REMOTE WORK & EQUIPMENT ASSIGNMENT AGREEMENT ================================================================ Effective Date: ________________________________________________________ Place: _________________________________________________________________ ================================================================ 1. Parties to the Agreement --------------------------- This Agreement is entered into on ____________________ (____________________) by and between: Employer Individual Full Legal Name: _______________________________________________________ SSN / ID: ______________________________________________________________ Doc Series: ____________________________________________________________ Address: _______________________________________________________________ _______________________________________________________________ Employee Individual Full Legal Name: _______________________________________________________ SSN / ID: ______________________________________________________________ Doc Series: ____________________________________________________________ Address: _______________________________________________________________ _______________________________________________________________ 2. SUBJECT-MATTER SCHEDULE & SPECIFICATIONS ------------------------------------------- Equipment Items & Serial Numbers: ____________________________________________________________________ Condition at Handover: _________________________________________________ Permitted Use: _________________________________________________________ Return Conditions: _____________________________________________________ 3. EXECUTION & SIGNATURES ------------------------- Employer Signature: _____________________________________________________________ Full Legal Name: _______________________________________________________ Date: __________________________________________________________________ Employee Signature: _____________________________________________________________ Full Legal Name: _______________________________________________________ Date: __________________________________________________________________