Plan and implement administrative systems

this assessment.
This assessment must be undertaken in a real or simulated workplace environment

Assessment
Methods Research Assessment 1
Research report on Administrative Systems
Project Assessment 2
Implementation report on Administration System
Project Assessment 3
Monitoring report on Administration System
Written / Project Assessment 4
Written assessment or project

Last Modification Date November2014
Proposed Review Date November 2015
Unit Summary
This unit describes the performance outcomes, skills and knowledge required to plan or review the requirements of effective administration systems and procedures for implementing, monitoring and reviewing the system.
No licensing, legislative, regulatory or certification requirements apply to this unit at the time of endorsement
Prerequisite Units
There are no recommended pre-requisite units for this competency.

Co-requisite Units
There are no recommended co-requisite units for this competency.

All products purchased remain the intellectual property of Accredited Education & Training. All rights reserved; no part of any publication provided by Accredited Education & Training may be reproduced by any means for use outside the purchasing organisation, without the prior written permission of Accredited Education & Training.
ASSESSMENT SUMMARY / COVER SHEET

This form is to be completed by the assessor and used as a final record of student competency.
All student submissions including any associated checklists (outlined below) are to be attached to this cover sheet before placing on the students file.
Student results are not to be entered onto the Student Database unless all relevant paperwork is completed and attached to this form.

Student Name:
Student ID No:
Final Completion Date:
Unit Code: BSBADM504
Unit Title: Plan and implement administrative systems

Please attach the following documentation to this form Result
S = Satisfactory
NS = Not Satisfactory
NA = Not Assessed
Assessment 1 ? Administrative system review report
?Checklist attached S | NS | NA
Assessment 2 ?Administrative system implementation report
?Checklist attached S | NS | NA
Assessment 3 ?Administrative system monitoring report
?Checklist attached S | NS | NA
Assessment 4 ?Written / Project attached S | NS | NA
Final Assessment Result for this unit C / NYC

Student Feedback: _______________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Student Declaration:I declare that I have been assessed in this unit, and I have been advised of my result. I also am aware of my appeal rights.
Name: ____________________________
Signature: ____________________________
Date: ____/_____/_____ Assessor Declaration:I declare that I have conducted a fair, valid, reliable and flexible assessment with this student, and I have provided appropriate feedback
Name: ____________________________
Signature: ____________________________
Date: ____/_____/_____

Administrative use only
Entered onto Student Management Database ?________________
Date
Initials

ASSESSMENT 1- STUDENT INFORMATION
Review an administrative system and make recommendations
This information is to be handed to each student to outline the assessment requirements.

There are three components to this unit. Assessment 1 requires you to review the administrative system currently being used by a gardening business called ‘Clippers Gardening Services’. As part of this review you will be researching new administrative systems and making recommendations in the form of a written report to management about your finding.

Clippers have experienced expansionover the last six months, growing from only employing one employee to five employees. Due to thisrapid growth, the dramatic increase in the number of quotes being written and the addition of four new employees. Management feel that there are elements of their current administrative system that need to be improved. The first review they would like you to conduct is how they go about quoting on jobs for customers. Use the information given to you below about the organisation, research two possible alternative systems and put forward your recommendations about which system should be implemented.

Some facts about the current administrative system at Clippers Gardening Services:
• The current quotation system Clippers uses is paper based. This means that all quotes that the gardeners give to customersare hand written in a carbon copy book
• Only gardening staff and the owner provide customers with quotations
• Office staff only handle the paperwork after the quote has been accepted
• When gardening staff are quoting on jobs they hand write the quote in a carbon copy book, tear a copy out for the customer and the original is still attached in the carbon book.
• If the customer proceeds with a quote, office staff take a photocopy of the quote and a customer file is created using a paper folder which is filed away alphabetically under the customers’ surname in a filing cabinet
• Clippers office hours are Monday-Friday 8.30-4.30pm. The gardeners work hours are Monday- Friday 8.30am-4.00pm and Saturday 9am-12noon

Management have identified the following problems with this system:
• There are four gardeners working at Clippers, each of them currently provides quotes to customers. There have been inconsistencies lately as to the different amounts being quoted by each gardener. There seems to be no defined fee structure in place
• Because there is no centralised system where a copy of every quote is kept on file, office staff are unable to access quotes if customers ring up with questions
• If the customer proceeds with the quote, the gardener assigned to the job has to obtain a copy of the original quote from the office
• Because the quotes are written in carbon books there is no way that office staff can follow up on quotes with prospective customers, because the gardeners carry the invoice books with them, and they rarely visit the office
• The quotes are often difficult to read because they are hand written at the time of quoting the customer and the quote is given to the customer on the spot
• Important details are often missing from quotes, because there is no procedure in place to encourage gardeners to collect or record the same information for each quote given
• Management realise that implementing a new system will come at a cost
• Management understand that training staff is important and are fully supportive of this however they have not identified how much support they will give

Organisational Chart
Clippers Gardening Services
Student assessment information:
• Your task is to research two possible alternative administrative systems to manage the quotation process that Clippers are currently using. You will be required to provide a recommendation as to which system you believe is best suited to this business, for implementation at Clippers. In preparation for this, you are to:
o detail how you would investigate what the requirements of a new administration system
o identify the people you would involve in this process
o document six questions you would askstakeholders in order to identify the organisationsand individuals needs. Don’t forget to include any budgetary issues

• Next you are to conduct thorough research on these two possible administrative systems.These systems maybeeither electronic or paper based. This will require you to:
o obtain quotes and pricing for all resources associated with these possible systems, including costs for both systems into your report
o provide comments onboth the positives and negatives of both systems
o Analyse all prices associated with purchasing the system, any relevant licensing agreements, and customer support or training offered by suppliers
o Make a recommendation about which system you think should beimplementedand why you believe this system is the right alternative system for Clippers

• You are to present your findings in the form of a written report, your report must be presented professionally using a report format and covering all of the points listed above

Throughout this task, your assessor will role-play the owner of Clippers. You may contact your assessor to ask further questions throughout this process. Remember to be prepared for any discussions with your manager. Know what you want to find out, and what you want to ask.

This assessment is due for submission on: ___________________________________

ASSESSMENT 1– ASSESSOR CHECKLIST

This checklist is to be used when assessing the students in this task. This checklist is to be completed for each student. Please refer to separate mapping document for specific details relating to alignment of this task to the unit requirements.

Please complete below
Student Name:
Student ID No:
In undertaking this assessment, did the student undertake the following: Satisfactory Comments
Review Component
Student consulted owner and asked about the budget for the new system ? Yes? No
Student identified and documented the names of the relevant people they consulted in relation to their needs of the new system
(Student must identify all six staff member) ? Jeff Smith
? Dean Dew
? Tim Flynn
? Jim Jones
? Sarah Long
? Chris Gln
Student consulted staff and identified six questions they would ask staff abouttheir requirements from the new system ? Yes? No
Student identified two alternate quotation systems
(Please tick reasons shared) ? 2 systems are paper based
? 2 systems are electronic
? 1 system is paper based and 1 is electronic
Student researched two possible quotation systems ? Yes? No
Student consulted suppliers and external service providers regarding the two systems ? Yes? No
Student identified customer support or training offered by suppliers ? Yes? No? N/A
Student identified the costings associated with implementing both systems ? Yes? No
Student gathered and organised information they had researched ready to analyse, interpret and disseminate ? Yes? No
Student analysed the research information obtained for relevance ? Yes? No
Student identified any licensing agreements associated with both systems ? Yes? No? N/A
Student identified the positive elements of both systems researched ? Yes? No
Student identified the drawbacks of both systems researched ? Yes? No
Student documented any organisational policies or procedure relating to reviewing the quotation system (if applicable) ? Yes? No
Student attached costing or quotes from suppliers (if applicable) ? Yes? No
Student selected one system they believe is best suited to the needs of the organisation ? Yes? No
Student identified the reasons why this system is the right one for the organisation
(Please tick reasons shared) ? Cost effective
? Easy to implement
? Limited resources required to implement
? Minimal training required
? Suits the needs of theorganisation
? Industry specific, is currently used in the gardening industry
? Has the capacity to growwith the organisation
? Is easy to review and make modifications too after implementation
? Components of thesystem can be used forother purposes
? Fits into the work practisesof the staff
? Can be easily adapted to the work environment
? Comes with support ortraining from suppliers
? System can be fixed internally, doesn’t require external consultants or technicians
? Other _______________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________

Student presented the report in a manner that:
o Used an appropriate presentation method ? Yes? No
o Used a professional report format ? Yes? No
o Used clear and concise language ? Yes? No
o Was easy to read ? Yes? No
o Was logical and sequenced ? Yes? No
o Identified the purpose of the report ? Yes? No
o Provided information and detail about the review process ? Yes? No
Report attached ? Yes? No
Comments
Comments
Result: Satisfactory | Not Satisfactory | Not Assessed
Student Declaration: I declare that I have been assessed in this unit, and I have been advised of my result. I also am aware of my appeal rights. Name: ________________________
Signature: ________________________
Date: ____/_____/_____

Assessor: I declare that I have conducted a fair, valid, reliable and flexible assessment with this student, and I have provided appropriate feedback
Name: ________________________
Signature: ________________________
Date: ____/_____/_____

ASSESSMENT 2 – STUDENT INFORMATION
Devise an implementation plan for the new system
This information is to be handed to each student to outline the assessment requirements.

There are three components to this unit – Assessment 1, 2 and 3.
Assessment 2 requires you to devise an implementation plan for implementing the new quotation system at Clippers Gardening Services. After conducting your research and having made recommendations to management about the system you believe should be implemented, they have taken your advice and decided to implement the system you have recommended. They have given you the task to compile an implementation plan for this system.

As part of this implementation plan you will be liaising with staff, identifying the involvement staff will play in implementing the new quotation system, assessing staff training needs, communicating the changes to staff about the newsystem. You will need toidentify the new procedures that need to be followed to make the system effective,highlighting possible problems that maybe encountered with implementation and putting in place a time line of implementation for the new system.

Student Assessment Information:

• Your task is to collate an implementation plan for the newquotation system that has been approved by management. Your report needs to be professionally presented and address all points listed below
Stakeholders
o identify stakeholders regarding implementation and identify costs associated with implementation

o explain methods used to consult stakeholders and explain why consultation is important

o outline timeframes associated with implementing this system

o detail staff involvement and staff support given during the process of change, identify the benefits of involving staff in process

Training and Communication
o identify training requirements factoring inwho needs to be involved in the training and the different training needs of staff

o detailhow and when training would be conducted, factoring in suitable times to train staff and implement the system

o document the new procedures associated with the system, detailing step by step each component of the new system and staff members responsibilities

o write a procedure for staff members on how to use the new system, clearly identifying their responsibility

o detail two strategies that could be used to communicate system changes to staff

Information
o detail how information will be transferredbetween the current administrative system and the newsystem

o identify the people involved in the planning and their roles in the system changeover

Timeframes
o detail when and how implementation willtake place, who will direct this process’

o create a timeline of events leading up to implementation including steps that need to be taken prior to implementation

Risks and Policies
o conduct a risk assessment of the possible issues that maybe encountered with implementing this system and detail waysof dealing with these issues

o identify any organisational or legislative policies may need to be considered when implementing this new system? (i.e. privacy laws, occupational health and safety, organisational policies)

• You are to present your findings in the form of a written report, your report must be presented professionally using a report format and covering all of the points listed above
Throughout this task, your assessor will role-play the owner and stakeholders of Clippers. You may contact your assessor to ask further questions throughout this process. Remember to be prepared for any discussions with your manager. Know what you want to find out, and what you want to ask.
This assessment is to be assessed on: _________________________

ASSESSMENT 2– ASSESSOR CHECKLIST

This checklist is to be used when assessing the students in this task. This checklist is to be completed for each student. Please refer to separate mapping document for specific details relating to alignment of this task to the unit requirements.

Please complete below
Student Name:
Student ID No:
In undertaking this assessment, did the student undertake the following: Satisfactory Comments
Implementation planning
Student consulted owner and asked about the budget for implementing the new system
? Yes? No

Student identified the stakeholders involved in the implementation phase
(Please tick identified people) ? Jeff Smith
? Dean Dew
? Tim Flynn
?Jim Jones
? Sarah Long
?Chris Gln
?Jim Jones
? Office suppliers
?Consultants
?Computer/software
suppliers
? Equipment suppliers
?Clients
?External consultants
? IT trainers
?IT technicians
?Trainers
?Tradesman
? Other _____________
____________________
____________________
________________________________________
___________________

Student consulted with stakeholders and gathered their feedback regarding implementing the new system
? Yes? No

Student identified the importance and benefits of consultation with stakeholders
(Please tick reasons shared) ?Boost staff confidence
?Team goal setting
?Organisational culture
?Boost staff confidence
? Consultative process makes staff feel part of change
?Consultative process assists staff in accepting change
?Identify training needs
? Redistribution of workload
? Informs people
?Identify potential issues
?Identify staffing needs
? Organisational culture
? Ensure system functions correctly
? Other _____________
Student identified any organisational or legislative policies that may need to be factored into the implementation plan
(Please tick reasons shared) ? Occupational health and safety laws
? Privacy laws
? Copyright laws
? Anti-discrimination legislation
? Ethical principles
?Codes of practise
?Organisational policies relating to the tasks
? Other _____________
Student identifiedtwo appropriate communication strategies to inform staff of system implementation
(Please tick reasons shared) ?Email
? Fax messages
? Internal newsletters
?Meetings
? Office memo
? Photocopied instructions
? Training sessions
? Team building tasks
? Other _____________
Student identified the different training needs for different staff. ? Yes? No
Student identified staff training needs in relation to system implementation by detailing types of training that maybe suitable
(Please tick reasons shared) ? On the job training
? Coaching/mentoring or a buddy system
? Professional development
? Skills assessment
? Training handbooks
? Videos/DVD’s
? Other _____________
Student outlined who will facilitatethe new system training ? Yes? No
Student outlined whoneeds to be trained ? Yes? No
Student outlined whowill conduct the training ? Yes? No
Student outlined where the training will take place ? Yes? No
Student identified the resources needed when implementing the training ? Yes? No
Student wrote a step by step procedure for how to use the new system and identified the responsibilities for each of the following people
• Owner ? Yes ? No
• Management ? Yes ? No
• Office staff ? Yes ? No
• Gardeners ? Yes ? No
Timeline of implementation
Students’ timeline for implementing the new systems identified and understanding of the following areas.
• Pre implementation planning of tasks to be completed prior to implementation ? Yes? No
• Pre implementation consultation regarding the new systemand old system prior to implementation ? Yes? No
• Pre implementation prioritising of system components, external service or product providers, training and workloads ? Yes? No
• Organisation; planning the process of implementation ? Yes? No
• Organisation; organising staff in relation to implementation and changeover to new system ? Yes? No
• Organisation; prioritising staff workloads, tasks, training and communication for implementation ? Yes? No
Student created a risk assessment and identified at least two possible problems associated with implementation
(Please tick reasons shared) ? Yes? No
• Staff illness ? Yes? No? N/A
• External service or product providers being unreliable ? Yes? No? N/A
• Cancellation of training due to unforeseen circumstances ? Yes? No? N/A
• Increases in workloads due to growth of business ? Yes? No? N/A
• Staff issues; lack of acceptance or understanding of the new system ? Yes? No? N/A
• Staff lack of confidence ? Yes? No? N/A
• Incorrect resources ? Yes? No? N/A
• Staff lack of understanding of the process of implementation ? Yes? No? N/A
Student identified strategies to overcome problems, and approaches that can be taken
(Please tick reasons shared) ? Coaching/mentoring or buddy system
? Reviewing the system and modifying it
? Seeking feedback from system users
? Reducing workload
?Retraining
?Other ____________

Student presented the report in a manner that:
o Used an appropriate presentation method ? Yes? No
o Used a professional report format ? Yes? No
o Used clear and concise language ? Yes? No
o Was easy to read ? Yes? No
o Was logical and sequenced ? Yes? No
o Identified the purpose of the report ? Yes? No
o Provided information and detail about the review process ? Yes? No
Report attached ? Yes ? No

ASSESSMENT 3 – STUDENT INFORMATION
Provide feedback onmonitoring the new system
This information is to be handed to each student to outline the assessment requirements.

There are three components to this unit – Assessment 1, 2 and 3.
Assessment 3 requires you to monitor the new quotation system that was implemented at ‘Clippers Gardening Services’. Management have come back to you a month after the new system was implemented with some issues. You are required to review these issues and provide recommendations and suggestions on how to improve these areas as well as addressing the additional assessment information below.

The issues are:
• Two gardeners Tim and Jim are not using the new quotation system. They are reverting back to the old system using a carbon book.
• The office manager Dean has informed you that the owner Jeff feels the old system was better
even though he hasn’t actually used the new system. Jeff trained in the new system a month ago
• A number of pricing errors have been made by Sarah and Chris when using the new system
• Two new staff Sam and Jane have joined Clippers since training took place a month ago

Student Assessment Information:

First you are to provideappropriate strategies that will assist management to monitor the system and address the following points.

o identify some strategies management could employ to monitor the use of this new system

o determine some methods management could use to identify problems with the system

o describe how management could ensure the system is being used properly and to its full potential

o highlight methods that could be used to ensure that information collection via this system is secure and identify potential security risks

o detail how Clippers can ensure new staff are trained properly on the system

o identify how new staff members should be trained in the new system

o identify methods of assessing if the system meets the needs of the organisation into the future

o recommend communication methods to inform staff of system changes

o identify methods of identifying ongoing training needs

Secondly you are to provide recommendations to management regarding the issues they identified.

o provide suggestionsabout understanding the issues Tim and Jim have with using the new system, and possible reasons why they may not want to use the new system

o provide recommendations about overcoming Jeff’s attitude towards the system and outlining recommendations on how Jeff could be assisted to adopt the new system

o identify strategies that could be used to modify the new system, decreasing the pricing errors being made by Sarah and Chris

o explain your thoughts about how should management proceed after implementing the changes you recommended
The new organisation chart incorporating the two new staff member is below

• You are to present your findings in the form of a written report. You must then present your report to management (your assessor), ensuring you cover all points listed above

Throughout this task, your assessor will role-play the owner of Clippers. You may contact your assessor to ask further questions throughout this process. Remember to be prepared for any discussions with your manager. Know what you want to find out, and what you want to ask.

Organisational Chart
Clippers Gardening Services

This assessment is to be assessed on: _________________________

ASSESSMENT 3 – ASSESSOR CHECKLIST

This checklist is to be used when assessing the students in this task. This checklist is to be completed for each student. Please refer to separate mapping document for specific details relating to alignment of this task to the unit requirements.

Please complete below
Student Name:
Student ID No:

In undertaking this assessment, did the student undertake the following: Satisfactory Comments
Monitoring recommendations
Student identified ways of monitoring the new administrative system
(Please tick reasons shared) ?Employing extra staff to support the new system and to monitor it’s usage,
?Employing existing staff to monitor usage
?Asking for feedback from internal clients
?Asking for feedback from external clients
? Conducting a reviewing on the system
?SWOT analysis identifying areas for improvement
? Other _____________
Student identified methods of identifying system problems
(Please tick identified people) ? Audits
? Checking accuracy of system information
? Assessing each component of the system
?Assessing staff knowledge of system
? Asking for feedback from external clients
?Asking for feedback from internal clients
?Employing an external trainer to conduct skills analysis
? Analyse errors or inconsistencies and identify if it relates to the system
? Other _____________
____________________
Student assessed the systems capabilities to see if it’s used to its full capacity ? Yes? No
Student assessed the systems capabilities to see if it will meet the future growth of the organisation ? Yes? No
Student identified possible security issues relating to the system and provided suggestions
(Please tick reasons shared) ?Passwords and codes are used to access information
?Information kept under lock and key
?Limiting access to the certain information in the system
?Staff are trained in privacy and confidentiality laws
? Staff are trained in the organisations policies and procedures
? Anti-virus software is updated
?Sensitive information is shredded
? Other _____________
Student identified methods of training new staff
(Please tick reasons shared) ? Induction
? On the job training
? External training
? Employing external trainers
? Mentoring
? Coaching/buddy system
?Providing staff with opportunities to practise new skills
? Professional development courses
? Other _____________
Student identified methods of ensuring the system continues to meet the needs of the users of the system
(Please tick reasons shared) ?Reviewing the system-SWOT analysis
? Identifying organisational growth patterns
? Reviewing the organisations business plan
?Reviewing feedback from internal clients
? Reviewing feedback from external clients
? Conduct quality surveys of the system
? Other _____________
Student provided recommendations on how the system can be further modified to improve performance ? Yes? No
Studentidentified communication strategies to inform internal and external clients of system changes
(Please tick reasons shared)
? One on one meetings
? Group meetings
? Training sessions
? Memos
? Faxes
? Emails
? Other _____________
Student identified methods of monitoring staff training needs
(Please tick reasons shared) ? Skills assessment
? Coaching/mentoring or a buddy system
? Professional development
? Performance review
? Reviewing
? Videos
? Other _____________
Responding to issues
Student described possible reasons for Jim and Tim not using the new system
(Please tick reasons shared) ? Lack of understanding
?Lack of confidence
? Lack of practise using the system
?Forgotten how to use the system
? Inability to adapt to change
? Didn’t feel part of the change process
? Other _____________
Student provided suggestions of how to assist Jim and Tim to use the new system
(Please tick reasons shared) ? Seeking feedback
? Providing support
? Retraining
? Mentoring
? Other _____________
Student described possible reasons for Jeff not embracing the new system
(Please tick reasons shared) ? Lack of understanding
?Lack of confidence
? Lack of practise using the system
?Forgotten how to use the system
? Inability to adapt to change
? Other _____________
Student provided recommendations on how Dean could assist Jeff to use the system
(Please tick reasons shared) ? One on one training
?Providing information on the success of the new system
? Demonstrating the positives of the new system
?Offering assistance in using the new system
? Sharing positive feedback about the system
? Other ____________
Student provided recommendations for training new employees ? Yes ? No
Student described how management should move forward after this monitoring process ? Yes ? No

Student presented the report in a manner that:
o Used an appropriate presentation method ? Yes? No
o Used a professional report format ? Yes? No
o Used clear and concise language ? Yes? No
o Was easy to read ? Yes? No
o Was logical and sequenced ? Yes? No
o Identified the purpose of the report ? Yes? No
o Provided information and detail about the review process ? Yes? No
Report attached ? Yes ? No
Whilst presenting the report, did the student
o communicated clearly ? Yes? No
o Use clear and concise language ? Yes? No
o provide accurate information ? Yes? No
o answer questions appropriately ? Yes? No

Refer to the instructions below regarding completing this assessment
Written Assessment Project
This is a closed book written assessment. In the time allocated, you are to answer all of the following questions. Make sure you:
• Print Clearly
• Answer all questions
• Use a pen. Assessments written in pencil will not be accepted.
• Ask your assessor if you do not understand a question. Whist your assessor cannot tell you the answer, he/she may be able to re-word the question for you
• Do not talk to your classmates. If you are caught talking, you will be asked to leave and your assessment will not be marked.
• Do not cheat or plagiarise the work of others. Anyone caught cheating will automatically be marked Not Yet Competent for this unit. There are NO EXCEPTIONS to this rule. You are to research and answer all of the following questions. Be sure to:
• Print Clearly
• Answer all questions
• Use a pen. Assessments written in pencil will not be accepted.
• Ask your assessor if you do not understand a question. Whist your assessor cannot tell you the answer, he/she may be able to re-word the question for you
• Return your assessment by the date set by your assessor
• Do not cheat or plagiarise the work of others. Anyone caught cheating will automatically be marked Not Yet Competent for this unit. There are NO EXCEPTIONS to this rule.

Questions
1 What are the National Privacy Principles?

2 List 3 points you should follow to ensure you comply with the National Privacy Principles.

3 In terms of privacy what is considered “Personal information”?

4 What is the state legislation that refers to privacy?

5 Outline the OH&S Hierarchy of Control, explaining how it effects OH&S / WHS

6 Provide a detailed explanation of 4 different anti-discrimination based legislation and requirements.

7 What are the roles and responsibilities of employers relating to OH&S / WHS?

5 Describe how copyright protects plagiarism in Australia

9 What effect doe ethics have on your work role?

10 What is a code of practice?
Student Declaration: I declare that the work submitted is my own, and has not been copied or plagiarised from any person or source. Name: ________________________
Signature: ________________________
Date: ____/_____/_____

ASSESSOR USE ONLY
Comments
Assessment Method: WRITTEN / PROJECT
Result
(Please Circle) Satisfactory Not Satisfactory Incomplete
Assessor: I declare that I have conducted a fair, valid, reliable and flexible assessment with this student, and I have provided appropriate feedback Name: ________________________
Signature: ________________________
Date: ____/_____/_____

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