zilongwang/ReadingBank huggingface dataset:
Description: Attach a separate sheet if necessary Map: FOSSICKING DETAILS Details of the nature of fossicking including equipment to be used Duration of intended fossicking What do you intend to fossick for FOSSICKER’S SIGNATURE AND DATE Note: all members are required to carry photographic identification at all times. For further information, please contact: Department of Mines and Energy Mineral Titles Division 5th Floor Centrepoint Building 48-50 Smith Street, DARWIN NT 0800 Department of Mines and Energy Mineral Titles Division GPO Box 4550 DARWIN NT 0801 Phone: 08 8999 5322 Fax: 08 8981 7106 Email: titles.info@nt.gov.au Website:
For further information – Licensing NT Darwin Level 3, NAB House 71 Smith St Darwin NT 0800 GPO Box 1154 Darwin NT 0801 t: (08) 8999 1800 f: (08) 8999 1888 Alice Springs Level 1, The Green Well Building 50 Bath St Alice Springs NT 0870 PO Box 8470 Alice Springs NT 0871 t: (08) 8951 5195 f: (08) 8951 5112 Katherine Ground Floor, Randazzo Building 18 Katherine Terrace Katherine, NT 0850 PO Box 2138 Katherine NT 0851 t: (08) 8973 8810 or (08) 8973 8811 f: (08) 8973 8867
course/ programme From (date) To (date) Seminar/Conference attended during the assessment period (enclosed document nos…………………..) Sl. No. Title of seminar/ conference Duration Place Organized by Whether oral/poster presentation or attended Title of paper presented From (date) To (date)
etc. ii)Involvement in contract etc. B03 Technologies developed etc. 4 C Extension 12 C01 Service provided in KVK etc. ii)Involvement in/Conduct of extension Training etc. 4 C02 i)Extension training organized ii)Involvement in/Conduct of extension Training etc. 4 C03 i)Innovation in extension 4
Signature:_______________ Signature:_________________ Signature:________________
Contact Officer’s Name: ____________________________________________ Contact Officer’s Signature: _________________________________________ ------- Commanding Officer’s Name: ________________________________________ Commanding Officer’s Signature: _____________________________________
INTEREST SCHEMES ACT 2016 Section 77 ANNUAL RETURN OF SCHEMES DETAILS OF MANAGEMENT COMPANY Name : Address of registered office : Company/ Business Registration No : Tel No : Fax No : E-mail : PARTICULARS OF SCHEMES Name of Schemes : Nature of schemes (please tick where applicable) Investment scheme Recreational membership scheme Time-sharing scheme Combination (please indicate): Types of schemes (please tick where applicable) Premium scheme Small scheme Foreign scheme PARTICULARS OF INTEREST HOLDERS (INDIVIDUAL) Name : NRIC No. : Date of Birth : Gender Male Female Race : Nationality : Address : Tel No. : Mobile Phone No. : Email : PARTICULARS OF INTEREST HOLDERS (BODY CORPORATE) Name : Place of Incorporation : Registration No. : Registered Address : * For additional interest holders, please use additional pages.
FORM-1 [See Rules 5(1) (g), 13(1) (i), 13(1) (vi)] Applicable to producers seeking Extended Producer Responsibility - Authorisation The application form should contain the following information: Name and full address along with telephone numbers, e-mail and other contact details of Producer (It should be the place from where sale in entire country is being managed) : Name of the Authorised Person and full address with e-mail, telephone and fax number : Name, address and contact details of Producer Responsibility Organisation, if any with full address, e-mail, telephone and fax number, if engaged for implementing the Extended Producer Responsibility : Details of electrical and electronic equipment placed on market year-wise during previous 10 years in the form of Table 1 as given below: : Table 1: Details of Electrical and Electronic Equipment placed on the market in previous years - Code wise Sr. No. Electrical and Electronic Equipment Item Electrical and Electronic Equipment Code Quantity, number and weight placed on market (year-wise) A Information technology and telecommunication equipment: 1 Centralised data processing: Mainframes, Minicomputers ITEW1 2 Personal Computing: Personal Computers (Central Processing Unit with input and output devices) ITEW2 3 Personal Computing: Laptop Computers (Central Processing Unit with input and output devices) ITEW3 4 Personal Computing: Notebook Computers ITEW4 5 Personal Computing: ITEW5
IV. Client Services We appreciate your interest in the WorkKeys® system. To help us serve our clients better, we would appreciate a description of how you and the organization with which you are affiliated plan to use the WorkKeys system. If you need additional space, please attach an additional page or pages. V. Contact Information – for Invoicing Purposes Organization Paying for SkillPro® License (must be same entity identified on Job Profiling and SkillPro License Agreements): Organization’s Billing Address: Billing Contact (Required): Billing Contact Email (Required): Billing Contact’s Phone (Required): Billing Contact’s Fax:
Decision following failure of negotiations s 54(2) A worker whose interests are affected by the decision or his or her representative Decision in relation to training of health and safety representatives s 72(6) A worker whose interests are affected by the decision A person conducting a business or undertaking whose interests are affected by the decision A health and safety representative who represents a worker whose interests are affected by the decision A mine safety and health representative at a coal mine who represents a worker whose interests are affected by the decision An industry safety and health who represents a worker at a coal mine whose interests are affected by the decision Decision relating to health and safety committee s 76(6) Decision on review of provisional improvement notices (PINs) s 102 The person to whom the PIN was issued. The health and safety representative who issued the PIN The mine safety and health representative at a coal mine who issued the PIN The industry safety and health representative at a coal mine who issued the PIN A worker whose interests are affected by the decision. A person conducting a business or undertaking whose interests are affected by the decision A health and safety representative who represents a worker whose interests are affected by the decision A mine safety and health representative at a coal mine who represents a worker whose interests are affected by the decision An industry safety and health representative who represents a worker at a coal mine whose interests are affected by the decision Decision to forfeit a seized thing s 179 The person entitled to the thing Decision to return a seized thing s 180 The person entitled to the thing Decision to issue of an improvement notice s 191 The person to whom the notice was issued A worker whose interests are affected by the decision. Decision to extend the time for compliance with improvement notice s 194
Are you? Deaf □ Hard of Hearing □ Visually Impaired □ Blind □ Deafblind □ Other □ (please specify): Preferred method of communication: BSL □ SSE □ Cued speech □ Speech □ Makaton □ Deafblind manual □ Other language □ (please specify): Ethnic Origin (Please tick the box which you feel most appropriately identifies your ethnic origin) White Scottish □ British □ Irish □ European / other □ (please specify): Asian Scottish □ British □ Irish □ Indian □ Pakistani □ Bangladeshi □ Chinese □ Other □ (please specify): Black Scottish □ British □ Irish □ Caribbean □ African □ Other □ (please specify): Mixed Racial Origin □ (please specify): Other ethnic Origin □ (please specify): Religion: I would prefer not to say: □ Sexual orientation: I would prefer not to say: □ Please return both completed application form and equal opportunities form to:
APPLICATION FOR STUDENT AIR TRAFFIC CONTROLLER’S LICENCE I. APPLICATION INFORMATION STUDENT LICENCE □ A. Full Name (First, Middle, Last) B. Date of Birth (dd-mm-yy) of Birth D. Nationality E. Sex Male □ Female □ F. Height (Inches) G. Weight (Lbs) H. Hair colour I. Eye colour J. Address & Contact numbers: Telephone: Facsimile: e-mail: K. Employer’s name, address & contact numbers: Telephone: Facsimile: e-mail: L. Do you hold a current Medical Certificate? Yes □ No □ M. Issuing Authority: Bermuda Civil Aviation Authority N. Class of Certificate O. Date of Issue (dd.mm.yy) II. STUDENT LICENCE APPLIED FOR ON BASIS OF TRAINING AT A BCAA APPROVED INSTITUTION: a. Name of training institution: b. Successful completion of training and examinations: YES □ c. Date of letter or certificate of completion from BCAA approved institution: III. THE FOLLOWING DOCUMENTS MUST BE ENCLOSED WITH THIS APPLICATION: a □ Valid Medical Certificate. b. □ Copy of letter or certificate of completion from BCAA approved institution. c. □ Two (2) passport size photographs of applicant. IV. CERTIFICATION: I certify that the above information is true and correct to the best of my knowledge. It is an offence to make, with the intent to deceive, any false representation for the purpose of procuring the grant, issue, renewal, or variation of a licence. Any person so doing renders himself liable, on summary conviction, to a fine not exceeding £400 (or equivalent) or on conviction on indictment to a fine or imprisonment for term not exceeding two years or both. Signature of Applicant………………………………………. Date………………………………. Form ATC 02 (08/16)
Name of association Application checklist (refer to factsheet for more information). This checklist must be completed to ensure all parts of the application are completed. An incomplete application will not be approved. Has your association been approved by the Director-General of Licensing? Yes Has an Approved Association Update form been lodged since the last AGM? Yes Is the person signing the application an authorised member of the association? Yes Are start to finish dates of the lottery three (3) months or less? Yes Are prizes at least 1/3 of total ticket sales (see conditions of permit)? Yes Have all details relating to the prizes been completed? Yes Have all restrictions and special conditions relating to prizes, eg. travel prize/s been detailed? Yes Is the lottery ticket compliant with Director-General of Licensing’s requirement & ticket proof attached? Yes Ticket and advertising checklist. All relevant details on list must appear on the tickets and on promotion of the lottery. (refer to factsheet for more information) Name of association Yes Permit number (e.g. D1234) Yes Ticket Price Yes Number of tickets to be issued Yes Description and value of main prizes Yes Conditions Apply” specified on Prizes with restrictions or conditions Yes Date, time and place of draw Yes Detail of how winner will be determined (barrel draw, random no. generator, etc) & draw policy Yes Date of publication of results and newspaper name Yes Ticket butt (name, address, phone no., association name) Yes Contact number for lottery information Yes Name of place where prizes are on display (if applicable) Yes
GENERAL INFORMATION Important: All fields are mandatory and should not be left blank 1. Party responsible for submission of application Applicant’s Shareholder/Head Office Labuan Trust Company Others:_______________________ (Please specify) 2. Officer responsible for submission of application Name :_______________________ Company :___________________________ Designation :_______________________ Contact No. :___________________________ Email :_______________________ Signature :___________________________ 3. How do you know about Labuan IBFC Website Newspaper/Media Previous Experience Business Referral Labuan Trust Company Labuan IBFC Inc. Sdn. Bhd. Others:_________________ (Please specify) 4. Consent for disclosure of information to be used for marketing/promotional purposes by Labuan FSA and Labuan IBFC Inc. Sdn. Bhd. Yes No
Application Form FOR OFFICE USE ONLY Ref no: Processed By: (A) Offer Details: Benefit Title Benefit Content Terms and Conditions Effective Date From: (DD/MM/YYYY) To: (DD/MM/YYYY) Eligibility Identification Membership Card Membership No Orally (Means of identification of eligibility, you may choose more than one ) Enquiry Information Name: Email: Tel: Website: Remarks
Horticulture Produce Agreement – Merchant Schedule SECTION A – DETAILS OF GROWER Grower Business / Trading Name ABN - - - Commencement of Date of HPA Warranty The Grower listed above is the grower of the Produce Grower Contact Postal Address Suburb: State: Postcode: Street Address Suburb: State: Postcode: Telephone Bus: Fax: Mobile: Email Banking Details Account Name: Bank: Branch: BSB: A/C No: Mobile number of Merchant that the Grower must send electronic acceptance of the terms of the Terms of trade, HPA and this Schedule to: Mobile - 0420 921 852 Email – By signing or accepting of this Schedule in writing I/we, for and on behalf of and with the authority of the Grower, agree that I/we have read and understood the attached Horticulture Produce Agreement and that upon such signing or acceptance of the Horticulture Produce Agreement the Grower will be bound by the terms of it, this Schedule and any relevant Terms of Trade and that a formal contract shall be deemed constituted between the Merchant and the Grower. By signing or acceptance of this Schedule, I/we also acknowledge, for and on behalf of and with the authority of the Grower, the recommendation set out in Section C below. EXECUTED by the Merchant Director – Anthony Gribben Director – Vince Mailli Director – Antoine Fakhry Where the Merchant is a partnership or other form of joint operation, all of the individuals or entities should sign. EXECUTED by GROWER Individual Grower (where the Director (where the Grower is a Director/Company Secretary the Grower is an Individual) a company) Sign above Sign above Sign above Where the Grower is a partnership or other form of joint operation, all of the individuals or entities should sign. SECTION B – DETAILS FOR HORTICULTURE PRODUCE AGREEMENT
List the name and address of the contractor in charge of carrying out the work program or the name and address of the personnel who participated in the work as well as the period (year, month, day) during which the work has been carried out . In the last column, inscribe the amounts disbursed for wages to the personnel or the cost disbursed to the contractor for the carrying out of work. Finally, add each costs and enter the total amount disbursed in box entitled TOTAL (1) Identification Name Address Date(s) of performance from (year/month/jday) to (year/month/day) Wages or cost $ + + + + + + + TOTAL (1) = Detail briefly the type of transportation, housing and supplying. Inscribe the costs incurred for each one such as expenses for truck or vehicle rental, accomodation, restaurant or grocery shopping, etc. Moreover, write for each means of transport the distance covered, in kilometers (km) from starting point to arrival point on the site, the number of people transported as well as the number of days of travelling . Then add each costs and enter the total amount disbursed in the box entitled TOTAL (2). Description Distance (in km) Nbre of people Nbre of days Cost $ + + + + + + + TOTAL (2) = Write the name of the laboratorie(s) who performed the samples analyses, the elements determined, the number of samples analyzed as well as the cost for each analysis. Add all the costs reported and enter the total amount in the box entitled TOTAL (3). Name of laboratory Elements determined Nbre of samples Cost $ + + + + + + + TOTAL (3) = Use this section to declare any other type of expenses incurred for drilling. Briefly describe the nature of expenses and enter the corresponding cost. Add each cost and enter the total amount in box entitled TOTAL (4) Description Cost $ + + + + + TOTAL (4) =
Application for Replacement of Certificates (FORM NMA-5_REP.2018.Rev.0) 1. PARTICULARS OF APPLICANT Name (In Block Letters, as in identity card/passport) NRIC / Passport No. Address Telephone No. 2. PARTICULARS OF REQUESTED CERTIFICATES FOR REPLACEMENT Type of Certificate Certificate No. Date of Issue Date of Expiry 3. REASON(S) FOR REQUESTING REPLACEMENT Provide brief description / account / explanation of how the certificates were misplaced / damaged / destroyed etc. 4. DOCUMENTS SUBMITTED AS EVIDENCE Police Report Statutory Declaration Damaged Certificate Others: *Tick as appropriate 5. DECLARATION OF APPLICANT I declare that the particulars and information furnished above are correct and true to the best of my knowledge and belief. I undertake that if I find the lost certificate(s), I will return the certificate(s) to the Nauru Maritime Administration. Date: Signature of Applicant:
I will disclose my financial interest to the appropriate co-Investigators, members of the research group, and students. I will disclose the existence of my Financial Interest in any abstracts, presentations, press releases, or publications and in any proposals or applications for research funding related to the nature of that interest. I will divestiture the financial interest to a permissible level. Date Signature of investigator with FI Date Signature of Chair of Financial Conflict Interest and Research Committee
STANDARD 9 Form of Ownership Check the appropriate box, complete the section of the form that applies to your institution, and provide any requested documentation. Include this form in the self-study. Check the appropriate box; complete that section of the form; and provide any requested documentation. (Only one box should be checked.) PUBLIC Governing Board (Public Institution) Name Chairman and/or Executive Director Address City State Zip Telephone FAX Provide a copy of the institution’s legislative authorization. NON-PROFIT CORPORATION; MAY INCLUDE CHARTER SCHOOLS Has the corporation been officially recognized by the Internal Revenue Service as an exempt organization under Section 501(c)3, Section 501(c)6, or other such category in the IRS Code? Yes No If yes, attach a copy of the determination letter from the IRS. If no, attach an explanation. Provide a copy of the corporate charter. Corporate Name Address City State Zip Telephone FAX Email Address Registered Agent
PARTNERSHIP Name of Partnership Address City State Zip Telephone FAX Email Address List names and titles of all owners and officers: NAME TITLE PERCENT OF OWNERSHIP HOURS PER WEEK SPENT AT THE INSTITUTION LIMITED LIABILITY PARTNERSHIP Name of Partnership Address City State Zip Telephone FAX Email Address List names and titles of all owners and officers: NAME TITLE PERCENT OF OWNERSHIP HOURS PER WEEK SPENT AT THE INSTITUTION SOLE PROPRIETORSHIP Name of Proprietor Address City State Zip Telephone FAX Email Address
[PLACE OF MEETING] [DATE] The [City/County] Council (the “Council”) of [ISSUER] (the “Issuer”), met in regular public session at the regular meeting place of the Council in _______________, Utah, on _______________, at the hour of _____ p.m. with the following members of the Council being present: Mayor Councilmember Councilmember Councilmember Councilmember Councilmember Also present: [City/County] Recorder [City/County] Manager Absent: After the meeting had been duly called to order and after other matters not pertinent to this resolution had been discussed, the Recorder of the Issuer presented to the Council a Certificate of Compliance with Open Meeting Law with respect to this _______________, meeting, a copy of which is attached hereto as Exhibit A. Thereupon, the following resolution was introduced in written form, discussed in full, and pursuant to a motion made by Councilmember ____________________ and seconded by Councilmember ____________________, adopted by the following vote: AYE: NAY: The resolution was then signed by the Mayor Pro tem in open meeting and recorded by the Recorder of the Issuer in the official records of _______________, Utah. The resolution is as follows:
2. the following additional aircraft types (if applicable): List additional aircraft here if applicable 5. Major and Minor Repairs All major and minor repairs will be carried out to the requirements of OTAR Part 21 Subpart M, and this organisation will forward all supporting documents to BCAA for approval and issue of a reference number. 6. Major and Minor Design Changes (Modifications) Approval of all major and minor design changes installed on the aircraft shall comply with the requirements of OTAR Part 21 Subpart C. Any continued airworthiness requirements arising from the changes will be incorporated in the aircraft maintenance program as necessary. 7. Maintenance Programme Approval The maintenance program shall be approved by BCAA and subject to regular development to ensure effective continued airworthiness of the aircraft and made available to those involved in the maintenance of the aircraft. The maintenance program will include an annual review. Any amendments to a maintenance program shall be approved by the BCAA. 8. Weight and Balance The aircraft should be weighed in accordance with the requirements of OTAR Part 39.81 and records maintained to reflect the approved aircraft configuration. 9. Contracted Maintenance All contracted maintenance will be carried out by an appropriately approved OTAR Part 145 Organisation.
The following table provides examples of control measures for a range of generic hazards. These examples are provided as a guide only and important site specific factors must also be considered. Note also that this table of examples does not include all possible hazards. Hazard Possible Cause Control Measure Traffic Hazards Working in close proximity to roads Installation of temporary traffic signals Use of Safety Signs Speed restriction signs displayed and enforced Use of witches hats or temporary barriers to cordon off sections or whole of road Manual Handling Handling of heavy objects Use of lifting aids Imposed restrictions on certain activities Contact with Heat Hot materials Fire in the Workplace Exposure to sun Provide appropriate protective clothing and training Remove flammable materials or store correctly Provide adequate fire fighting equipment Employee fire fighting awareness Provide protective clothing and sunscreen Reduce exposure time Contact with Electricity Faulty electric leads and tools No earth leakage detectors Electric leads on ground Electrical leads in damp areas Electric leads tied to metal rails Contact with underground or overhead cables Tools and leads inspected and tagged Residual current devices in all circuits and tested Electrical leads kept elevated and clear of work areas All electric leads kept dry All electric leads are kept insulated Location of services and overhead cables to be established Services to be isolated when working in proximity Establish safe clearance distances Exposure to Noise Not wearing appropriate noise protection All personnel to wear appropriate PPE (hearing protectors) Contact with dangerous substances (chemicals) Incorrect handling procedures Lack of information Not wearing appropriate PPE Incorrect storage Elevated exposure levels All personnel informed with regard to correct handling and product sheets as required Staff provided with appropriate PPE Hazardous substances stored and labelled correctly Provide mechanical ventilation Struck Against Protruding objects in access routes Not wearing appropriate PPE Protruding objects are removed or marked Provide appropriate PPE and training Struck by Object Objects falling from work platforms Debris from grinding operations Windblown particles Loads slung from cranes All work platforms fitted with toe-boards Fence off areas below to prevent access Materials stacked securely All personnel wear appropriate PPE (hard hats) Secure loose objects to structure Loads not slung over personnel Loads slung correctly
BCAA USE ONLY Invoiced by: Approved by: Batch # Invoice Date: INVOICE REQUEST APPLICATION FORM BILLING INFORMATION DETAILS CUSTOMER NUMBER : COMPANY NAME: ADDRESS: E-MAIL ADDRESS (to send invoices to): CONTACT PERSON: CONTACT NUMBERS: Date of Submittal: DD/MM/YY *** This document shall be sent in electronic format via E-mail directly to: NO LATER than 90 days prior to the expiration date of the C of A *** AIRCRAFT INFORMATION C of A Initial C of A Renewal Export Certificate (*** select the appropriate Check Box ***) CRT # Registration Mark Aircraft Type Serial Number C of A Category Current Maximum Take-Off Mass (Kg) (as per AW268) C of A Current Expiry Date (N/A for Export C of A) BCAA USE ONLY GL TOTAL COST INVOICE # DISTRIBUTION 1. *** Insert rows as needed *** SPECIAL REMARKS :
What decision are you asking the court of appeal to make? I am asking that (Please tick as appropriate): the order(s), parts of order(s) or decision(s) I am appealing against be set aside the order(s), parts of order(s) or decision(s) I am appealing against be varied and the following order(s) or decision(s) substituted: a re-hearing by the Crown Court be ordered the Court of Appeal to make the following additional orders: i) an extension of time in which to seek leave to appeal (please give details in Part A) ii) an order for costs (please give details):
The Court of Appeal Criminal Division NOTICE and GROUNDS of opposition to an application for leave to appeal and appeal against restraint or receivership decision s.13B, s.43 and s.65 Proceeds of Crime Act 2002 Form POCA 4 Write in BLACK INK and use BLOCK CAPITALS CAO No. Your (respondent’s) name and address Give full name If in custody give prison address where detained Surname Forenames Prison Index No. (if applicable) Address Postcode Date of birth Solicitors details (if any) Details of the case Crown Court Case number Name of defendant* *(or alleged offender: 40(9)(a) Proceeds of Crime Act 2002) Details of the order(s), part(s) of order(s) or decision(s) you want to appeal or seek to uphold Name of Judge Date of order(s) or decision(s) Description of order(s) or decisions(s) If only part of an order is appealed, write out that part (or those parts): Are you (Please tick as appropriate): the person who applied for the order? a person affected by the order or decision? the receiver?
subsequent adoption of a new or revised program or policy direction that had programmatic impact on the entire agency. Senior Authority directly influences management decisions on overall CSU organizational objectives as a top-level individual consultant. Senior authorities have a unique level of expertise that does not exist in any other agency. What major program area of expertise is the basis for senior authority designation? Provide at least one example of a strategy, guideline, rule, etc., where this position’s findings resulted in the subsequent adoption of a new or revised program or policy that had programmatic impact in a different department(s). Leading Authority directly influences management decisions beyond State boundaries. Leading authorities have a rare level of expertise that does not exist in Colorado, and possibly other state governments. This position is recognized as a regional, national, or international expert. What major program area of expertise is the basis for leading authority designation? How is this position recognized as an expert regionally, nationally, or internationally? Why does the agency and State of Colorado need this position to function as a leading authority? VI. CONDITIONS OF EMPLOYMENT - **Including the Special Entry Requirements/ Qualifications below** Pre-employment Physical – Describe any special physical requirements: Pre-employment Drug Testing – Describe any specific test: Ongoing Functional Capacity Testing Colorado Driver’s License Regular Commercial List any endorsements required. Essential Services Designation – Required to report without delay or interruption to provide essential or emergency services to ensure health, safety, and welfare. Background Check – Specify the type(s): Shift Work – Explain: On-call Status – Explain: Use, Handling, or Exposure to hazardous materials – Explain: Use of Firearms or Other Weapons – Explain: Travel – Explain: Special Qualifications and/ or Special Entry Requirements: 1) Do you think this position requires a special qualification that differs from the established minimum qualifications for other positions in the class (certification, licenses, education and/or experience)? Yes No
10. Safety Management Systems (This is optional until implemented by EASA / FAA / Transport Canada) This organisation has established a safety management system for the proactive management of safety, that integrates the management of operations and technical systems with financial and human resource management which reflects quality assurance principles. The safety management system for this organisation is incompliance with OTAR Part 145 Subpart B and has been document in an SMS manual. reference xxx. 11. Continued Compliance At least one complete and current copy of this organisation’s MOE / RSM / MPM and this supplement are located at each approved location. Applicable sections are available to personnel who require the documents in order to carry out their duties. This organisation shall determine that each aircraft or component released to service by it is in an airworthy condition. 12. Major and Minor Repairs This organisation will carry out all repairs in accordance with the requirements of OTAR Part 21 Subpart M. 13. Major and Minor Modifications This organisation will install all modifications in accordance with OTAR Part 21 Subpart C. 14. Certificate of Release to Service This organisation will issue a Certificate of Release to Service (CRS) for Bermuda registered aircraft listed in the approved scope of work in accordance with OTAR Part 43 Subpart C. All components fitted or installed on Bermuda registered aircraft by this organisation will be supported by a suitable serviceable release certificate in accordance with OTAR Part 21 Subpart K.
BCAA Contacts: Bermuda: Address: Contact: P.O. Box GE 218 St. George's GE BX Bermuda Office: +1 (441) 2931640 Fax: +1 (441) 2932417 Email: United Kingdom: Address: Contact: Farnborough Airport Ively Road Farnborough Hampshire GU14 6XA United Kingdom Office: +44 (0) 1252 942170 Email: 20. Aircraft Availability Recovery
Branch Name: President/Administrator Name Address Phone Email Director for Programs Name Address Phone Email Director for Membership Name Address Phone Email Director for Finance Name Address Phone Email Director for Public Policy Name Address Phone Email Director for Communications/Newsletter Name Address Phone Email Director for Development-AAUW Funds Name Address Phone Email (Continued next page) Branch Number: Co-President Name Address Phone Email Co-Director for Programs Name Address Phone Email Co-Director for Membership Name Address Phone Email Co-Director for Finance Name Address Phone Email Co-Director for Public Policy Name Address Phone Email Co-Director for Communications/Newsletter Name Address Phone Email Co-Director for Development-AAUW Funds Name Address Phone Email
NSW Nomination Application Form R Skilled Regional (Provisional) visa (subclass 489) Nominating region SkillSelect EOI Number Title: Last Name (as shown on passport): First Name (as shown on passport): Date of birth (DD/MM/YYYY): Age: Country of Birth: Citizenship: No. of Dependents: Passport No.: Australian Visa Held (if any): Expiry Date: Address: Tel No (incl. country code): Email: NOMINATED OCCUPATION Nominated Occupation ANZSCO Code ENGLISH LANGUAGE TEST RESULT (IELTS or OET) Listening Reading Writing Speaking Overall EDUCATIONAL QUALIFICATIONS (for which you are claiming points) Qualification Course Date Completed Name of Institution SKILLED EMPLOYMENT (for which you are claiming points) Occupation Employer Dates of employment From To Australian skilled employment Overseas skilled employment
at time of invitation 18–24 (inclusive) 25 25–32 (inclusive) 30 33–39 (inclusive) 25 40–44 (inclusive) 15 45–49 (inclusive) 0 at time of invitation Competent English—IELTS 6 / OET B 0 Proficient English—IELTS 7 / OET B 10 Superior English—IELTS 8 / OET A 20 at time of invitation Doctorate from an Australian educational institution or a Doctorate awarded by an overseas educational institution of a recognised standard 20 At least a Bachelor degree, including a Bachelor degree with Honours or Masters, from an Australian educational institution or a Bachelor qualification awarded by an overseas educational institution of a recognised standard 15 Diploma or trade qualification awarded by an educational institution in Australia, or qualification or award recognised by the relevant assessing authority in determining your skills for your nominated occupation 10 at time of invitation A maximum of 20 points can be awarded for any combination of overseas and Australian skilled employment in your nominated occupation Skilled employment outside Australia (in the last 10 years) At least three but less than five years 5 At least five but less than eight years 10 At least eight and up to 10 years 15 Skilled employment in Australia (in the last 10 years) At least one but less than three years 5 At least three but less than five years 10 At least five but less than eight years 15
Local Education Agency State Project No. Phase School Architect Date DAS - OFFICE OF SCHOOL CONSTRUCTION GRANTS & REVIEW (OSCG&R) PLAN REVIEW CHECKLIST STAND-ALONE POLYCHLORINATED BIPHENYLS (PCB’S) ABATEMENT AND MANAGEMENT PLAN FORM SCG-3012 Do not use Not Applicable (N/A). Use “None”, “NPS” (Not in Project Scope), or explain condition. Submit completed Pre-Bid Conformance Review (PCR) Checklist with this completed form. Status column (by SCG staff): Accepted Open Item PCB Abatement Plan Preparer: ___________________________________ Status Drawings Specifications 01. Type(s) and amount(s) of PCB’s to be abated per Drawings / Specifications 02. If a Self-Implementing Plan (SIP) is being prepared, notification of PCB work/SIP to USEPA (>50 ppm PCB- containing materials) 03. If <50 ppm PCB-containing materials, notification of PCB remediation work to DEEP 04. Proper worker protection (OSHA req.) 05. Pre-abatement meeting 06. All PCB locations identified 07. Employees' decontamination system 08. Remediation methods 09. Decontamination and cleaning procedures for PCB work areas 10. Waste disposal system (PCB removal from contaminated area) 11. Proper worksite preparation 12. Verification testing (performance based or SIP) and re-occupancy clearance standards 13. Replacement materials specified 14. If a SIP were prepared and submitted to EPA, include copy of EPA approval and any conditions
National Passport Travel Document (internationally recognised) Travel Document (1951 Convention) Aliens Passport Diplomatic Passport Service Passport Government Official Passport 2.41 Document number 2.42 Date of issue D D M M Y Y Y Y 2.43 Date of expiry D D M M Y Y Y Y 2.44 Place of Issue 2.45 Surname(s) 2.46 Forename(s) 2.47 Date of birth D D M M Y Y Y Y 2.48 Gender ( ) Male Female Other 2.49 Nationality
Abstraction quantities Provide details of the abstraction quantities proposed, including any deregulated abstractions (< 20 cubic meters per day) you currently have. Abstraction location name / reference Number of days abstraction per year Maximum annual abstraction volume (cubic metres) Maximum daily abstraction volume (cubic metres) Maximum hourly abstraction volume (cubic metres) Peak abstraction rate (litres per second) Total Please show us how you have calculated these quantities or reference any supporting information submitted. If necessary, continue on a separate sheet and tick here to show that you have done this. Flow data Provide the flow data (in cubic metres per second) & ratios specified below: Q95 Q10 Qmean What is the ratio of Q95:Qmean? What is the ratio of Q10:Qmean? Please send us a copy of the full flow duration curve for the site and confirm the method used to derive this. If you have used modelling software such as LowFlows, please provide us with a copy of the output (graph, data and catchment map) including the Long Term Average rainfall. What low flow protection* do you propose to maintain in the depleted reach when the hydropower scheme is operating (in m3/s)? * Low flow protection is the flow rate above which abstraction can begin and is separate to the abstraction % take, see HGN2 for details.
Part 4 – Operating Schedule Please tick those parts of the Operating Schedule which would be subject to change if this application to vary was successful. Provision of regulated entertainment (please read guidance note 5) Please tick all that apply a) plays b) films c) indoor sporting events d) boxing or wrestling entertainment e) live music f) recorded music g) performances of dance h) anything of a similar description to that falling within (e), (f) or (g) Provision of late night refreshment Supply of alcohol (Note that this can only relate to reducing licensed hours, or moving them without any overall increase between 7am and 11pm) Please tick to indicate you have enclosed the following: I have enclosed the premises licence/club premises certificate I have enclosed the relevant part of the premises licence/ club premises certificate I have included a copy of the plan (this is necessary if the proposed variation will affect the layout) If you have not ticked one of the previous three boxes, please explain why in the box below. Reasons why you have not enclosed the premises licence/club premises certificate or relevant parts.
Post-Secondary Scholarship Application LEVEL 1 – COLLEGE PROGRAMS Check One (√) Hilda Young Memorial Personal Achievement Scholarship GPA 2.5 to 2.9 Hilda Young Memorial Academic Achievement Scholarship GPA 3.0 & Higher LEVEL 2 – UNIVERSITY PROGRAMS Check One(√) Hilda Young Memorial Personal Achievement Scholarship GPA 2.5 to 2.9 Hilda Young Memorial Academic Achievement Scholarship GPA 3.0 and higher Ernest Cowley Memorial Personal Achievement Scholarship GPA 2.5 to 2.9 Ernest Cowley Memorial Academic Achievement Scholarship GPA 3.0 and higher LEVEL 1 OR 2 – COLLEGE OR UNIVERSITY PROGRAMS Joseph Albert Ross Memorial Scholarship (First Year Student) Highest GPA LEVEL 1, 2 OR 3 – PART-TIME PROGRAMS Check One (√) Level 1 – Community College Level 2 – University Undergraduate Level 3 – University Graduate Student: ______________________________________ Treaty #: ______________ Mailing Address: ________________________________________________________ Banking Information: _____________________________________________________ Attending: _______________________ Program of Study: ______________________ Year ____ of a _____ Year Program Transcript Must Be Attached – GPA _______ (minimum of 24 credit hours university or full-time college program) Student Signature: __________________________________ Date: ______________ Deadline: August 31st of each year
Option 3: The flat will be sold in the open market. 1. The selling price shall be determined in the following manner [please tick where appropriate]: □ By mutual agreement; □ Not lower than $____________; □ Not lower than __________% of the valuation and the valuation is to be determined by: □ A valuer appointed by the HDB on a loan basis; □ Others [please specify] ___________________________on: □ An open market basis; □ A loan basis; □ others [please specify] _________________________. 2. The sale proceeds will be used to [please tick if applicable]: □ (a) repay the outstanding mortgage loan; □ (b) pay all moneys due to the HDB (including resale levy and upgrading levy, if applicable, but excluding the conveyancing, stamp, registration and administrative fees of the sale); □ (c) refund the Plaintiff’s CPF moneys used for the flat and the accrued interest*; □ (d) refund the Defendant’s CPF moneys used for the flat and the accrued interest*; □ (e) others [please specify] _____________________________. 3. If 2(a) or (b) above is not selected and there is an outstanding mortgage loan or moneys due to the HDB [please tick if applicable]: □ The outstanding mortgage loan will be repaid by: Plaintiff $____________* Defendant $____________* □ The moneys due to the HDB will be repaid by: Plaintiff $____________* Defendant $____________*
LEARNING AGREEMENT FOR SEMESTER EXCHANGE (COURSE SELECTION FORM) (FOR FBA STUDENTS USE ONLY) Student No. Student Name Contact Mobile No. Cumulative GPA Major Year of Study Country of Exchange Exchange University Template (if applicable) Exchange Period 1st semester / 2nd semester in academic year 20 / 20 Overseas University University of Macau Head of Department or Programme Coordinator Associate Dean “Selected” Overseas Course Information “To-be-replaced” UM Course Information Pre-requisite Agree to Transfer Signature of Dept. Head or Prog. Coordinator Agree with Decision Course Code Course Title ECTS / Credits Contact Hours Course Code Course Title Course Code Grade Yes No Yes No 1 2 3 4 5 6 7 8 9 10 Approved by Associate Dean (Curriculum and Teaching): Date:
How many hours are required to complete the program? Name of physician organization that developed the self-assessment program Name and contact information for requesting accreditation: Name of physician organization: Address: Email: Telephone #: Website address: Contact information for main point-of-contact First Name: Last Name: Address: Email: Telephone#: Name and contact information for Scientific Planning Committee Chair: (If different from above) First Name: Last Name: Email: Telephone #: Address: Name and contact information for organization the activity – only applicable if activity was Name of organization: Address: Email: Telephone #: Is the co-developing organization a physician organization? Yes No Will the physician organization maintain attendance records for 5 years? Yes No Content development Was the content developed by the applying physician organization? Yes No If no, who developed the content? Scientific planning committee members (SPC) Complete the table below. Include it as an attachment if you have this information already available electronically. Name of SPC member How does the individual represent target audience? Is the individual a member of the physician organization responsible for planning the CPD activity? Example: Jane Smythe, MD Endocrinologist Yes developing
Form 26 R. 56 (DEFENDANT’S PROPOSED MATRIMONIAL PROPERTY PLAN FORM) IN THE FAMILY JUSTICE COURTS OF THE REPUBLIC OF SINGAPORE Divorce Writ No. Between [Plaintiff’s Name] (ID No. ) Plaintiff And [Defendant’s Name] (ID No. ) Defendant DEFENDANT’S PROPOSED MATRIMONIAL PROPERTY PLAN (FOR HOUSING AND DEVELOPMENT BOARD FLATS ONLY) 1. I, the Defendant, disagree with the proposed arrangements set out in the Plaintiff’s Proposed Matrimonial Property Plan (For Housing Development Board flats Only). 2. The relevant CPF statements and additional CPF information (if applicable) dated [to state date] are annexed to this plan as Annex [to state number]. 3. *(For Defendants who are above the age of 55 years) I am above the age of 55 years and the amount required to be refunded into my CPF account in the event of a sale of the flat/transfer in ownership of the flat is: 4. My proposal in relation to the matrimonial property is as follows*: (Choose one or more of the following options. If more than one option is chosen, state the order of preference in brackets beside the option.) (i) Option 1: The Flat will be surrendered to the HDB. (ii) Option 2: The Agreement for Lease with the HDB will be terminated. (iii) Option 3: The Flat will be sold in the open market. (iv) Option 4: The Plaintiff’s share in the Flat will be sold/transferred* to: (A) The Defendant (B) The Defendant and [state name and relationship with the Defendant] (C) [state name and relationship with the Plaintiff/the Defendant] (v) Option 5: The Defendant’s share in the Flat will be sold/transferred* to: (A) The Plaintiff
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Service Area Treatment Plant (Table I) TABLE F Past Water Use Year Past Population* Per Capita Usage Total Annual Use (MG) Average Month Use (MG) Maximum Month Use (MG) Ratio Max:Average * Source of Projected Population Information: TABLE G Projected Water Use Year Projected Population* Per Capita Usage Total Annual Use (MG) Average Month Use (MG) Maximum Month Use (MG) Ratio Max:Average * Source of Projected Population Information:
GasSO Ref: EMSD/GSD-B/ Page 3 of 4 For Item D4 - Date of Pipework Test/Inspection Underground LPG pipes within Compound/Store Exposed LPG pipes within Compound/Store Date of pressure test (dd/mm/yyyy) Comply with requirement? Date of inspection (dd/mm/yyyy) Comply with requirement? For Item D5 - Date of HPRV replacement Batch No. 1 Batch No. 2 Batch No. 3 Batch No. 4 Number of HPRV (dd/mm/yyyy) Comply with requirement? Comply with requirement? Comply with requirement? Comply with requirement? * delete as appropriate For Item F3 - Date of Replacement of Flexible Gas Tubings Batch No. 1 Batch No. 2 Number of Flexible Gas Tubings Last replacement date of flexible gas tubing (dd/mm/yyyy) Comply with requirement? Comply with requirement? For Item G - Summary of Irregularities Observed/Other Information (e.g. unsafe/adverse conditions, overdue examination/testing etc.) * delete as appropriate Section III Recommendations and Remedial Work Recommendations by Competent Person Remedial work done by Owner (Tick if completed or put down planned completion date)# Checklist Item Description Note: # Remedial work should be completed as soon as possible and in any case not later than 3 months from the date of inspection. Otherwise, substantiation should be provided. The Gas Authority may conduct follow up inspection on the irregularities. GasSO Ref: EMSD/GSD-B/ Page 4 of 4
NAME DATE Expense Category (See below) Receipts Attached? Yes or No Description Amount TOTAL Expense Categories 1 Database Programming and Technical Support 2 Visual Website Updates and Maintenance 3 Programming Support 4 Office Supplies, Postage, and Copies 5 Meeting Expenses – Gift Cards, Refreshments, and Lunches 6 Yearbook and Schedule Preparation 7 Yearbook Printing 8 Equipment and Computer Software 9 Secretarial Support 10 Stipends 11 Appreciation Gifts 12 USTA Publications 13 Travel Expenses 14 Miscellaneous Additional Comments: Signature
___________________________________ _______________ _____________________________________ _____________ Student’s Signature Date Faculty Advisor’s Signature Date Form14_MPH_SBHS_F16 (05/18)
___________________________________ _______________ _____________________________________ _____________ Student’s Signature Date Faculty Advisor’s Signature Date Form 14 MPH SBHS-F18 (05/18)