Holder's Name definition

Holder's Name. Taxpayer Identification Number: _______________________________ By: _______________________________ Printed Name: _______________________________ Title: _______________________________ Address: _______________________________ _______________________________ _______________________________ Cashless Exercise (Y or N) _________
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Examples of Holder's Name in a sentence

  • Authorized Signature Card Holder's Name (Please Print) Credit card # exp.

  • Witness: ) ____________________________ ) Holder's Name ) ) ) --------------------------- ) Authorized Signature ) ) ) --------------------------- ) Title (if applicable) Signature guaranteed: ASSIGNMENT FORM TO BE COMPLETED IF WARRANTS ARE TO BE ASSIGNED: TO: ALTAIR INTERNATIONAL INC.

  • Account Holder's Name: [Institution] Account Type: [Saving] [Current] Bank Account No.: …………………………………………………...

  • Witness: ) ___________________________________ ) Holder's Name ) ) ) ___________________________________ ) Authorized Signature ) ) ) ___________________________________ ) Title (if applicable) Signature guaranteed: ASSIGNMENT FORM TO BE COMPLETED IF WARRANTS ARE TO BE ASSIGNED: TO: ALTAIR INTERNATIONAL INC.

  • Witness: ) ________________________________ ) Holder's Name ) ) ________________________________ ) Authorized Signature ) ) ________________________________ Title (if applicable) Signature guaranteed: THE SIGNATURE MUST BE GUARANTEED BY A CANADIAN CHARTERED BANK OR A MEMBER OF A RECOGNIZED STOCK EXCHANGE OR OTHER ENTITY ACCEPTABLE TO MED-EMERG INTERNATIONAL INC.

  • Holder's Name ) ) ---------------------------------- ) Authorized Signature ) ) ---------------------------------- ) Title (if applicable) Signature guaranteed: The signature must be guaranteed by a Canadian chartered bank or a member of a recognized stock exchange or other entity acceptable to the Corporation.

  • Primary Medical Insurance: Subscriber Number: Policy Holders Name: □Self □Parent □Spouse Policy Holders Date of Birth: / / Secondary Medical Insurance: Subscriber Number: Policy Holders Name: □Self □Parent □Spouse Policy Holders Date of Birth: / / Patient/Parent/Legal Guardian Signature: Date: All patients are requested to read, initial, and comply with Heart of Florida Health Center’s (HFHC) below.

  • Holder's Name ) ________________________________) --------------------------------------- ) Authorized Signature ) ) --------------------------------------- ) Title (if applicable) Signature guaranteed: The signature must be guaranteed by a Canadian chartered bank or a member of a recognized stock exchange or other entity acceptable to the Corporation.

  • By:___________________________________ Name:_________________________________ Title:________________________________ HOLDER: ______________________________________ [Holder's Name] I, _______________________________, am the spouse of Holder.

  • Given by (Account Holders Name): Bank Name: Branch Code: Account No.: Type of Account: • You hereby authorise the Credit Provider and any of its successors-in-title or assigns, to issue and deliver payment instructions to your bank for collection against Your above mentioned account at Your above-mentioned bank (or any other account, bank or branch to which You may transfer Your account) on condition that the sum of such payment instructions will never exceed Your obligations as agreed to in the Agreement.