U.S. Department of Health and Human Services,

a US Government Agency
whose principal place of business is 200 Independence Avenue, S.W., Washington, DC 20201, United States of America,
represented by __________________, its _________________,
herein referred to as "{Handle}",

{Name.Given}

US Government Agency au capital de {Capital.All.#},
immatriculée au RCS de {Register.Adr.City} sous le numéro {Register.Account.#},
Dont le siège social est situé 200 Independence Avenue, S.W., 20201 Washington , United States of America,
Représentée par {Signer.FR.M/Ms_NameFull} en qualité de _________________, dûment habilité aux fins des présentes,
ci-après dénommée la « {Handle} » ,

U.S. Department of Health and Human Services

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 200 Independence Avenue, S.W., Washington, DC 20201, United States of America
reprezentowaną przez {Signer.PL.M/Ms_NameFull}, _________________
zwaną dalej «{Handle}»,

U.S. Department of Health and Human Services

("{Handle}")

By:

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

Date: {Sign.YMD}
Signed at: Washington, District of Columbia, United States of America

U.S. Department of Health and Human Services

( « {Handle} » ),

Par :

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

le : {Sign.YMD}
à : Washington, District of Columbia, United States of America

U.S. Department of Health and Human Services

("{Handle}")

BY

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

Dnia: {Sign.YMD}
Podpisana w: Washington, District of Columbia, United States of America