Common use of Electronic Submission Clause in Contracts

Electronic Submission. Please electronically deliver the signed Acknowledgement of Confidentiality to ETA via e-mail at: ▇▇▇▇@▇▇▇.▇▇▇. Signed Word documents are not acceptable. Digital signatures and scanned or electronic documents are acceptable. Signature of SUIA or ▇▇▇▇▇ Contact: Employee Name (Please print): Is the Employee a staff member of theState SUIA? Yes No or a State ▇▇▇▇▇? Yes No Is the individual an employee of the State, a contractor, or agent? State Contractor Agent Does the employee require ETA- approved individual credentials to access the password-protected SWIS Clearinghouse ▇▇▇▇▇ portal? Yes No [INSERT LSP NAME]

Electronic Submission. Please electronically deliver the signed Acknowledgement of Confidentiality to ETA via e-mail at: ▇▇▇▇@▇▇▇.▇▇▇. Signed Word documents are not acceptable. Digital signatures and scanned or electronic documents are acceptable. Signature of SUIA or ▇▇▇▇▇ Contact: Employee Name (Please print): Is the Employee a staff member of theState SUIA? Yes No or a State ▇▇▇▇▇? Yes No Is the individual an employee of the State, a contractor, or agent? State Contractor Agent Does the employee require ETA- approved individual credentials to access the password-protected SWIS Clearinghouse ▇▇▇▇▇ portal? Yes No [INSERT LSP NAME]No

Electronic Submission. Please electronically deliver the signed Acknowledgement of Confidentiality to ETA via e-mail at: ▇▇▇▇@▇▇▇.▇▇▇. Signed Word documents are not acceptable. Digital signatures and scanned or electronic documents are acceptable. Annex 2 Form (Part I) Signature of SUIA or ▇▇▇▇▇ Contact: Annex 2 Form (Part II) Employee Name (Please print): Is the Employee a staff member of theState SUIA? Yes No or a State ▇▇▇▇▇? Yes No Is the individual an employee of the State, a contractor, or agent? State Contractor Agent Does the employee require ETA- approved individual credentials to access the password-protected SWIS Clearinghouse ▇▇▇▇▇ portal? Yes No [INSERT LSP NAME]