IPSubmission IDSubmission DateCycleKeytag #_Row_1Weight_Row_1Body Fat %_Row_1DateFull NameMonday_Breakfast P: C: HF:Tuesday_Breakfast P: C: HF:Wednesday_Breakfast P: C: HF:Thursday_Breakfast P: C: HF:Friday_Breakfast P: C: HF:Saturday_Breakfast P: C: HF:Sunday_Breakfast P: C: HF:Snack/ FruitSnack/ FruitSnack/ FruitSnack/ FruitSnack/ FruitSnack/ FruitSnack/ FruitLunchLunchLunchLunchLunchLunchLunchSnack/ FruitSnack/FruitSnack/FruitSnack/FruitSnack/FruitSnack/FruitSnack/FruitDinnerDinnerDinnerDinnerDinnerDinnerDinnerSnack/ FruitSnack/FruitSnack/FruitSnack/FruitSnack/FruitSnack/FruitSnack/FruitWaterWaterWaterWaterWaterWaterWaterAlcoholAlcoholAlcoholAlcoholAlcoholAlcoholAlcoholTitle of Training:Date of TrainingName of Trainer(s):Was this training mandatory?Name ofWere there any technical issues that impacted the success of this training?Describe any technical issues which impacted the success of this training:Did you have the opportunity for hands-on participation (using a computer, mobile device, etc.) during this training?The training objectives were clearly stated by the trainer?The training was organized in a manner that supported the objective(s)?The training was effectively delivered based on the identified objective(s)?This training included time for acquiring new knowledge/skills?The trainer demonstrated expertise on the training topic(s)?The trainer responded to my needs as a participant?The trainer provided opportunities for transferring knowledge into practice (time for processing, reflection, and/or collaboration)?Which topics/aspects of the training did you find most interesting or useful?As a result of this training, what changes will you make in your professional practice?As a result of this training, what knowledge/skills have you acquired that will help increase student achievement?Would you recommend this training to a colleague?Please add any other additional comments about this training/trainer(s).First NameLast NameStreet AddressCityCountryState/ProvinceZip/Postal CodeYour emailPhone number(s) where we can reach youBest times to call (check all that apply)What life stage are you interested in?Best times to call (check all that apply)What life stage are you interested in?Best times to call (check all that apply)What life stage are you interested in?Best times to call (check all that apply)Best times to call (check all that apply)Name of the pet you are interested inHow did you learn about this pet?What breed(s) are you interested in?Describe your living situationDescribe your living situationI want this pet for the following reasons (check all that apply):Do you rent?If yes, does your lease allow pets?Monthly or yearly lease?When does your lease expire (enter n/a if you are the property owner)?How long have you lived at your current address?Landlord name and contact information (enter n/a if you are the property owner)Do you have a yard?Is the yard fenced?Approximate square feetIf fenced, what type of fencing? (e.g. wood, small-gauge wire, poultry fencing, chain link, locking gate, secure entry, etc. - please be specific. If no fence, enter n/aHow tall is the fence? If no fence, enter n/aAre you a student?What hours is someone usually home?How will the pet be exercised?How often?Where will the pet be kept when no one is home?Where will the pet spend most of his/her time?Where will the pet be kept when no one is home?Where will the pet be kept when no one is home? Check all that applyWhere will this pet sleep?Where will this pet sleep?Do you have other animals?If yes, what kinds and how many? If no, enter n/aWhat are their ages?How long have you had them?How many pets have you owned in the last five years? Please specify what kind of pet.Have you had a pet in your home and/or on your property die of a disease such as Distemper, Feline Leukemia, or Parvo Virus?Have you had a pet in your home and/or on your property die of a disease such as Distemper, Feline Leukemia, or Parvo Virus?Do your other pets have up-to-date vaccinations (within the last year)?If no, explain why or enter n/aIf no, explain why or enter n/a Are your other pets spayed and/or neutered?If no, explain why or enter n/aDo you feel you can afford the cost of maintaining this pet for his/her lifetime?What source of income do you have to make this possible? Check all that applyWhat source of income do you have to make this possible? Check all that applySince most shelter animals have unknown medical/health backgrounds, are you prepared to provide and pay for any necessary medical treatment throughout the pet's lifetime?Do you have a regular veterinarian?If yes, to which clinic to you take your pet(s)? Provide name and contact information or enter n/aIf no, and you currently have pets, explain why or enter n/aHow many children live in your home?What are their ages?Do they have experience with animals?Do they have experience with animals?Do you or any family members have allergies to pets?Who will be responsible for taking care of this pet?How will this pet be cared for if you go out of town?Do you have training experience?Have you attended formal obedience classes?Have you attended formal obedience classes?Are you familiar with local animal control ordinances for the area in which you reside? (A volunteer can provide you with local information regarding spay/neuter, licensing, fees, etc.)If something were to happen to the primary care giver for this pet, is there a long-term care solution in place? Please describe.Would there ever be a reason you would give up this pet?Please explain why you want a pet at this time, in as many words as you need. THIS IS AN IMPORTANT PART OF YOUR APPLICATION.May we visit your home?Full NameDateNQ BUYER'S AGENT - PROPERTY PROFILEPROPERTY IDAVAILABLEAGENTPRICEPHONEPRICEPHONETYPEPRICEBEDSPHONEBATHSBATHSBATHSCARCARCARPOOLPOOLBUILDING AND BLOCKBUILDING AND BLOCKBUILD. HEIGHTBUILD. HEIGHTBUILD. HEIGHTBUILDINGBUILDINGBUILDINGROOFROOFROOFCONDITIONCONDITIONBUILDING SIZEBUILDING SIZEBUILDING SIZEBLOCKBLOCKBLOCKBUILD. POSITIONBUILD. POSITIONBUILD. POSITIONBUILD. ASPECTBUILD. ASPECTBUILD. ASPECTLOCATIONLOCATIONAMENITIESAMENITIESAMENITIESCRIMECRIMEHOUSING SESHOUSING SESNBNNBNEDUCATIONLANDLAND SIZELAND SIZELAND VALUELAND VALUEFLOOD FREEZONINGZONINGOVERLAYSOVERLAYSCLIENTDRAINSAGENTCASH FLOW - EST.PRICE APPRAISALPURCHASE STRATEGYSUBMITName of StudentALLY CONSENT TICIPATION.ALLY CONSENT TDateCONDITIONS.Parent/GMy student may take over the counter medications YES _________ NO _________NameName:Phone:Enter 10 Digit Phone NumberPhone:Enter 10 Digit Phone NumberEnter 10 Digit Phone NumberEnter 10 Digit Phone NumberDate of last tetanus boosterSpecial dietary needsMy child is allergic toMedication taken routinelySpecial health needsFamily PhysicianPhone NumberName of insurance companyPolicyStudent-s Address [1]Birthdate:Student-s Address [2]Revised 8/08Parent/GuardianStudent-s nameStudent-s teacher and school:_______________________________________________Parent/Guardian:__________________________________________________________Date of signature:___________________________________Street address, city, state, zipPlease return this form byTeacher (s):Email:Date:Grade (s):Destination:Address:Purpose of trip:Transportation needs:Number of children:Number of adults:OtherTime leaving:Pick up time:ApprovedDisapprovedPET NAME:BREED:MICROCHIP:OWNER NAME:OWNER ADDRESS:TELEPHONE HOME:TELEPHONE CELL:BEST E-MAIL ADDRESS:VETERINARIAN NAME:VETERINARIAN TELEPHONE:OWNER'S LOCAL ADDRESS:FOOD:ALLERGIES:EMERGENCY CONTACT NAME:EMERGENCY CONTACT PHONE:EMERGENCY CONTACT CELL:multiline_textfieldFirstMiddleInitiDOLastMiddleInitiDO(mm/dd/yyyy)OwnHome AddressHome AddressHome AddressHome Addressmail addressHomeWorkMobileYesTypeofbusinessPosition/TitleLength of employment with current employerName of Borrower,Describe the individual borrower or principal officer's experience as a Real Estate Investor or other related experience:noDescribe the courses, seminars, boot camps, training tapes, etc. you've used to learn about real estate investing.VA, MD, DC area?CorporationBusiness InformationFederal Tax ID#eStreetCityStateZipBusiness InformationBusiness InformationYesYesYesIf you answered yes to any of the precDate:Date:Property Address:Borrower:Loan Amount at maximumLoan Amount at maximumARVBest CaseWorst Caseof Loan AmountBest CaseWorst CaseClosing Costs- estimate of charges for documents, title companyClosing Costs- estimate of charges for documents, title companyClosing Costs- estimate of charges for documents, title companySellers obligations you agree to paySellers obligations you agree to payHazard Insurance PolicyHazard Insurance PolicyFlood Insurance PolicyFlood Insurance PolicyFlood Insurance PolicyTotal Acquisition CostsTotal Acquisition CostsLoan Amount (from A. above)Loan Amount (from A. above)Soft 2nd Lien NoteSoft 2nd Lien NoteTotal Loans available at closingTotal Loans available at closingPurchase Price (or existing financing take-out)Purchase Price (or existing financing take-out)Estimated Rehab CostEstimated Rehab CostEstimated Acquisition Costs (from B. above)Estimated Acquisition Costs (from B. above)TotalTotalE. Estimated Cash Needed at Closing (note 1)E. Estimated Cash Needed at Closing (note 1)Purchase Price (or existing financing take-out)Purchase Price (or existing financing take-out)Estimated Rehab CostEstimated Rehab CostEstimated Acquisition Costs (from B. above)Estimated Acquisition Costs (from B. above)TOTAL DIRECT COSTSTOTAL DIRECT COSTSSelling Price at 90% of ARVSelling Price at 90% of ARVGROSS MARGINGROSS MARGINInterest: Best: 6 mos/13% Worst 9 mos/14%Interest: Best: 6 mos/13% Worst 9 mos/14%Sales Commission at 3%Sales Commission at 3%$ NET PROFIT$ NET PROFIT% NET PROFIT (note 2)% NET PROFIT (note 2)NQ BUYER'S AGENT - PROPERTY PROFILEPROPERTY IDAVAILABLEAGENTPRICEPHONEPRICEPHONETYPEPRICEBEDSPHONEBATHSBATHSBATHSCARCARCARPOOLPOOLBUILDING AND BLOCKBUILDING AND BLOCKBUILD. HEIGHTBUILD. HEIGHTBUILD. HEIGHTBUILDINGBUILDINGBUILDINGROOFROOFROOFCONDITIONCONDITIONBUILDING SIZEBUILDING SIZEBUILDING SIZEBLOCKBLOCKBLOCKBUILD. POSITIONBUILD. POSITIONBUILD. POSITIONBUILD. ASPECTBUILD. ASPECTBUILD. ASPECTLOCATIONLOCATIONAMENITIESAMENITIESAMENITIESCRIMECRIMEHOUSING SESHOUSING SESNBNNBNEDUCATIONLANDLAND SIZELAND SIZELAND VALUELAND VALUEFLOOD FREEZONINGZONINGOVERLAYSOVERLAYSCLIENTDRAINSAGENTCASH FLOW - EST.PRICE APPRAISALPURCHASE STRATEGYDISCLOSUREProposed Company NameAlternative company name if not availableObjects and business of the companyPrivate/PublicNominee shareholderNominee directorsAmount of share capitalPercentage of capital paid up (minimum 20%)Number of directorsNumber of shareholdersName of first shareholder (beneficial owner)Percentage of shares heldName of second shareholder (beneficial owner) optionalPercentage of shares heldName of third shareholder (beneficial owner) optionalPercentage of shares heldName of fourth shareholder (beneficial owner) optionalPercentage of shares heldName of first directorName of second director (optional)Name of third director (optional)Name of fourth director (optional)Are the directors to act jointly or independently of each other?Are the directors to act jointly or independently of each other?Family nameFirst/given nameFather's nameNationalityAddressPassport numberIssuing countryPlace of issueDate of issueExpiry dateEmail addressTelephone Number (inc country/area)Mobile number (inc country/area)Fax Number (inc country/area)Details of professional/commercial career and present careerSource of wealth/incomeFamily nameFirst/given nameFather's nameNationalityAddressPassport numberIssuing countryPlace of issueDate of issueExpiry dateEmail addressTelephone Number (inc country/area)Mobile number (inc country/area)Fax Number (inc country/area)Details of professional/commercial career and present careerSource of wealth/incomeFamily nameFirst/given nameFather's nameNationalityAddressPassport numberIssuing countryPlace of issueDate of issueExpiry dateEmail addressTelephone Number (inc country/area)Mobile number (inc country/area)Fax Number (inc country/area)Details of professional/commercial career and present careerSource of wealth/incomeFamily nameFirst/given nameFather's nameNationalityAddressPassport numberIssuing countryPlace of issueDate of issueExpiry dateEmail addressTelephone Number (inc country/area)Mobile number (inc country/area)Fax Number (inc country/area)Details of professional/commercial career and present careerSource of wealth/incomeFamily nameFirst/given nameFather's nameNationalityAddressPassport numberIssuing countryPlace of issueDate of issueExpiry dateEmail addressTelephone Number (inc country/area)Mobile number (inc country/area)Fax Number (inc country/area)Family nameFirst/given nameFather's nameNationalityAddressPassport numberIssuing countryPlace of issueDate of issueExpiry dateEmail addressTelephone Number (inc country/area)Mobile number (inc country/area)Fax Number (inc country/area)Family nameFirst/given nameFather's nameNationalityAddressPassport numberIssuing countryPlace of issueDate of issueExpiry dateEmail addressTelephone Number (inc country/area)Mobile number (inc country/area)Fax Number (inc country/area)Family nameFirst/given nameFather's nameNationalityAddressPassport numberIssuing countryPlace of issueDate of issueExpiry dateEmail addressTelephone Number (inc country/area)Mobile number (inc country/area)Fax Number (inc country/area)Place and dateName of first beneficial ownerSignaturePlace and dateName of second beneficial ownerSignaturePlace and dateName of third beneficial ownerSignaturePlace and dateName of fourth beneficial ownerSignaturePlace and dateName of witnessProfession of witnessSignatureAddressEmail addressTelephone Number (inc country/area)Mobile number (inc country/area)Fax Number (inc country/area)Company structure chartCorporateCorporateCorporateNQ BUYER'S AGENT - PROPERTY PROFILEPROPERTY IDAVAILABLEAGENTPRICEPHONEPRICEPHONETYPEPRICEBEDSPHONEBATHSBATHSBATHSCARCARCARPOOLPOOLBUILDING AND BLOCKBUILDING AND BLOCKBUILD. HEIGHTBUILD. HEIGHTBUILD. HEIGHTBUILDINGBUILDINGBUILDINGROOFROOFROOFCONDITIONCONDITIONBUILDING SIZEBUILDING SIZEBUILDING SIZEBLOCKBLOCKBLOCKBUILD. POSITIONBUILD. POSITIONBUILD. POSITIONBUILD. ASPECTBUILD. ASPECTBUILD. ASPECTLOCATIONLOCATIONAMENITIESAMENITIESAMENITIESCRIMECRIMEHOUSING SESHOUSING SESNBNNBNEDUCATIONLANDLAND SIZELAND SIZELAND VALUELAND VALUEFLOOD FREEZONINGZONINGOVERLAYSOVERLAYSCLIENTDRAINSAGENTCASH FLOW - EST.PRICE APPRAISALPURCHASE STRATEGYSUBMITYour e-mail address will allow acknowledgement of receipt of your survey.1. In some cases more lifting force at the surface stretches more pipe. True/False - Why?2. A pipe pull sub properly welded to the casing string is the preferred method to access the casing. True/False - Why?3.The diameter, weight, and grade of the pull sub is important. True/ False - Why?4. A proper weld procedure should be used to attach the pull sub. True/False - Why?5.There should be a gap between the pull sub and the casing. True/False - Why?6.It is sometimes necessary to preheat the pipes in the area of the weld. True/False - Why?7. Straps should be used to used to reinforce the butt weld. True/False - Why?8. Proper material should be used for the straps. True/False - Why?9. Straps should be welded along all sides for additional strength. True/False - Why?10. The length of the pull sub matters. True/False - Why?11. In order for the wellhead slips to come up with the pipe the should be tack welded to casing. True/False - Why?12. Define "working the pipe".13. Can the casing string be fully "worked down" when a short pull sub is used? Yes/No - Why?14. Working the pipe favorably affects the condition of the bore hole. True/False - Why?15. Completion reports and well records provide useful P & A information. True/False - Why?16. A drilling rig can always apply a sufficient lift force to remove well head slips. True/False - Why?17. A work over rig can always supply a sufficient lift force to remove well head slips. True/ False - Why?18. The accuracy of the drilling rig and/or the work over rigs weight indicator is sufficient for use as a stretch force indicator. True/False - Why?19. A work over rig can always supply a sufficient lift force to stretch or move pipe at the maximum free point depth. True/False - Why?20. A hydraulic casing jack is a better tool to use to apply required lift forces when removing well head slips. True/False - Why?21. A hydraulic casing jack is a better tool to use to apply lift forces required in free pointing? True/False - Why?22. The top of the pull sub should always have usable collar. True/False - Why?23. A pull sub should always be carefully examined throughout its length for evidence of having been welded on. True/False - Why?24. When free pointing the definition of string weight is pipe weight per foot times the depth to top of cement in feet. True/False25. The lift force equal to the string weight (see 24.) should be pulled and the pipe marked before a stretch force is applied. True/False - Why?26. Consider free pointing with electric wire line tools. (a) The free point tool is positioned down hole (b) a specified lift force is applied at the surface. (c) free point tool indication is noted. (d)tension is relaxed. (e) free point tool is relocated further down hole. (f) the specified lift force is applied again at the surface. (g) tool indication is noted. This process is repeated until the free point tool indicates no movement. Will this method result in valid information concerning maximum length of free pipe? Yes/No - Why?27. A constant lift force can be maintained using a drilling rig or a work over rig. True/False - Why?28. Pulling a pipe string after attempt to part same at free point requires a lift force that will overcome the weight of the pipe, forces that constrain its movement and in some cases finish parting the pipe. True/False - Why?29. When a work over rig applies a lift force to a pipe string and the brake is set the applied lift force is maintained. True/False - Why?30. When a lift force is applied by a hydraulic jack powered with a pressure compensated pump the lift force is maintained. True/False - Why?31. When marking the pipe string to measure the pipe movement a fixed datum (reference point) should be used. True/False - Why?32. When marking the pipe wait until the pipe stops moving while a constant lift force is maintained before marking the pipe. True/False - Why?33. A fine line should be used to mark the pipe position when free pointing. True/False - Why?34. Accumulative errors made in measuring stretch and stretch force result in a greater free point error than compensating errors. True/False - Why?35. Work over rigs can work the pipe down faster and better than a hydraulic casing jack. True/False - Why?36. When operating using a safe pull force a work over rig can pull casing faster than a hydraulic casing jack. True/False - Why?37. What is the safe pulling capacity (pulling casing) of a work over rig rated at 210,000 lb's.?38. When pulling casing the pull weld parts or the casing parts up hole is a work over rig is a safe as a hydraulic jack. True/False - Why?39. When pulling pipe with a hydraulic casing jack the slip handles should be tied together. True/False - Why?40. Grade P-110 casing does not stretch as much as J-55 pipe. True/False - Why?41. Casing joint strength is always less than the casing body strength. True/False - Why?42. If pipe stretch is measured, the string stacked out and stretched again for free point without working down the second free point would be usable. True/False - Why?43. The amount and location of different weights of pipe in a combination casing string are necessary to determine an accurate free point. True/False = Why?44. Subsidence occurs when a work over rig applies a lift force to casing string. True/False - Why?45. When a work over rig lifts a load the mast compresses. True/False - Why?46. When a work over rig lifts a load the wire rope lines stretch. True/False - Why?47. A hydraulic casing jack can be mounted on top of blow out preventer. True/False - Why?48. Wellhead slips can never be pulled through a annular blow out preventer. True/False - Why?49. Work over rig - move to location time (miles/hr) ?50. Work over rig - move to location (cost/hr) ?51. Work over rig - rig up time (hrs) ?52. Work over rig - rig up (cost/hr) ?53. Backhoe. Dig plugging pit. time (hrs) ?54. Backhoe. Dig plugging pit. (cost/hr) ?55. Plugging pit. material cost?56. Remove pumping unit. time (hrs) ?57. Remove pumping unit. (cost/hr)?58. Unseat pump. time (hrs) ?59. Unseat pump. (cost/hr) ?60 Pull and lay down sucker rods. time (1000 ft./hr) ?61. Pull and lay down sucker rods. (cost/hr) ?62. Rig up B.O.P. for pulling tubing. time (hrs) ?63. Rig up B.O.P. for pulling tubing. (cost/hr) ?64. Unseat tubing. time (hrs)?65. Shoot off tubing. (if required). time (hrs)?66. Shoot off tubing. (if required) (cost/hr) ?67. Stand back tubing for required cement plugs. time (hrs)68. Stand back tubing for required cement plugs. (cost/hr) ?69. Pull and lay down tubing. average time (1000 ft./hr)70. Pull and lay down tubing. (cost/hr) ?71. Remove well head section to access casing long string. time (hrs) ?72. Remove well head section to access casing long string. ( cost/hr) ?73. Long string pull sub (with usable collar) cost ?74. Long string pull sub (transportation to location cost) ?75. Weld on long string pull sub. time (hrs) ?77. Weld on long string pull sub. (cost/hr) ?78. Remove wellhead slips time (hrs) ?79. Remove wellhead slips (cost/hr) ?80. Casing jack to remove wellhead slips. time portal to portal (hrs) ?81. Casing jack cost to remove wellhead slips (cost/hr) ?82. Rig up B.O.P. for long string. time (hrs)83. Rig up B.O.P. for long string. (cost/hr) ?84.Rig up casing tongs, tong back-up, casing slip bowl, and casing slips. time (hrs) ?85. Rig up casing tongs, tong back-up, casing slip bowl, and casing slips. (cost/hr)?86. Casing jack to work pipe, free point, part pipe (assist), and jack pipe until rig takes over. time (hrs.)83. Casing jack to work pipe, free point, part pipe (assist) and jack pipe until rig takes over. (cost/hr)84. Work over rig to lay down jacked long string. time (hrs)85. Work over rig to lay down jacked pipe. (cost/hr) ?86. Work over rig to pull and lay down long string. time (hrs)87. Work over rig to pull and lay down long string. (cost/hr) ?88. Remove wellhead section to access intermediate string. time (hrs) ?89. Remove wellhead section to access intermediate string. cost/hr) ?90. Intermediate string pull sub. Cost Including transportation to location ?88. Weld on intermediate string pull sub. time (hrs) ?89. Weld on intermediate string pull sub. (cost/hr)?90. Casing jack to remove intermediate string slips. time (hrs) ?91. Casing jack to remove intermediate string slips. (cost/hr) ?92. Casing jack to work pipe, free point, part pipe (assist), and jack pipe until rig takes over. time (hrs) ?93. Casing jack to work pipe, free point, part pipe (assist), and jack pipe until rig takes over. (cost/hr ?94. Wireline. place explosive in collar or other location near free point. time (hrs) ?95. Shoot pipe. Cost of cutter?96. Wireline. retrieve wireline. time (hrs) ?97. Wireline. (cost/hr) ?98. Work over rig to lay down jacked intermediate pipe. time (hrs) ?99. Work over rig to lay down jacked intermediate pipe. (cost/hr) ?100. Set 100 ft in and out plug at bottom of surface pipe time (hrs) ?101. Set 100 ft in and out plug at bottom of surface pipe. (cost/hr) ?102. Wait on cement. Tag with wireline or tubing. time (hrs) ?103. Wait on cement . Tag with wireline or tubing. (cost/hr) ?104. Place 10 sack cement plug at top of surface pipe. time (hrs) ?105. Place 10 sack cement plug at top of surface pipe. (cost/hr) ?106. Welder. cut off surface pipe and cap with I.D. plate. time (hrs) ?107. Welder. cut off surface pipe and cap with I.D. plate. (cost/hr.First Name:Last Name:PhoneEmail address:How many of your group will attend? Please list names of other attendees.Last Name:Home Phone No.:First Name:Home Phone No.:First Name:Last Name:Home Phone No.:First Name:Last Name:Home Phone No.:Je choisis :Commentaire éventuel :Nom prénom (Obligatoire)save the completed report on your device before uploading it through the FIAU websiteName of subject personType of activity (1Type of activity (2Type of activity (3Type of activity (4Type of activity (5Company Registration NoDate of registration/ licencewarrantAddress line 1Address line 2TownCountryPost codeAddress line 1Address line 2TownCountryPost codeTelephone numberFax numberWebsiteundefinedA6. Number of staffConnected undertaking (1Connected undertaking (2Connected undertaking (3Connected undertaking (4Connected undertaking (5Both corporate and individual customersBoth local and foreign residentsYes_Category 1No_Category 1Yes_Category 2No_Category 2Yes_Category 3No_Category 3Both face-to-face and non face-to-faceNoNoTitleNameSurnameDesignation/ positionAppointment date as MLROApproval date as MLROCountry of residenceNationalityDate of birthIdentification numberOffice telephone numberOffice fax numberE-mail addressC2. To whom does the MLRO report within the organisationTitleNameSurnameDesignation/ positionAppointment date as MLROApproval date as MLROResignation date as MLRONone (skip to Section ETitleNameSurnameDesignation/ PositionAppointment date asOffice telephone numberOffice fax numberE-mail addressTitleNameSurnameDesignation/ PositionAppointment date asOffice telephone numberOffice fax numberE-mail addressActivity (1Activity (2Activity (3Activity (4Activity (5Activity (1Activity (2Activity (3Activity (4Activity (5skip to Section FReason (1Reason (2Reason (3MonthYearNoNoYes_Customer riskNo_Customer riskNot Applicable_Customer riskYes_Product/ service riskNo_Product/ service riskNot Applicable_Product/ service riskYes_Interface riskNo_Interface riskNot Applicable_Interface riskYes_Geographical riskNo_Geographical riskNot Applicable_Geographical riskF5b. Please give a brief overview of the procedures that are currently in placeYearsundefinedG2. Please indicate the year when the last compliance assessment or verification exercise was carried outYearG3b. Kindly list the findings and recommendationsG4. Please list the actions taken to address the findings and recommendations outlined aboveCourses/ seminars/ conferencesTopicsYearCourses/ seminars/ conferencesTopicsYearTopicsTopicsTrainersNo training conducted during 2014I1. Kindly detail any explanatory notes or additional comments with respect to this submissionFull NameDate of completionFull NameDesignationTelephone numberE-mail addressDate of confirmationif not submitted electronicallyRush orders may be subject to higher hourly rate.Requested ByPhoneBadge #EmailStart DateTarget DateWork TypeQty.Drawing numberSelect FileDescriptionDept CodeDept CodeApprovedDept ManagerCorp. ApprovalNameBadgeStart DateTarget DateundefinedDrawing NumberRepair 50DescriptionundefinedCorp. ApprovalDept. ManagerStudentOSISGrade LelStudentStreCity/State/Parent SuCell PhoneParent SuAge:OSIS #:me/OSIS/Ageyou takingg1.)2.)AftAft [2]PlePleNameVornamePLZOrtStrasse / Nr.TelefonMobileE-MailHomepageSBK MitgliZSR NummerBeschreibung:Skala:Beschreibung:Skala:Beschreibung:Skala:Skala:Beschreibung:Beschreibung:Skala:Beschreibung:Skala:Beschreibung:Skala:Skala:Beschreibung:Beschreibung:Skala:Skala:Beschreibung:Skala:Beschreibung:Beschreibung:Skala:Skala:Beschreibung:Beschreibung:Skala:Beschreibung:Skala:Beschreibung:Skala:Skala:Beschreibung:Beschreibung:Skala:Skala:Beschreibung:Beschreibung:Skala:Skala:Beschreibung:Beschreibung:Skala:Skala:Beschreibung:Skala:Beschreibung:Skala:Beschreibung:Skala:Beschreibung:Beschreibung:Skala:Skala:Beschreibung:Formular zur Selbstevaluati
46.140.23.13034190145703182046616-06-2016 17:50:57 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - MusterFranz3013BernAltenbergstrasse 18031 333 66 22078 757 50 16cuno@infowerkstatt.chwww.infowerkstatt.ch - - - - - Psychiatrische PflegeAndere - - - asdfa sdfa sdf 1asd fasdf asdf 2as dfas dfa s12asd fas dfasd asd fasdf asdf 2asd fasdf ad1 asdf asdf asd12as dfasdf asdfasd fasdf 10asd fasdf a2as dfasdf asdfasd fasdf asdf11asdf asdf asdasdf asdf asdf 1asdf asdf asdf1asdf asdf adf11asdf asdf asdf asdf asdf22asdf asdf asdf asdf asdf 22asd fasdf asd fasd fasd11asdf asdf 2asdf asdf 1as dafs daf 1asd fasd fasd fasdf 00asdf asdf -