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Form preview Bank declaration form SOURCE OF FUNDS DECLARATION FORM Name Passport ID Driver s license Employer Residency Nationality Copy identification document attached Occupation Non Resident Account number Bank Permanent/Legal address State/City Country Temporary address in Aruba Tel E-mail This section must be filled out when performing a financial transaction on behalf of the company. If deemed necessary by the bank supporting documents should be submitted. Specify currency type s and denomination s This transaction includes check all applicable transactions cash out of check exchange foreign currency wire transfer payment on loan cash / check deposit on account no i. n.o. payment on credit card no State purpose of the transaction Provide relevant information on the destination of the funds if not credited on an account. Did you exchange foreign currency in the last three months No Yes Amount I certify that the information in this Source of Funds declaration form is complete and correct to the best of my knowledge and belief. Signature Date // ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- CSR/CCS AE/CCS AE/AUA Compliance Officer General Manager Date. Company Name Company address Tel I declare that the amount of AFL/USD/EUR/NAFL/Other represents funds obtained by the undersigned from the following source s Provide such information such as the person/entity from which funds have been received date of receipt and the reason for receiving funds. If deemed necessary by the bank supporting documents should be submitted* Specify currency type s and denomination s This transaction includes check all applicable transactions cash out of check exchange foreign currency wire transfer payment on loan cash / check deposit on account no i. n*o. payment on credit card no State purpose of the transaction Provide relevant information on the destination of the funds if not credited on an account. Did you exchange foreign currency in the last three months No Yes Amount I certify that the information in this Source of Funds declaration form is complete and correct to the best of my knowledge and belief* Signature Date // ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- CSR/CCS AE/CCS AE/AUA Compliance Officer General Manager Date. Company Name Company address Tel I declare that the amount of AFL/USD/EUR/NAFL/Other represents funds obtained by the undersigned from the following source s Provide such information such as the person/entity from which funds have been received date of receipt and the reason for receiving funds. If deemed necessary by the bank supporting documents should be submitted* Specify currency type s and denomination s This transaction includes check all applicable transactions cash out of check exchange foreign currency wire transfer payment on loan cash / check deposit on account no i.
Form preview Nmc international travel decla... TRAVEL DECLARATION FORM for NMC members Your Medical Scheme membership entitles you to International Travel Insurance. This policy will insure you and your dependants as listed under your Medical Aid membership against emergency medical expenses that may be incurred while traveling abroad for trips of up to 90 days at a time. In order to activate this benefit please complete the form below. Once the form has been completed please fax to 264 61 287 6091 or email to enquiries methealth. com*na* A policy document confirming your emergency medical cover will be issued and sent to you. Please note Should you have any queries or in case of emergencies please contact the Travel Guard Chartis 24 hour emergency medical assistance call centre on 44 1273 739 274 or the South African number 27 11 525 3109 Application For International Emergency Medical Expenses Cover Scheme Membership Number Please complete main member dependant details below Title Firstname Lastname Date of birth Telephone No Fax No Email address Departure Date from home Return Date Return to home Countries to be visited House Doctor Name and tel Next of Kin Telephone number Passport Nr Please indicate with an asterisk to which e-mail/fax the Travel Protection Certificate must be sent Fax to. This policy will insure you and your dependants as listed under your Medical Aid membership against emergency medical expenses that may be incurred while traveling abroad for trips of up to 90 days at a time. In order to activate this benefit please complete the form below. Once the form has been completed please fax to 264 61 287 6091 or email to enquiries methealth. In order to activate this benefit please complete the form below. Once the form has been completed please fax to 264 61 287 6091 or email to enquiries methealth. com*na* A policy document confirming your emergency medical cover will be issued and sent to you. Please note Should you have any queries or in case of emergencies please contact the Travel Guard Chartis 24 hour emergency medical assistance call centre on 44 1273 739 274 or the South African number 27 11 525 3109 Application For International Emergency Medical Expenses Cover Scheme Membership Number Please complete main member dependant details below Title Firstname Lastname Date of birth Telephone No Fax No Email address Departure Date from home Return Date Return to home Countries to be visited House Doctor Name and tel Next of Kin Telephone number Passport Nr Please indicate with an asterisk to which e-mail/fax the Travel Protection Certificate must be sent Fax to. This policy will insure you and your dependants as listed under your Medical Aid membership against emergency medical expenses that may be incurred while traveling abroad for trips of up to 90 days at a time. In order to activate this benefit please complete the form below. Once the form has been completed please fax to 264 61 287 6091 or email to enquiries methealth. com*na* A policy document confirming your emergency medical cover will be issued and sent to you. Please note Should you have any queries or in case of emergencies please contact the Travel Guard Chartis 24 hour emergency medical assistance call centre on 44 1273 739 274 or the South African number 27 11 525 3109 Application For International Emergency Medical Expenses Cover Scheme Membership Number Please complete main member dependant details below Title Firstname Lastname Date of birth Telephone No Fax No Email address Departure Date from home Return Date Return to home Countries to be visited House Doctor Name and tel Next of Kin Telephone number Passport Nr Please indicate with an asterisk to which e-mail/fax the Travel Protection Certificate must be sent Fax to.
Form preview Positive declaration of compli... BSP-12-P19F00x Positive Declaration of Compliance Form Positive Declaration of Compliance We the Manufacturer and the CONTRACTOR confirm that our quotation is in full compliance with the COMPANY s specification s in respect of the request for a priced quotation / enquiry. Please refer to Part I / Part II for the list of compliant GOODS* request for a priced quotation / enquiry. Please refer to Part I / Part II for the list of exception s / deviation s. Delete where not applicable Manufacturer CONTRACTOR Name Address Signed Date Page 1 of 3 Part I For Standard GOODS Item Description confirm that Alternative/CONTRACTOR s Offer Code 3 TA TNA Code 4 Code 5 Scope of supply of the GOODS as per the shall be met. Exception/ Deviation Code 2 The time stipulated for the delivery of the GOODS in the request for priced quotation / enquiry document shall be met or improved upon* Code 1 The GOODS shall be packed in accordance with the requirements specified in the request for priced quotation / enquiry document. Compliant The GOODS to be supplied are fully compliant with the specified manufacturer and country of origin in accordance with the TAMAP/AML* with the SAP buying descriptions and specifications as stated in the request for priced quotation / enquiry document. List of deviation s Note Columns 2 for items 5. 1 and above 3 4 and 5 are to be completed by the CONTRACTOR* The CONTRACTOR shall furnish detailed description s of any alternative offer s. Columns 6 and 7 will be completed by the COMPANY. Part II For Non-standard GOODS The following is only a guideline and will be updated by the COMPANY prior to issue of the request for a priced quotation / enquiry document s. / General Codes Standards Specifications and Procedures Technical Requirements Inspection Testing and Commissioning Documentation Requirements Spares and Special Tools Equipment Protection and Packing Quality Assurance Requirements Planning and Scheduling Guarantees/Warranty Approved Manufacturer Lists Columns 3 4 and 5 are to be completed by the CONTRACTOR* The CONTRACTOR shall furnish detailed description s of any alternative offer s. Please refer to Part I / Part II for the list of compliant GOODS* request for a priced quotation / enquiry. Please refer to Part I / Part II for the list of exception s / deviation s. Delete where not applicable Manufacturer CONTRACTOR Name Address Signed Date Page 1 of 3 Part I For Standard GOODS Item Description confirm that Alternative/CONTRACTOR s Offer Code 3 TA TNA Code 4 Code 5 Scope of supply of the GOODS as per the shall be met. Please refer to Part I / Part II for the list of exception s / deviation s. Delete where not applicable Manufacturer CONTRACTOR Name Address Signed Date Page 1 of 3 Part I For Standard GOODS Item Description confirm that Alternative/CONTRACTOR s Offer Code 3 TA TNA Code 4 Code 5 Scope of supply of the GOODS as per the shall be met. Exception/ Deviation Code 2 The time stipulated for the delivery of the GOODS in the request for priced quotation / enquiry document shall be met or improved upon* Code 1 The GOODS shall be packed in accordance with the requirements specified in the request for priced quotation / enquiry document.
Form preview Lee county declaration domicil... State of Florida Declaration of Domicile To the Clerk of the Circuit Court of Lee County This is my Declaration of Domicile in the State of Florida that I am filling this day in accordance and in conformity with Section 222. 17 of the Florida Statutes. I hereby declare that I reside in and maintain a place of abode at Number and Street Lee City Zip County Date You Became a Resident Which place of residence I recognize and intend to maintain as my permanent home and if I maintain another place or place of above in some other state or states I hereby declare that my above-described residence and abode in the state of Florida constitutes my predominant and principal home. And I intend to continue it permanently as such. I am at time of making this declaration a bona fide resident of the State of Florida* I formerly resided at I maintain another home at Address Number and Street Address City State Zip and County Date Signature Print Name County of Lee The foregoing instrument was acknowledged before me this day of 20 Identification type of ID produced Notary Public State of Florida Linda Doggett Clerk of Circuit Court Print type or stamp Commissioned name Seal. 17 of the Florida Statutes. I hereby declare that I reside in and maintain a place of abode at Number and Street Lee City Zip County Date You Became a Resident Which place of residence I recognize and intend to maintain as my permanent home and if I maintain another place or place of above in some other state or states I hereby declare that my above-described residence and abode in the state of Florida constitutes my predominant and principal home. And I intend to continue it permanently as such. I am at time of making this declaration a bona fide resident of the State of Florida* I formerly resided at I maintain another home at Address Number and Street Address City State Zip and County Date Signature Print Name County of Lee The foregoing instrument was acknowledged before me this day of 20 Identification type of ID produced Notary Public State of Florida Linda Doggett Clerk of Circuit Court Print type or stamp Commissioned name Seal.

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