Authorizing Signatures and Dates Clause Samples

Authorizing Signatures and Dates. The signatories below warrant and represent that they have the competent authority on behalf of their respective entities to enter into the obligations set forth in this Reimbursable Agreement. _________________________________ Date __________ (Signature) Printed name: ________________________________ Title: _______________________________________ Social Security Administration

Authorizing Signatures and Dates. The signatories below warrant and represent that they have the competent authority on behalf of their respective entities to enter into the obligations set forth in this User Agreement. (Signature) Printed Name: ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ Associate Commissioner, Office of Data Exchange & Policy Publications (Signature) Printed Name: Title: Company Name: SAMPLE Attachment B - Form SSA 89‌ SAMPLE Page 25 of 46 Nombre en letra de molde Fecha de nacimiento Número de Seguro Social Quiero que esta información sea divulgada porque estoy llevando a cabo la siguiente transacción de negocios Razones para solicitar el CBSV: (Favor de marcar todo lo que aplique a esta divulgación) Empresa hipotecária Investigación de antecedentes Investigación crediticia con la siguiente empresa (“la Empresa”): Servicios bancarios Requisito para obtener una licencia Otra razón (explique) Nombre de la Empresa Dirección SAMPLE Yo autorizo a la Administración del Seguro Social a que verifique mi nombre y número de Seguro Social (SSN, sus siglas en inglés) a la Empresa o al agente de la Empresa, si procede, para el propósito que he identificado. El nombre y la dirección del agente de la Empresa es: Yo soy la persona a quien el número de Seguro Social fue emitió o el representante legal de un menor o el representante legal de una persona quien ha sido declarado por la corte un adulto incompetente. Yo declaro y afirmo bajo ▇▇▇▇ de perjurio que la información contenida aquí es verdadera y correcta. Yo reconozco que si hago alguna representación, que yo sé que es falsa, para obtener información de los registros del Seguro Social, puedo ser declarado culpable de un delito menor y penalizado con una multa de hasta $5,000. Este consentimiento ▇▇ ▇▇▇▇▇▇ por ▇▇▇▇ de la fecha en que es firmado. (Sus iniciales, por favor.) Firma Fecha en que firmó Parentesco (si no es la persona a quien le pertenece el SSN): Información de contacto de la persona que firma esta autorización: Dirección Cuidad/Estado/Zona Postal Número telefónico Formulario SSA-89 (Página 1 de 2)

Authorizing Signatures and Dates. APPROVED AND ACCEPTED BY APPROVED AND ACCEPTED

Authorizing Signatures and Dates. Each signatory below warrants and represents that he/she has the competent authority on behalf of his/her respective agency to enter into the obligations and agree to the terms set forth in this Memorandum of Understanding between FHFA and HUD regarding Fair Lending Coordination.

Authorizing Signatures and Dates. ‌ The signatories below warrant and represent that they have the competent authority on behalf of their respective entities to enter into the obligations set forth in this User Agreement. Date (Signature) Printed Name: Laura Train Associate Commissioner, Office of Data Exchange, Policy Publications, and International Negotiations Date (Signature) Printed Name: Title: Company Name: Attachment A - Form SSA-89 and Form SSA-89 SP‌ Attachment B – Form SSA-88 Pre-Approval Form for CBSV‌ Attachment C - Form SSA-200 CBSV Enrollment Application‌ Attachment D - Form SSA-1235 Agreement Covering Reimbursable Services‌ Atta‌ Name and address of company requesting services: The Requesting Party understands that the Social Security Administration (SSA) will verify Social Security Numbers (SSN) solely to ensure that the records of my Clients or my Principal’s Clients are correct for the purpose(s) indicated on the Form SSA-89 (Authorization for SSA to Release SSN Verification – Attachment A), obtained from the Clients. The information received from records maintained by SSA is protected by Federal statutes and regulations, including 5 U.S.C. § 552a(i)(3) of the Privacy Act. Under this section, any person who knowingly and willfully requests or obtains any record concerning an individual from an agency under false pretenses must be guilty of a misdemeanor and fined not more than $5,000. The Requesting Party must inform all authorized personnel with access to confidential information of the confidential nature of the information and the administrative, technical and physical safeguards required to protect the information from improper disclosure. All confidential information must at all times be stored in an area that is physically safe from unauthorized access. The Requesting Party must restrict access to all confidential information to the minimum number of employees and officials who need it to perform the process. Name Title Phone Number Signature Date

Authorizing Signatures and Dates. SWhen M.ooNCConttngr fin ficer

Authorizing Signatures and Dates