Application for Accommodation at Flower Foundation
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a certain declaration regarding treatment in circumstances in which you are not able to express informed consent
I/We hereby authorise Flower Foundation Retirement Homes Non-Profit Organisation number 000-836 NPO (the Foundation) to debit my/our/the under mentioned account with the amount due in respect of my/the Annual Subscription Fee. The debit order will be processed on the 1st business day of April each year.
I hereby certify that the information in this document is, to the best of my knowledge and belief, correct.
Flower Foundation, means you belong