by the Client in order to apply for the Company’s Services under this Agreement and a Client Account, via which form/questionnaire the Company will obtain amongst other things information for the Client’s identification and due diligence, his categorization and appropriateness or suitability (as applicable) in accordance with the Applicable Regulations.

  • Proxy Form means the proxy form attached to the Notice;

  • Designation Letter has the meaning specified in Section 2.17(a).