REASON FOR SUBMISSION Sample Clauses
The "Reason for Submission" clause requires a party to clearly state the purpose or justification for submitting a particular document, request, or application under the agreement. In practice, this clause ensures that each submission is accompanied by an explanation, such as providing supporting information for a claim, requesting approval, or notifying of a change. By mandating that the reason for each submission is specified, the clause promotes transparency and helps the receiving party efficiently process and respond to submissions, reducing misunderstandings and administrative delays.
REASON FOR SUBMISSION. INSTRUCTIONS: If you are signing a Medicaid application on behalf of the applicant, you must provide the authorization/legal document authorizing you to apply on the applicant’s behalf OR attest that the applicant is incompetent or incapacitated. Please check the appropriate boxes below. Attach the authorization I have authorization to apply for Medicaid on behalf of the applicant. (Check the box for the type of authorization you have and submit the authorization OR complete Section D below.) Guardianship Document Power of Attorney (POA) Document Other Written Authorization (Specify) I attest that the applicant is incompetent or incapacitated. S/he is unable to sign the application herself/himself and is unable to provide written consent for me to apply on his/her behalf. Signature of Person Completing This Form Date Signed
REASON FOR SUBMISSION. Indicate your reason for completing this form by checking the appropriate box: New EFT authorization or change to your account information. If you are authorizing EFT payments to the home office of a chain organization of which you are a member, you must attach a letter authorizing the contractor to make payment due the provider of service to the account maintained by the home office of the chain organization. The letter must be signed by an authorized official of the provider of service and an authorized official of the chain home office.
REASON FOR SUBMISSION. Indicate your reason for completing this form by checking the appropriate box: New EFT enrollment, a change to your EFT enrollment account information, or cancellation of your EFT enrollment.
REASON FOR SUBMISSION. Reason for Submission:
REASON FOR SUBMISSION. See Instructions on Page 2 Document Included: Voided Check Bank Letter PART II: ACCOUNT HOLDER INFORMATION- See Instructions on Page 2
REASON FOR SUBMISSION. Must select one from below
REASON FOR SUBMISSION. See Instructions on Page 3 New Enrollment Change Enrollment Cancel Enrollment Document Included: Voided Check Bank Letter Account Holder Legal Name: DBA Name if different from above: Legal Address: number, street, and apt. or suite no. City: State: Zip Code: Account Holder Tax Identification Number (9 digits EIN or SSN) EIN: SSN:
REASON FOR SUBMISSION. See Instructions on Page 2
REASON FOR SUBMISSION. Reason for Submission: ❑ New EFT Authorization ❑ Revision to Current Authorization (e.g. account or bank changes) Chain Home Office: ❑ Check here if EFT payment is being made to the Home Office of Chain Organization (Attach letter Authorizing EFT payment to Chain Home Office)
REASON FOR SUBMISSION. The Department of Health and Social Care (DHSC) have agreed a 5 year lease at Skipton House. This was agreed earlier this year, following an extended period of negotiation (previous lease ended December 2016). As a result we have requested a MOTO base on the standard Civil Estate Occupancy Agreement (and similar to our previous arrangement) to reflect the revised terms and extend our lease period at Skipton House. Term: 1 April 2018 – 20th December 2021 Space occupied: 631.42sqm (3.11% of total occupancy) Licence payment: £233,250/annum Other costs (rates, facilities management; utilities recharged at 3.11%) HRA responsible for decorations / lighting / cleaning in own demise HRA scheme of delegation require Board approval for all contracts greater than £250,000. Total annual costs associated with this MOTO are £475,000. There are no further extensions anticipated to these arrangements with the expectation that all current occupants will move to government hubs (Stratford or Canary Wharf) or other DHSC London buildings at the end of this term. We are actively participating in the DHSC London Strategy Group to ensure our future requirements are met as well as meeting Government Policy initiatives. Once approved, HRA Chair to sign MOTO.