SIGNED by …………………………………………….. Signature [INSERT AUTHORISED SIGNATORY’S NAME] …………………………………………….. for and on behalf of [INSERT PROVIDER NAME] ……………………………………………… Date *Delete if only effecting National Variation/add further details in box if also effecting Variation
SIGNED by [INSERT AUTHORISED SIGNATORY’S NAME] for and on behalf of [INSERT PROVIDER NAME] …………………………………………….. Signature …………………………………………….. ……………………………………………… Date *Delete if only effecting National Variation/add further details in box if also effecting Variation
nat-var-agt-shrt-frm-tmp-fin.docx