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Confidential character referen... O. Box City/Town Province/State Country Postal Code/Zip Code hereby consent the following referee Please print referee s name to provide the Ministry of Education with this confidential character reference as part of my application for authorization to teach in BC and I acknowledge that this confidential character reference is not a teaching report. Confide nt ia l Cha r a ct e r Re fe re nce for Aut hor iza t ion t o Te a ch in Br it ish Colum bia Pa ge 1 Applicant please complete this page. I Full given names Applicant s legal surname Date of Birth YYYYMMDD Birth Surname Previous Surnames Street Address/P. Date Signature of Applicant Notes This two-page character reference form is to be provided by the applicant to a referee who shall complete page 2. The referee must not be a relative partner or spouse or equivalent of the applicant and must have known the applicant for a minimum of two years. trb. certification gov*bc*ca. This character reference will not be accepted as a teaching report. Delay in the receipt of this form will result in delay in the processing of the application* Ministry of Education Teacher Regulation Branch Mailing Address 400-2025 West Broadway Vancouver BC V6J 1Z6 Telephone 604 731-8170 Toll Free 1 800 555-3684 Facsimile 604 731-9142 Pa ge 2 Referee please complete this page and send it directly to the Ministry of Education by mail fax or scanned email trb. certification gov*bc*ca. Applicant s Name How long have you known this applicant A referee must have known the applicant for a minimum of two years. In what capacity have you known this applicant A referee must not be a relative partner or spouse or equivalent of the applicant. Describe situation s in which you have observed the applicant working with children or youth. If you have not observed the applicant working with children or youth what characteristics and/or qualities have you seen the applicant exhibiting that would be valuable in working with young people Explain why you consider the applicant to be a fit and proper person to be working with students. Do you have any reason to believe the applicant should not be granted authorization to teach To the best of my knowledge the above information is complete and correct. Name of Referee Please print full name Signature of Referee Address Telephone H W Should the applicant under the Freedom of Information and Protection of Privacy Act request a copy of this reference do you consent to its release Yes No Delay in receipt of this form will result in delay in the processing of the application* This is a character reference only and may not be used as a teaching report or professional evaluation*. Confide nt ia l Cha r a ct e r Re fe re nce for Aut hor iza t ion t o Te a ch in Br it ish Colum bia Pa ge 1 Applicant please complete this page. I Full given names Applicant s legal surname Date of Birth YYYYMMDD Birth Surname Previous Surnames Street Address/P. Date Signature of Applicant Notes This two-page character reference form is to be provided by the applicant to a referee who shall complete page 2. The referee must not be a relative partner or spouse or equivalent of the applicant and must have known the applicant for a minimum of two years.

Canada authorized letter form Title Titre Signature Date Year Ann e The above named firm or individual hereby authorizes representatives whose signatures appear below to receive parcel and letter mail for which signature may or may not be required addressed to or in care of the above named individual or firm until otherwise notified in writing. Any previous authorizations are hereby revoked. Authorized Representatives Repr sentants autoris s La section ci-apr s doit tre remplie par la personne qui pr sente ce formulaire en pr sence d un employ charg de la livraison ou d un pr pos la vente au d tail. Cette personne doit tre un repr sentant autoris dont le nom figure plus haut ou la personne accordant l autorisation. Signature of clerk witnessing Signature du pr pos t moin Customer s signature de la signature du client Type of ID verified Pi ce d identit v rifi e 22-053-126 09-10 MM DJ This form duly completed is to be retained on file at the designated post office for the address indicated. Par la pr sente l entreprise ou la personne susmentionn e autorise les repr sentants dont la signature figure ci-apr s recevoir colis et courrier poste-lettres pour lesquels une signature peut tre requise ou non adress s la personne ou l entreprise ou exp di s aux soins de l une ou l autre de ces derni res jusqu avis contraire mis par crit. Toute autorisation pr c dente est r voqu e par la pr sente. Nom en lettres moul es The section below is to be completed by the individual submitting this form in the presence of a Canada Post delivery employee or Retail postal clerk. Letter of Authorization Lettre d autorisation Name of Individual or Business/Organization Nom de la personne de l entreprise ou de l organisme Telephone No* N de t l phone Address Adresse Prov* City Ville Authorization granted by Individual with authority to sign on behalf of the business/organization named above. If this authorization is on behalf of an individual the authorized by signature must be that of the individual named at the top of the form no title required. Printed Name Nom en lettres moul es Postal Code Code postal Autorisation accord e par la personne autoris e signer au nom de l entreprise ou de l organisme susmentionn. Si cette autorisation est accord e au nom d une personne la signature figurant sous Signature accord e par doit tre celle de la personne nomm e au haut du formulaire le titre n est pas n cessaire. Title Titre Signature Date Year Ann e The above named firm or individual hereby authorizes representatives whose signatures appear below to receive parcel and letter mail for which signature may or may not be required addressed to or in care of the above named individual or firm until otherwise notified in writing. Any previous authorizations are hereby revoked* Authorized Representatives Repr sentants autoris s La section ci-apr s doit tre remplie par la personne qui pr sente ce formulaire en pr sence d un employ charg de la livraison ou d un pr pos la vente au d tail* Cette personne doit tre un repr sentant autoris dont le nom figure plus haut ou la personne accordant l autorisation* Signature of clerk witnessing Signature du pr pos t moin Customer s signature de la signature du client Type of ID verified Pi ce d identit v rifi e 22-053-126 09-10 MM DJ This form duly completed is to be retained on file at the designated post office for the address indicated* Par la pr sente l entreprise ou la personne susmentionn e autorise les repr sentants dont la signature figure ci-apr s recevoir colis et courrier poste-lettres pour lesquels une signature peut tre requise ou non adress s la personne ou l entreprise ou exp di s aux soins de l une ou l autre de ces derni res jusqu avis contraire mis par crit.

Tenant application and owner a... AUTHORIZATION AGREEMENT TO BILL TENANT Water & Sewer Account : Tax Roll Number: Service Address: Unit: I, (We) (Print Name of Owner (s) of (mailing address) declare as follows that: (City) (Province)

Heco net agreement sample shee... Section 15. Company Signature THIS SECTION FOR HECO USE ONLY I hereby acknowledge receipt and completeness of the Net Energy Metering Agreement. SHEET NO. 39A-1 Effective June 17 2005 APPENDIX I NET ENERGY METERING AGREEMENT 10 kW or Less Section 1. Applicant Information Customer-Generator Name Mailing Address City/State Zip Code Generating Facility Location if different from above /Tax map key Daytime Phone Evening/Cell Phone Electric Service Account Owner of Generating Facility if different from Customer-Generator Operator of Generating Facility if different from Customer-Generator Section 2. Generating Facility Information Power Conditioning Equipment Energy Storage kW/ ea X kW Solar Rated generator capacity in kW Generator/Inverter Make/Model Rated photovoltaic module capacity in kWDC. kWh. PTC Wind Biomass Hydro Hybrid Total rated capacity in kW Shall not exceed 10 kW Attach specification sheet if available. Generating System Building Permit Certificate of Completion or Notice of Electrical Inspection Is system self-excited with potential to island Yes No Please submit a single line diagram* Submitted HAWAIIAN ELECTRIC COMPANY INC. Docket No* 05-0037 D O No* 21877 Dated June 17 2005 Transmittal Letter Dated June 24 2005. Section 3. Certification by Licensed Electrical Contractor Generating and interconnection systems must be compliant with all applicable safety and performance standards of the National Electrical Code NEC Institute of Electrical and Electronic Engineers IEEE and accredited testing laboratories such as the Underwriters Laboratories UL and where applicable the rules of the Public Utilities Commission of the State of Hawaii Commission or other applicable governmental laws and regulations and the Electric Company s Company interconnection requirements in effect at the time of signing this agreement. The following certifies that the installed generating system meets all preceding requirement s. Signed Licensed Electrical Contractor License Holder printed Date Hawaii License C City Hawaii Zip Code Installation date Section 4. Installation Design installation operation and maintenance of the Generating Facility shall include appropriate control and protection equipment and a manual load-break disconnect device lockable in the open position and accessible by the Company as a means of electrically isolating the Generating Facility from the Company s system and to establish working clearance for maintenance and repair work in accordance with the Company s safety rules and practices. This load-break disconnect device shall be furnished and installed by the The disconnect device shall preferably be located in the immediate vicinity of the electric meter serving the location which is accessible to utility company personnel on a 24-hour basis. The Customer-Generator and/or Owner/Operator grants access to the Company to utilize the disconnect device if needed* The CustomerGenerator shall obtain the authorization from the owner and/or occupant of the premises where the Generating Facility is located that allows the Company access to the Generating Facility for the purposes specified in this Agreement.

Authorization for prescribed m... Principal/School Nurse Signature MCPS Form 525-13 Rev. 1/06 DISTRIBUTION COPY 1/Student Health Record COPY 2/Parent/Guardian INFORMATION AND PROCEDURES 1. I agree to release indemnify and hold harmless MCPS and MCDHHS and any of their of cers staff members or agents from lawsuit claim demand or action against them for administering prescribed medication to this student provided MCPS and MCDHHS staff are following the physician s order as written ...

Intertops credit card authoriz... CREDIT CARD AUTHORIZATION FORM Email this Form along with copies of the following to documents intertops. ag P. O. BOX W247 Wood s Centre St* John s Antigua Tel 1-268-480- 3100 documents intertops. ag 1 Passport or Drivers license of Intertops Accountholder both sides. 3 Authorized Credit Card s both sides. 4 Utility Bill bank statement or credit card statement Intertops Logon User Name or Customer Number Date Intertops Accountholder Name Accountholder Contact Telephone 1 By signing below I authorize the use of the following credit cards Authorized Card s for loading my Intertops account identified above. I also agree that I have been authorized to use all of the Authorized Card s listed below and agree to pay any and all charges incurred by these cards to fund my intentionally or inadvertently you shall be under no liability whatsoever including any fees imposed by my bank even though such dishonor may result in the inaccessibility of my Intertops account. By Signed Print Name CARD TYPE VISA DINERS CLUB CARD NUMBER EXPIRATION DATE MASTERCARD AMEX CARD BILLING ADDRESS if different than above CARDHOLDER S NAME as it appears on the credit card TODAY S DATE SIGNATURE OF CARDHOLDER Question Call 1-268-480-3100. ag P. O. BOX W247 Wood s Centre St* John s Antigua Tel 1-268-480- 3100 documents intertops. ag 1 Passport or Drivers license of Intertops Accountholder both sides. 3 Authorized Credit Card s both sides. 4 Utility Bill bank statement or credit card statement Intertops Logon User Name or Customer Number Date Intertops Accountholder Name Accountholder Contact Telephone 1 By signing below I authorize the use of the following credit cards Authorized Card s for loading my Intertops account identified above. 3 Authorized Credit Card s both sides. 4 Utility Bill bank statement or credit card statement Intertops Logon User Name or Customer Number Date Intertops Accountholder Name Accountholder Contact Telephone 1 By signing below I authorize the use of the following credit cards Authorized Card s for loading my Intertops account identified above. I also agree that I have been authorized to use all of the Authorized Card s listed below and agree to pay any and all charges incurred by these cards to fund my intentionally or inadvertently you shall be under no liability whatsoever including any fees imposed by my bank even though such dishonor may result in the inaccessibility of my Intertops account. I also agree that I have been authorized to use all of the Authorized Card s listed below and agree to pay any and all charges incurred by these cards to fund my intentionally or inadvertently you shall be under no liability whatsoever including any fees imposed by my bank even though such dishonor may result in the inaccessibility of my Intertops account. By Signed Print Name CARD TYPE VISA DINERS CLUB CARD NUMBER EXPIRATION DATE MASTERCARD AMEX CARD BILLING ADDRESS if different than above CARDHOLDER S NAME as it appears on the credit card TODAY S DATE SIGNATURE OF CARDHOLDER Question Call 1-268-480-3100.

Get faxback credit card author... CREDIT CARD AUTHORIZATION FORM Please fill out and sign and send this form alongside copies of the following documents to documents jackpotcapital.com 1) Copy of your valid Driver License or Passport

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