U.S. Department of Health and Human Services Office for Civil Rights,

a {Personality.type}, registered at {Register.Adr.City}, {Register.Adr.State}, {Register.Adr.Nation} with the identity number {Register.Account.#},
whose principal place of business is {Adr.Street.#} {Adr.Street.Name}, {Adr.City}, {Adr.ST} {Adr.Zip}, {Adr.Nation},
represented by {Signer.US.M/Ms_NameFull}, its {Signer.Title},
herein referred to as "{Handle}",

{Name.Given}

{Personality.type} au capital de {Capital.All.#},
immatriculée au RCS de {Register.Adr.City} sous le numéro {Register.Account.#},
Dont le siège social est situé {Adr.Street.#} {Adr.Street.Name}, {Adr.Zip} {Adr.City} , {Adr.Nation},
Représentée par {Signer.FR.M/Ms_NameFull} en qualité de {Signer.Title}, dûment habilité aux fins des présentes,
ci-après dénommée la « {Handle} » ,

U.S. Department of Health and Human Services Office for Civil Rights

spółką, {Capital.All},
zarejestrowaną pod adresem {Register.Adr.City}, {Register.Adr.State}, {Register.Adr.Nation} pod numerem: {Register.Account.#},
której siedziba znajduje się pod adresem {Adr.Street.#} {Adr.Street.Name}, {Adr.City}, {Adr.ST} {Adr.Zip}, {Adr.Nation}
reprezentowaną przez {Signer.PL.M/Ms_NameFull}, {Signer.Title}
zwaną dalej «{Handle}»,

U.S. Department of Health and Human Services Office for Civil Rights

("{Handle}")

By:

{xSignature}
Name: {Signer.Name.Full}
Title: {Signer.Title}

Date: {Sign.YMD}
Signed at: {Adr.City}, {Adr.State}, {Adr.Nation}

U.S. Department of Health and Human Services Office for Civil Rights

( « {Handle} » ),

Par :

{xSignature}
Nom : {Signer.Name.Full}
Titre : {Signer.Title}

le : {Sign.YMD}
à : {Adr.City}, {Adr.State}, {Adr.Nation}

U.S. Department of Health and Human Services Office for Civil Rights

("{Handle}")

BY

{xSignature}
Reprezentowana przez: {Signer.Name.Full}
Tytuł: {Signer.Title}

Dnia: {Sign.YMD}
Podpisana w: {Adr.City}, {Adr.State}, {Adr.Nation}