Pre-Qualification Application Form for Third Party Agencies
|
|
|
- Ada Dickerson
- 5 years ago
- Views:
Transcription
1 Pre-Qualificatin Applicatin Frm fr Third Party Agencies Ntes t Applicants General: Please type r print yur replies legibly. Submitted dcuments must be in PDF Frmat. s shall be submitted at EHSPrts.PreQualificatin@trk.pcfc.ae (each nt exceeding 5 MB). Applicatin and Frms are available n Trakhees Website fr dwnlading. Third Party Agencies wh are seeking registratin with Trakhees shall submit ne cpy f this frm duly filled by an authrized cmpany representative alng with cpy f the supprting dcuments as required. Third Party Agencies shall ensure that all prvided infrmatins are crrect and nt fund t be indulging in any malpractice such as prviding f frged, incrrect r incmplete infrmatins. Table f Cntents: Cntent Part A General Cmpany Particular... General Details Part B s Checklist Table 1 (New )... Table 2 (Renewal )... Table 3 (Amendment ) Table 4 (Additinal Requirements)... Part C Appendixes Appendix 1 (Request Letter) Appendix 2 (Resume)... Appendix 3 (Prven Track Recrds)... Appendix 4 (List f Staff)... Appendix 5 (List f Gas Mnitrs).. Appendix 6 (List f Diving Equipment). Appendix 7 (List f Bunker Rad Tankers)... Appendix 8 (List f Bunker Barges)... Appendix (List f Vehicles)... Page N Classificatin: Public Rev. 00 January 2018 Page 1 f
2 1. Cmpany Particulars Part A (Applicable fr All Types f s) Cmpany Name Cmpany Address Details P.O Bx Telephne Address Website Client Trakhees ID Persn in Charge fr Client Query Mbile Number Nte: Infrmatin prvided in abve table will be upladed in Trakhees Website. 2. General Details Third Party Agency Categry Type f Applicatin Date f Number f Emirati Staff Number f Staff Number f Years in Operatin in UAE Offices Abrad (If Yes Mentin Detail) Rev. 00 January 2018 Page 2 f
3 Part B ( s Checklist) Please tick mark ( ) all relevant bxes with reference t the categry submitted. All s mentined n belw Tables as applicable shall be submitted alng with the Applicatin Frm. s file must be renamed as per belw: (Ex: D1- Request Letter) Table (1) (Applicable nly fr New ) 1 D1-Request Letter* 2 D2-Trade License 3 D3-Cmpany Prfile Name 4 D4-Liability Insurance (Includes cmpany activity and peratin area ) 5 D5-HSE Management System (Quality Manual) 6 D6-Quality Certificatin ( ISO )** 7 D7-Cnflict f Interest (Refer t Frm: PMF-01b) 8 D8-Blacklisting Frm (Refer t Frm: PMF-01c) D-Apprval frm Other Authrity (Internatinal / Federal / Lcal )** 10 D10-Valid Training Card (s)*** 11 D11-Valid Accreditatin Card*** 12 D12-Prven Track Recrds * 13 D13-List f Staff * Rev. 00 January 2018 Page 3 f
4 Table (2) (Applicable nly fr Renewal ) 1 D1-Request Letter* 2 D2-Trade License Name 3 D3-Liability Insurance (Includes cmpany activity and peratin area ) 4 D4-Quality Certificatin ( ISO )** 5 D5-Cnflict f Interest (Refer t Frm: PMF-01b) 6 D6-Blacklisting Frm (Refer t Frm: PMF-01c) 7 D7-Apprval frm Other Authrity (Internatinal / Federal / Lcal )** 8 D8-Valid Training Card (s)*** D-Valid Accreditatin Card*** 10 D10-List f Staff * Table (3) (Applicable nly fr Amendment ) 1 D1-Request Letter* 2 D2-Trade License Name 3 D3-List f Staff / Rad Tanker fr Amendment * 4 D4-Valid Training Card(s)*** Rev. 00 January 2018 Page 4 f
5 Table (4) (Additinal Requirements) 1. Ship Survey Cmpany (B) (Refer Client Prcedure Clause 5.0/5.1 Minimum Eligibility Criteria) Name 14 D14 -Surveyrs Resume* 15 D15 -Prf f Educatinal/Prfessinal/Training/Experience Certificate(s) 16 D16 -List f List f Gas Mnitr(s) and Calibratin Certificate(s)* 2. Cmmercial Diving Cmpany (Refer Client Prcedure Clause 5.0/5.2 Minimum Eligibility Criteria) Name 17 D17 -Prf f Prfessinal /Experience Certificate(s) 18 D18 -Valid Medical Certificate(s) 1 D1 -List f Diving Equipment(s) and Test Certificate(s)* 3. Hazmat Operatin Cmpany (Refer Client Prcedure Clause 5.0/5.3 Minimum Eligibility Criteria) 20 D20 -Hazmat Supervisr Resume* Name D21 -Prf f Educatinal/Prfessinal/Training/Experience Certificate(s) fr Hazmat Supervisr D22 -Prf f Educatinal /Training/Experience Certificate(s) fr Hazmat Operatrs 23 D23 -Occupatinal Health Card Rev. 00 January 2018 Page 5 f
6 4. Bunker Supply Cmpany A. Rad Tanker(s) Name 24 D24-Driving License 25 D25-Rad Bunker Tanker Registratin (Frnt and Back Units) 26 D26-Hazmat Material Vehicle Driving Permit fr Drivers 27 D27-Rad Bunker Tanker Apprval frm UAE Civil Defense 28 D28-Valid Hse Test Certificate(s) 2 D2- Rad Bunker Tanker Pump Test Certificate 30 D30-List f Rad Bunker Tanker(s) * B. Bunker Barge(s) Name 31 D31-Dubai Maritime City Authrity ( DMCA) Marine Craft Bunkering Permit 32 D32-Navigatin License and Minimum Safe Manning Certificates frm FTA 33 D33-Permanent Certificate f Registry 34 D34- Certificate f Class with Annual Endrsement 35 D35- Updated OCIMF Questinnaire (Q 88) 5. Ship Chandler Cmpany. 36 D36-List f Vehicle(s) * 37 Name D37-Trakhees Vehicle Entry Permit (Applicable fr Fd /Gas Cylinder Suppliers) Nte: *Refer t Appendix **Nt Mandatry ***Refer t Prcedure PMP-01 Sectin 6.0 Training Rev. 00 January 2018 Page 6 f
7 Part C (Appendix) Appendix 1 Request Letter (Applicable fr all Third Party Agencies Categry) Date: T: Prts & Maritime Sectin - Manager Inspectin Department -Trakhees Dubai, UAE. Sub: Registratin with Trakhees Prts & Maritime Sectin fr Third Party Agency Prequalificatin Dear Sir, Our Cmpany M/S wants t register with Trakhees - Prts & Maritime Sectin t carry ut jbs in Prts, Shipyards and Maritime Areas within PCFC Jurisdictin. Necessary dcuments attached as per applicatin Frm fr yur perusal. Cmpany Jb Prfile Outline (Prvide a descriptin f cmpany activities currently undertaken within 200 wrds): Example: LSA & FFA Servicing. Navigatin Equipment Service. Equipment Lad Testing. Under Water Survey. Ship Agency Services. Regards, Name: Designatin: Date: Signature: Cmpany Stamp: Rev. 00 January 2018 Page 7 f
8 Appendix 2 Resume (Applicable fr Ship Surveyr and Hazmat Supervisr) Psitin : Name : Date f birth : Natinality : Educatin : Prfessinal Qualificatins: Training Curses Attended: Membership f Internatinal/Federal Scieties (If Available): Wrk Experience: Regards, Name: Designatin: Date: Signature: Cmpany Stamp: Rev. 00 January 2018 Page 8 f
9 Appendix 3 Prven Track Recrd (Summary fr Last 5 Activities) (Applicable fr all Third Party Agencies Categry) Sr. N. Date Lcatin Vessel / Client Name Jb Descriptin Appendix 4 List f Staff (Relevant t Services Prviders) (Applicable fr all Third Party Agencies Supervisrs / Surveyrs /Hazmat Operatrs /Divers /Shipping Agent / Ship Chandlers and Bunkers Drivers) Sr. N. Name Designatin Trakhees Training Card N Training Expiry Date Appendix 5 List f Gas Mnitr(s) (Applicable fr Survey Cmpanies-B) Sr. N. Gas Detectin Equipment Calibratin Date Calibratin Due Date Certificate Number Appendix 6 List f Diving Equipment(s) (Applicable fr Diving Cmpanies) Sr. N. Diving Equipment Test Date Test Due Date Certificate Number Appendix 7 List f Bunker Rad Tanker(s) (Applicable fr Bunker Cmpanies) Sr. N. Bunker Rad Tanker Frnt Unit Registratin Number Bunker Rad Tanker Back Unit Registratin Number Specify Number f Mnth(s) fr Permit Issuance Appendix 8 List f Bunker Barge(s) (Applicable fr Bunker Cmpanies) Sr. N. Bunker Barge Name Bunker Barge IMO Number Specify Number f Mnth(s) fr Permit Issuance Appendix List f Vehicle(s) (Applicable fr Ship Chandler Cmpanies) Sr. N. Vehicle Registratin Number Supply Prduct Details Expiry Date f Trakhees Pass Rev. 00 January 2018 Page f
Pre-Qualification Form: RISK ASSESSMENT STUDY Consultants
PRE-QUALIFICATION FORM RA CONSULTANTS Pre-Qualificatin Frm: RISK ASSESSMENT STUDY Cnsultants Name and Address f Cnsultants: Date: Revisin: 00 April 2008 Page 1 f 11 Ntes t Applicants Please type r print
Producer Statements will be accepted only in accordance with this policy.
Prducer Statements Plicy This plicy has been prepared t ensure that Cuncil has clearly dcumented plicies and prcedures fr the request fr and acceptance f Prducer Statements in cnnectin with applicatins
INDIAN INSTITUTE OF MANAGEMENT LUCKNOW
INDIAN INSTITUTE OF MANAGEMENT LUCKNOW Prabandh Nagar, IIM Rad, Lucknw, Uttar Pradesh 603 Fellw Prgramme in Management (FPM) 0th Batch Admissin-09 INSTRUCTIONS This Frm is a key part f the Admissin Prcess.
Recognition of Prior Learning Information and Application Form
Recgnitin f Prir Learning Infrmatin and Applicatin Frm What it is Recgnitin f Prir Learning (RPL) means recgnitin f cmpetencies currently held, regardless f hw, when r where the learning ccurred. Under
APPLICATION FORM FOR ASSISTANCE FROM THE AFRICAN WORLD HERITAGE FUND
APPLICATION FORM FOR ASSISTANCE FROM THE AFRICAN WORLD HERITAGE FUND This template is the riginal assistance request frm which when sent shuld cver all the questins asked. It can be adjusted t accmmdate
Supplier On-boarding Question Set. Section A Company Information
Supplier On-barding Questin Set Sectin A Cmpany Infrmatin Cmpany Infrmatin Cmpany Name Trade type Already wrk with Mitie? D yu have any declared interests, r a cnnectin in any way t a Mitie emplyee? E.g.:
Application Checklist: Supporting documents you need to provide with your application: o Application fee
Applicatin fr Special Licence Sectin 138, Sale and Supply f Alchl Act 2012 General infrmatin: Office Use Only An applicatin fr a special licence MUST be ldged at least 20 wrking days befre the event(s)
Direct Entry Pre-Approval Requirements for Level II Technician Candidates
Direct Entry Pre-Apprval Requirements fr Level II Technician Candidates The Direct Entry prgram is intended t allw rpe access technicians wh have btained rpe access skills and experience n an industrial
Distribution Code Review Panel. HSE Procedures for Electrical Safety Rules
Distributin Cde Review Panel HSE Prcedures fr Electrical Safety Rules Pursuant t the requirement f Distributin Cde Review Panel (DCRP) DOC5.1, Licensed Distributrs (and their agents) and Distributin System
ANNEX III FINANCIAL AND CONTRACTUAL RULES I. RULES APPLICABLE TO BUDGET CATEGORIES BASED ON UNIT CONTRIBUTIONS
2016_KA2_ Annex 3_EB.dcx ANNEX III FINANCIAL AND CONTRACTUAL RULES I. RULES APPLICABLE TO BUDGET CATEGORIES BASED ON UNIT CONTRIBUTIONS I.1 Cnditins fr eligibility f unit cntributins Where the grant takes
FORM 2. INDEPENDENT REGULATORY BOARD FOR AUDITORS (Established under Section 3 of Act 26 of 2005)
FORM 2 INDEPENDENT REGULATORY BOARD FOR AUDITORS (Established under Sectin 3 f Act 26 f 2005) APPLICATION BY A FIRM FOR ADMISSION TO THE REGISTER OF AUDITORS (Fr applicatin in terms f Sectin 38(2)) and
Use the included checklist to ensure that the plan(s) include at least the minimum required information.
RCOC Applicatin Instructins CHELMSFORD CONSERVATION COMMISSION Request fr Certificate f Cmpliance Applicatin Instructins Certificates f Cmpliance (COC) are the final permit issued by the Cnservatin Cmmissin
BC&BF/Form /1 STATE BAN K OF INDIA APPLICA TION FORM FOR ENGAGEMENT AS BUSINESS CORRESPONDENT
. BC&BF/Frm /1 STATE BAN K OF INDIA APPLICA TION FORM FOR ENGAGEMENT AS BUSINESS CORRESPONDENT Instructins : Use additinal sheets wherever necessary. Strike ut which ever is nt applicable I : GENERAL INFORMATION
HEAVY DUTY EQUIPMENT TECHNICIAN
T qualify t challenge certificatin in this trade r be granted authrity t supervise and sign-ff n apprentices in this trade, individuals must have: wrked a minimum f 9,540 hurs perfrming the tasks listed
Application for Employment (Please print)
Crdage Cmmerce Center 10 Crdage Park Circle Suite 208 Plymuth, MA 02360 WWW.THEARCOFGP.ORG Email:Inf@Thearcfgp.rg PHONE: 508.732.9292 FAX: 508.732.9229 Applicatin fr Emplyment (Please print) Name Last
Company specific data
2014 Purchasing WOCO Grup f Cmpanies Cmpany (General Infrmatin) Name: Address: Hmepage: Subsidiary f: This frm sheet shuld give us a first verview f yur cmpany. It includes imprtant elements f a ptential
NHCAC North Hudson Community Action Corporation
NHCAC Nrth Hudsn Cmmunity Actin Crpratin RFP 340B Prgram Auditing Services INQUIRIES SHOULD BE DIRECTED TO: Name: Title: Entity: Address: Manny Diaz Directr f Cmmunity Develpment Nrth Hudsn Cmmunity Actin
Renewal of Manager s Certificate
Applicatin fr Renewal f Manager s Certificate Sectin 219, Sale and Supply f Alchl Act 2012 General infrmatin: Yu must renew yur manager s certificate befre it expires. Once yur manager s certificate has
Expression of Interest for Project Management Unit (PMU) for monitoring Real Estate Projects in Greater Noida City
Expressin f Interest fr Prject Management Unit (PMU) fr mnitring Real Estate Prjects in Greater Nida City Issued by: Greater Nida Industrial Develpment Authrity (GNIDA) Plt N: 01, Knwledge Park IV, Greater
2018 J. H. BUDDY RASPBERRY SCHOLARSHIP FINANCIAL ASSISTANCE APPLICATION
2018 J. H. BUDDY RASPBERRY SCHOLARSHIP FINANCIAL ASSISTANCE APPLICATION BASIS OF ELIGIBILITY Due Mnday, April 16, 2018 NO EXCEPTIONS The J.H. Buddy Raspberry Schlarship Fund is ffering an additinal schlarship
Hawaii Division of Financial Institutions 2019 Renewal Checklist
Hawaii Divisin f Financial Institutins 2019 Renewal Checklist Instructins Renewal requests must be submitted thrugh by the date specified by yur state regulatr(s). Click here t review all renewal deadlines,
APPLICATION FORM LICENSED TRADES ISSUE OF QUALIFICATION POST GAP TRAINING. SECTION A Applicant Details & Document Checklist
APPLICATION FORM LICENSED TRADES ISSUE OF QUALIFICATION POST GAP TRAINING SECTION A Applicant Details & Dcument Checklist INSTRUCTIONS FOR APPLICANTS This Applicatin Frm is a request fr the issue f a qualificatin,
Verifying Your Account & Identity
Verifying Yur Accunt & Identity Acceptable Identificatin Dcumentatin The Anti Mney Laundering and Cunter Terrrism Financing Act 2006, requires Luxbet t verify the identity f anyne wh pens a new wagering
Customer due diligence guide for clients
Custmer due diligence guide fr clients Nvember 2018 19499409 2 As a reprting entity under the Anti-Mney Laundering and Cuntering Financing f Terrrism Act 2009 (the AML/CFT Act), MinterEllisnRuddWatts has
WHOLESALE AND RETAIL SETA. Skills Development for Economic Growth. ETQA Assessor and Moderator Registration Policy
WHOLESALE AND RETAIL SETA Skills Develpment fr Ecnmic Grwth ETQA Assessr and Mderatr Registratin Plicy WHOLESALE AND RETAIL SETA ETQA ASSESSOR AND MODERATOR POLICY Effective Date: 00/00/2007 Dc ID: Rev:
Overview. Procedure. ERP Replacement Program Non Contract Hourly (NCH) Form July 26, 2018
Overview Accunting fr hurs wrked utside f an emplyee s nrmal schedule can be recrded as nn cntracted hurly, secnd jbs, additinal duty hurs, r vertime. Prcedure Additinal Duty Hurs hurs wrked by exceptin
IMPORTANT INFORMATION PERTAINING TO A SANDF EDU TRUST BURSARY. who are or will be attending primary, secondary or tertiary educational institutions.
Suth African Natinal Defence Frce Educatin Trust (SANDF EDUCATION TRUST Reg N IT 3428/13) (Applicatin fr Financial Aid fr Educatinal Purpses) IMPORTANT INFORMATION PERTAINING TO A SANDF EDU TRUST BURSARY
South African National Defence Force Education Trust (SANDF Education Trust Reg. No IT 3428/13/PBO No /NPO )
Suth African Natinal Defence Frce Educatin Trust (SANDF Educatin Trust Reg. N IT 3428/13/PBO N 930044495/NPO 134-347) (Applicatin fr Financial Aid fr Educatinal Purpses: 2016) IMPORTANT INFORMATION PERTAINING
Cardholder KYC Guide
Cardhlder KYC Guide 10.01.2018 WaveCrest, as a regulated e-mney Issuer, is respnsible fr the Knw Yur Custmer (KYC) prcess f all cardhlders as per the EU Third Mney Laundering Directive. WaveCrest currently
8722 S. HARRISON ST. SANDY, UT P.O. BOX 4439 SANDY, UT FAX
8722 S. HARRISON ST. SANDY, UT 84070 P.O. BOX 4439 SANDY, UT 84091 877-678-7342 FAX 800-478-9880 HOT AIR BALLOON PROPOSED EFFECTIVE DATE: A. General Infrmatin Applicant s Name: Applicant s Mailing Address:
EMPLOYMENT APPLICATION LEE COUNTY GOVERNMENT P.O. Box 398 ATT: Human Resources Fort Myers, Florida (239)
PERSONAL INFORMATION EMPLOYMENT APPLICATION LEE COUNTY GOVERNMENT P.O. Bx 398 ATT: Human Resurces Frt Myers, Flrida 33902 (239) 533-2245 http://www.lee-cunty.cm JOB NUMBER: JOB TITLE: EXAM ID#: Received:
A. Accept only those clients whose identity is established by conducting due diligence appropriate to the risk profile of the client.
Custmer Acceptance Plicy (CAP) A. Accept nly thse clients whse identity is established by cnducting due diligence apprpriate t the risk prfile f the client. B. Where the investr is a new investr, accunt
P u n j a b H a l a l D e v e l o p m e n t A g e n c y Government of the Punjab (Pakistan) Website:
www.phda.cm.pk inf@phda.cm.pk APPENDIX-I (PHDA/REC-06) Rev: 02 APPLICATION FORM HALAL FOOD MANAGEMENT SYSTEMS (Requirements fr any rganizatin in Halal fd chain) 4/6 Shaheen Cmplex, Egertn Rad, Lahre Tel:
Supplier Registration form. Supplier Registration Form
Supplier Registratin frm TO ALL SUPPLIERS SEEKING REGISTRATION AS A PREFERRED SUPPLIER OF GOODS AND SERVICES TO GA ENVIRONMENT (PTY) LTD All suppliers are herewith invited t register as a preferred supplier
Application Guide for Employers
Ministry f Citizenship, Immigratin and Internatinal Trade Applicatin Guide fr Emplyers Ontari Immigrant Nminee Prgram Dispnible en français Effective: July 24, 2015 CONTENTS INTRODUCTION... 1 1. ELIGIBILITY...
NH Mortgage Banker Branch License New Application Checklist (Branch)
NH Mrtgage Banker Branch License New Applicatin Checklist (Branch) CHECKLIST SECTIONS General Infrmatin License Fees Requirements Cmpleted in Requirements/Dcuments Upladed in Requirements Submitted Outside
Purpose... 1 Definitions... 1 Policy... 2
Cntents Purpse... 1 Definitins... 1 Plicy... 2 1. Privacy Principles... 2 2. Cllectin f infrmatin... 2 3. Unique Student Identifiers (USI)... 3 4. Strage and use f infrmatin... 4 5. Disclsure f infrmatin...
JAUPT Appraisal Criteria Centre Application. November 2016
JAUPT Appraisal Criteria Centre Applicatin Nvember 2016 1. Intrductin T be able t assess centre applicatins fr the suitability f Peridic Training many factrs have t be taken int accunt and cnsidered befre
BRITISH VIRGIN ISLANDS Features of a Segregated Portfolio Company GOVERNING LAW
BRITISH VIRGIN ISLANDS Features f a Segregated Prtfli Cmpany GOVERNING LAW The BVI Business Cmpanies Act 2004, as amended in 2005, 2006 and 2012 ( BVI BC Act ) and the Segregated Prtfli Cmpanies Regulatins,
Supplier Registration Form
TO ALL SUPPLIERS SEEKING REGISTRATION AS A PREFERRED SUPPLIER OF GOODS AND SERVICES TO GLADAFRICA GROUP (PTY) LTD All suppliers are herewith invited t register as a preferred supplier n the database f
Verification Worksheet- V1 DIRECTIONS 2016 INCOME TAX FILER DIRECTIONS:
2018-2019 Verificatin Wrksheet- V1 DIRECTIONS 2016 INCOME Yur applicatin was selected by the U.S. Dept. f Educatin fr review in a prcess called "verificatin". Yu must submit the last 3 pages f this verificatin
MD Sales Finance License Amendment Checklist (Company)
Amendment Checklist (Cmpany) CHECKLIST SECTIONS General Infrmatin Amendments GENERAL INFORMATION Instructins Maryland Cmmissiner f Financial Regulatin (MD) Agency des nt require advance ntice fr any changes;
CORPORATE ONLINE BANKING SERVICE APPLICATION FORM(ENQUIRY ONLY) SECTION 1: ACCOUNT HOLDER S INFORMATION
BANK OF CHINA Singapre Branch www.bankfchina.cm/sg CORPORATE ONLINE BANKING SERVICE APPLICATION FORM(ENQUIRY ONLY) SECTION 1: ACCOUNT HOLDER S INFORMATION * f Accunt Hlder 1 *Mailing Address 1 Ntice Email
Joining SportsWareOnLine
Dear new MBU Student-Athletes, Prir t participating n an athletic team fr Missuri Baptist University (MBU), student-athletes must prvide the Athletic Training Department with lcal and permanent addresses,
Salt Lake City Area Office 8722 S. Harrison St. Sandy, UT P.O. Box 4439 Sandy, UT Fax
Salt Lake City Area Office 8722 S. Harrisn St. Sandy, UT 84070 P.O. Bx 4439 Sandy, UT 84091 800-257-5590 Fax 800-478-9880 Chicag Office 303 W. Madisn Street Suite 2075 Chicag, IL 60606 800-456-4576 Fax
ISA CERTIFIED ARBORIST APPLICATION
ISA CERTIFIED ARBORIST APPLICATION This applicatin must be received at least 12 WORKING DAYS prir t the date f the chapter r assciate rganizatin exam fr which yu are applying. There is n deadline fr the
April 20, 2017 IMPORTANT: THESE GUIDELINES START ON THE NEXT PAGE: Go to
April 20, 2017 Dear Returning Lyn Cllege Athlete: Prir t participating n a team frm Lyn Cllege, athletes must prvide the Athletic Training Department with current address, emergency cntact, insurance,
Employment Application. Name: Last First Middle. Home ( ) Alternate( ) Type: i.e. cell phone, message, etc. Social Security No.
Tribal Lending Enterprise (TLE) a whlly wned Crpratin f the Habematlel Pm f Upper Lake 635 B E. Hwy 20 Upper Lake, CA 95485-0516 7300 Cllege Blvd., Ste. 650, Overland Park, KS 66210 D: (913) 717-4664 TF:
2 Up to $250 total (receipts required if travel by air). Up to $95 per day of conference attendance
2016 ICADD Millennium Fund Schlarship Applicatin In the spring f 2015 the ICADD Fundatin was awarded an Idah Millennium Fund grant ffering a limited number f cnference schlarships t supprt attendance by
2017 LOCAL 1101 REGINA SCHOLARSHIP APPLICATION
2017 LOCAL 1101 REGINA SCHOLARSHIP APPLICATION T be eligible applicants must be members/family members f Regina Lcal 1101 Public Service Sectr emplyees. Mail t: Attentin: Muna Deciman 35 Marsh Cres. Regina,
Tenancy Application Form
Tenancy Applicatin Frm Applicatins will nly be prcessed nce this applicatin is fully cmpleted. Shuld the applicant fail t prvide the fllwing details the applicatin will nt be prcessed. If yur applicatin
Completing the identification form for Australian regulated trusts and trustees (including self-managed super funds)
Instructin sheet Cmpleting the identificatin frm fr Australian regulated trusts and trustees (including self-managed super funds) Identificatin and Verificatin All clients applying fr a new plicy must
J-1 DS-2019 Request Form for Exchange Visitor Applicant
J-1 DS-2019 Request Frm fr Exchange Visitr Applicant 1. Persnal Infrmatin (as it appears in yur passprt) Email Address Gender: Male Female Last psitin/ccupatin yu held in yur cuntry f legal permanent residence
Information Checklist for Candidates
INSTRUCTIONS: All candidates must bring dcuments as stated in pints 1, 2, 3, 4 and 5. Bx 6 states additinal requirements fr nn EEA students. Originals AND phtcpies are required where stated. Instructins
Professional Web Portal Tutorial. Revised 5/11/17
Prfessinal Web Prtal Tutrial Revised 5/11/17 1 Cntents PROFESSIONAL CLAIMS... 3 PROVIDER INFORMATION... 8 SUBSCRIBER/CLIENT INFORMATION... 9 CLAIM INFORMATION... 10 DIAGNOSIS CODES... 11 BASIC LINE ITEM
Condominium Authority of Ontario
Cndminium Authrity f Ontari Guide t Filing Cnd Returns and Paying CAO Assessments Cntents 1. What Are Cnd Returns?... 2 2. What Cnd Returns Need t be Filed in 2018?... 3 3. Hw Will the Infrmatin Prvided
Instruction Page. Verification of 2014 Income Information for Individuals with Unusual Circumstances
Instructin Page Imprtant Nte: Please ntify the financial aid ffice if the student r their parents had a change in marital status after the end f the 2014 tax year n December 31, 2014 and als if the parents
The Safety Net Foundation
The Safety Net Fundatin Instructins fr Kineret (anakinra) and Sensipar (cinacalcet HCl) Instructins The Safety Net Fundatin prvides temprary prduct assistance t financially needy patients wh meet predetermined
APPLICATION FOR PROJECT FUNDING REQUEST 2018 Charlevoix County Parks Millage 301 State St., Charlevoix, MI
APPLICATION FOR PROJECT FUNDING REQUEST 2018 Charlevix Cunty Parks Millage 301 State St., Charlevix, MI 49720 administratin@charlevixcunty.rg PROJECT APPLICANT INFORMATION Name f Municipal Applicant(s):
GUIDELINES FOR COMPLIANCE IN TERMS OF THE PRIVATE SECURITY INDUSTRY REGULATION ACT DURING EVENTS
GUIDELINES FOR COMPLIANCE IN TERMS OF THE PRIVATE SECURITY INDUSTRY REGULATION ACT DURING EVENTS 1. INTRODUCTION 1.1 The purpse f the Private Security Industry Regulatin Act (Act N 56 f 2001) (the Act)
Vision Service Plan (VSP) New Group Implementation Guide
Visin Service Plan (VSP) New Grup Implementatin Guide Nrth Ranch Benefits Trust (NRBT) Administered by HealthSmart Benefit Slutins, Inc. Agents shuld submit the cmpleted New Grup Implementatin Guide back
Invitation to Bid ITB18/ Amendment No. 2
Invitatin t Bid ITB18/01769 Amendment N. 2 Ref. n. ITB18/01769 Date: 04 July 2018 Subject: MIA/Recnstructin wrks fr the mdernizatin f the swimming pl within the "Dinam Central Sprt Club" Dear Sir/Madam,
Caregiver/Respite Application (Please print)
52 Armstrng Rad Plymuth, MA 02360 WWW.THEARCOFGP.ORG Email:Inf@Thearcfgp.rg PHONE: 508.732.9292 FAX: 508.732.9229 Caregiver/Respite Applicatin (Please print) Name Last First Middle Address Street City
WRITTEN DIRECTIVES & POLICY DESSEMINATION SOG
WRITTEN DIRECTIVES & POLICY DESSEMINATION SOG SCOPE This guideline shall apply t all members f the Stney Pint Fire Department (SPFD) and shall be adhered t by all members regarding disseminatin f written
Create/Modify a Position Description for Benefits Eligible Staff (ONLY)
Create/Mdify a Psitin Descriptin fr Benefits Eligible Staff (ONLY) GENERAL POSITION INFORMATION Start psitin descriptin prcess frm the Dashbard FIELD REFERENCES Click n Manage psitin descriptins and create
Salt Lake City Area Office 8722 S. Harrison St. Sandy, UT P.O. Box 4439 Sandy, UT Fax
Salt Lake City Area Office 8722 S. Harrisn St. Sandy, UT 84070 P.O. Bx 4439 Sandy, UT 84091 800-257-5590 Fax 800-478-9880 Chicag Office 303 W. Madisn Street Suite 2075 Chicag, IL 60606 800-456-4576 Fax
KESS2 Participant Proposal Form Student Application Form for KESS Studentship funding (v.dec16)
KESS2 Participant Prpsal Frm 2016-17 Student Applicatin Frm fr KESS Studentship funding (v.dec16) **FORM TO BE COMPLETED BY THE STUDENT APPLICANT, and SUBMITTED TO THE ACADEMIC SCHOOL** The infrmatin yu
There are two ways to submit your banking information for direct deposit into your personal bank account:
Cmpleting Yur Master Student Financial Assistance (MSFAA) Agreements Alberta and Canada have lifetime Master Student Financial Assistance Agreements (MSFAAs) that will cver yu fr all f the time yu are
Renewal of Off-Licence
Applicatin fr Renewal f Off-Licence Sectin 127, Sale and Supply f Alchl Act 2012 General infrmatin: An applicatin fr renewal f club licence must be filed at least 20 wrking days befre the licence is due
Lifestream Guaranteed Income via Colonial First State FirstChoice Instruction sheet
Lifestream Guaranteed Incme via Clnial First State FirstChice Instructin sheet Cmpleting the identificatin frm fr Australian regulated trusts and trustees (including self-managed super funds) 21119/1115
2017 Funding Application Loan Repayment Assistance Program
2017 Funding Applicatin Lan Repayment Assistance Prgram Lewis & Clark Law Schl Deadline May 30, 2017 Eligibility is based n the factrs in the brchure entitled Overview f the Lan Repayment Assistance Prgram
BLM Incident Management Payment Packages Guidelines and Checklist
BLM Incident Management Payment Packages Guidelines and Checklist These checklists are intended t be used fr the prcessing f Casual and Equipment Time Invices while assigned t BLM Incident. Please attach
MAKING TAX DIGITAL SET UP GUIDE
Depending n yur versin, yu may need t make sme changes t yur sftware t enable yu t submit yur VAT return in line with Making Tax Digital (MTD). T ascertain what versin yu are n navigate t: Tls > Abut Sage
ACAAI Responsibilities
85 W. Algnquin Rad, Suite 550 Arlingtn Heights, Illinis 60005-4460 847-427-1200 www.acaai.rg ACAAI Jint Prvidership Prgram Descriptin The American Cllege f Allergy, Asthma & Immunlgy (ACAAI) is accredited
Three different auditor levels are available that reflect the respective auditing experience / skills:
Title A02 Auditrs Prfile Status Definitive Revisin / Date Rev09 / 1 st January 2017 Cntent 1 Cntext...1 2 Types and stages f WEEELABEX Auditrs...1 3 Prfile f WEEELABEX auditrs...3 4 Applicatin Prcess...4
MD Collection Agency License Amendment Checklist (Company)
MD Cllectin Agency License Amendment Checklist (Cmpany) CHECKLIST SECTIONS General Infrmatin Amendments GENERAL INFORMATION Instructins Maryland Cmmissiner f Financial Regulatin (MD) Agency des nt require
The Veolia Environmental Trust Online Application Form
The Velia Envirnmental Trust Online Applicatin Frm Stage 2 questins Please nte: this is nt the Stage 2 applicatin frm 1. Cntact and Organisatin Details a. Main Cntact 1.1 Title 1.2 First Name 1.3 Surname
REQUEST FOR PROPOSAL (RFP) SELECTION OF ISO20000 CONSULTING COMPANIES. Version 1.3
REQUEST FOR PROPOSAL (RFP) SELECTION OF ISO20000 CONSULTING COMPANIES Versin 1.3 Nvember, 2016 1 ` Table f Cntents Sr. # Descriptin Page # 1 Pakistan Sftware Exprt Bard (G) Ltd 3 2 Majr Functins f PSEB
FORM-K. [See Rule 45(1)]
![FORM-K. [See Rule 45(1)]](/thumbs/91/107233304.jpg "FORM-K. [See Rule 45(1)]")
FORM-K [See Rule 45(1)] (Applicatin fr registratin Rule 45 f MCDR fr taking mining r prspecting r recnnaissance peratins, r trading r strage r end use r exprt f minerals) IMPORTANT INSTRUCTIONS FOR FILLING
Form 1B AU UK Competent Authority (CA)
Frm 1B AU UK Cmpetent Authrity (CA) Applicatin fr Assessment fr Registratin in Australia via the Cmpetent Authrity Pathway This frm is fr the use f Ostepaths wh are bth: 1. Graduates frm ne f the listed
ApplicantCare is an online application and candidate management tool that automates the hiring process.
Plicy Overview It is the plicy f Kelis t prvide equal emplyment pprtunities. Emplyment decisins and actins will be cnducted withut regard t gender, sexual rientatin, race, clr, age, natinal rigin, ancestry,
APPLICATION FOR MISCELLANEOUS MEDICAL PROFESSIONAL LIABILITY INSURANCE
APPLICATION FOR MISCELLANEOUS MEDICAL PROFESSIONAL LIABILITY INSURANCE Sectin I General Infrmatin 1. Full Name f Applicant: 2. Mailing and Lcatin Address: (Include all dba s and subsidiaries seeking cverage
Physical Therapists and Related Occupations Application
Physical Therapists and Related Occupatins Applicatin Darwin Natinal Assurance Cmpany Main Administrative Office: Crprate Office: 9 Farm Springs Rad 1807 Nrth Market Street Farmingtn, CT 06070 Wilmingtn,
Application Guide for Nominees: Foreign Workers
Ministry f Citizenship, Immigratin and Internatinal Trade Applicatin Guide fr Nminees: Freign Wrkers Ontari Immigrant Nminee Prgram Dispnible en français Effective: July 24, 2015 CONTENTS INTRODUCTION...
NM Mortgage Loan Company License New Application Checklist (Company)
NM Mrtgage Lan Cmpany License New Applicatin Checklist (Cmpany) CHECKLIST SECTIONS General Infrmatin License Fees Requirements Cmpleted in Requirements/Dcuments Upladed in Requirements Submitted Outside
NURSE PROFESSIONAL LIABILITY
8722 S. Harrisn St. Sandy, UT 84070 P.O. Bx 4439 Sandy, UT 84091 877-678-7342 Fax 800-498-9880 NURSE PROFESSIONAL LIABILITY 1. General Infrmatin Prpsed Effective Date: Applicant is (check all that apply):
IDENTIFICATION FORM AUSTRALIAN COMPANY
AUSTRALIAN COMPANY GUIDE TO COMPLETING THIS FORM This frm is fr nly. Fr cmpanies incrprated r registered utside f Australia use the FOREIGN COMPANY IDENTIFICATION FORM. Cmplete ne frm fr each cmpany. Tax
Topic: SAP PPM Close Project. Contents
Tpic: SAP PPM Clse Prject Cntents Tpic: SAP PPM Clse Prject... 1 Intrductin/Cntext... 2 Clse Prject HNO Business Prcess Map... 2 Clse Prject HNO Business Prcess... 2 Prcess: Clse Prject... 5 Cnfirm Prject
Golf Relief and Assistance Fund Application
Glf Relief and Assistance Fund Applicatin Eligibility The Glf Relief and Assistance Fund is designed t supprt individuals wrking in the glf industry and their husehld family members wh have been impacted
Exit Interview Check List
Name: Exit Interview Check List Date Exit Interview Scheduled: Separatin/Retirement Date: Reasn fr Leaving (circle ne): Retirement Resignatin Terminatin Other: Health Benefits (COBRA) Life Insurance Cntinuatin
Name of Applicant/Beneficiary
Name f Applicant/Beneficiary (Applicatin fr Financial Aid fr Educatinal Purpses: 2018) IMPORTANT INFORMATION PERTAINING TO A SANDF EDUCATION TRUST BURSARY The main bjective f the SANDF Educatin Trust is
1. Accounts Payable > Tasks > Transactions > Recurring Bills
1. Accunts Payable > Tasks > Transactins > Recurring Bills 1. On the Applicatins menu bar pint t Accunts Payable > Tasks > Transactins > Recurring Bills, and then click + t the left f the Recurring Bills.
Odisha Tourism Development Corporation Ltd
Odisha Turism Develpment Crpratin Ltd Request Fr Prpsal (RFP) FOR Cnsultancy Supprt fr survey, planning, cnceptualize, design, estimating with BOQ, preparatin f bidding dcument, supervisin etc. fr Light
JOB MATCHING PROCEDURE AGAINST NATIONAL (BENCHMARK) JOB EVALUATION PROFILES
JOB MATCHING PROCEDURE AGAINST NATIONAL (BENCHMARK) JOB EVALUATION PROFILES 1. AIMS The aims f the matching prcedure are: (1) T match as many jbs as pssible t natinal evaluatin prfiles in the mst efficient
EMIR Fees Disclosure
EMIR Fees Disclsure Merrill Lynch Internatinal Merrill Lynch, Pierce, Fenner & Smith Incrprated August 2014 Versin 5.0/August 2014 #37490657 Versin 5.0/August 2014 #37490657 Merrill Lynch Internatinal
ASETS APPLICATION. Are you receiving Income Support. Name Age Date of Birth Relationship Living with me. Emergency
Inuvialuit Reginal Crpratin Human Resurces, Educatin & Training Department ASETS Prgram 867-777-7091 Tll Free: 1-855-777-7011 Fax: 867-777-4506 CRF EI PERSONAL IDENTIFICATION SIN Surname ASETS APPLICATION
ATTENTION. This Sales and Use Tax Exemption Certificate Application is for: 1. FIRST TIME sales and use exemption certificate filers or;
ATTENTION This Sales and Use Tax Exemptin Certificate Applicatin is fr: 1. FIRST TIME sales and use exemptin certificate filers r; 2. Organizatins hlding a card with expiratin date f 2012 r earlier. 3.
IMPORTANT NOTICE. 2. This is part of an on-going effort by Jurong Port to enhance safety and maintain a safe working environment for all port users.
N. 27 f 2009 29 September 2009 IMPORTANT NOTICE Dear Prt Users, REVISION OF VEHICLE ENTRY AND PARKING POLICIES 1. Fllwing yur feedback and ur internal review, we have further imprved ur vehicle entry and
University of Pittsburgh Office of the Controller General Accounting
University f Pittsburgh Office f the Cntrller General Accunting PRISM ACCOUNT REQUEST APPLICATION (PARA) Frm Instructins September 2017 PARA The PRISM Accunt Request Applicatin (PARA) is a web-based applicatin
HOUSEHOLD MEMBERS (please include head of household)
Date: ST. TAMMANY PARISH COMMUNITY ACTION AGENCY WAP Applicatin Last Name: First Name: Address: City: Zip Cde Telephne Number: Cell: MARITAL STATUS: Single (Never Married) Married Separated Divrced Widwed