ࡱ> (*%&' @ @bjbj)) ,DKzKz)bbbbb^VVV8WWl^u:[b](]]]^`attttttt$vRx2t c^^ c ctbb]]Yufff c4bR]]tf ctff"f].[ pNV>c4fg ou0ufzrc zf4@bbbbzf<Sbgbfub bSbSbSbtt^^4:|f^^: This contract form has been approved by the South Carolina Department of Consumer Affairs as prescribed by law. No other contract form may be used in writing non-guaranteed price preneed funeral contracts. The preneed funeral statutes are regulated by South Carolina Department of Consumer Affairs, 3600 Forest Drive, 3rd Floor, P.O. Box 5757, Columbia, S.C. 292505757 (803)7344236.NONGUARANTEED PRICE PRENEED CONTRACTThe Provider and the undersigned purchaser agree as follows: Provider: FORMTEXT      Preneed License No.: FORMTEXT      Address: FORMTEXT      Funeral Home License No.: FORMTEXT      Purchaser: FORMTEXT      SSN: FORMTEXT      Address: FORMTEXT      FUNERAL SERVICES AND MERCHANDISE Provider, its successors and assigns, agrees to conduct a funeral and burial (or cremation) and furnish the services, merchandise and facilities described for:(Beneficiary) FORMTEXT      SSN FORMTEXT      (Full Address) FORMTEXT      The services and merchandise will be as follows: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      FINANCIAL AGREEMENTThe purchase price of the services and merchandise is $ FORMTEXT      as of the date of this contract (plus a $ FORMTEXT      filing fee, payable to the South Carolina Department of Consumer Affairs). Purchaser will pay the purchase price to Provider: FORMCHECKBOX By paying the total price in cash, receipt of which is acknowledged;  FORMCHECKBOX Other (Explain below);  FORMCHECKBOX By paying$ FORMTEXT      (Receipt of which is acknowledged) this date of this contract, and further installments asfollows: FORMTEXT       FORMCHECKBOX By writing his or her initials, Purchaser acknowledges that this contract will be funded by a trust deposit in a federally insured financial institution with account number. FORMCHECKBOX By writing his or her initials, Purchaser acknowledges that his or her contract will be funded by insurance policy number  FORMTEXT      in face amount of $ FORMTEXT      with FORMTEXT      Insurance Company.NATURE OF AGREEMENT FORMCHECKBOX By writing his or her initials, Purchaser chooses to make this contract revocable. That is, Purchaser has the right to revoke it. FORMCHECKBOX By writing his or her initials, Purchaser chooses to make this contract irrevocable. That is, Purchaser does not have the right to revoke it.The parties have caused this contract (which includes the provisions of all three (3) pages) to be executed this  FORMTEXT      day of  FORMTEXT      20 FORMTEXT   IF THE PURCHASER HAS CHOSEN TO MAKE THIS CONTRACT IRREVOCABLE, HE OR SHE HAS 30 DAYS TO CONSIDER THIS DECISION AND REVERSE IT THEREBY MAKING THE CONTRACT REVOCABLE.IF THIS CONTRACT IS FUNDED BY INSURANCEThe Provider may declare this contract void and terminated if the life insurance to provide funding of the purchase price is not in force; has not been voided. lapsed, borrowed against, or surrendered; any payments are paid out before death; scheduled payments are not made; death benefits are paid under the suicide provision of the policy; a significant change is made to any of the items on the statement of funeral goods and services; or the Provider is no longer designated to receive the death benefit of the insurance. The Provider must be designated to receive the death benefit of the insurance.USE OF PURCHASE PRICEProvider will provide the services and merchandise described above at Providers rates at the time they are provided. The trust fund and its income, or the death benefit of the insurance policy, will be credited against the cost of services and merchandise. Any excess funds will be paid to the estate of the beneficiary or in accordance with the terms of the insurance policy. Any shortfall in funds will be paid by the estate or next of kin of the beneficiary.IF THIS CONTRACT IS TRUST FUNDEDProvider (Funeral Home) will deposit all funds required for services and merchandise in a Federally insured account in a financial institution licensed to do business in S.C. chosen by Provider. Purchaser names Provider Trustee of trust fund.TERMS OF TRUSTExcept for withdrawals to pay administrative fees or applicable taxes on the trust fund, payments to the Provider for trust administration, and Purchasers right, if any, to revoke, the deposits in trust and all income on the trust fund will remain in trust until the death of Beneficiary and until Provider furnishes the services and merchandise. The Financial Institution will pay the trust fund to Provider when Provider gives it a certified statement that this contract has been fully performed and a certified copy of the death certificate. (See also Use of Other Facility) Ten percent of the annual earnings may be paid to the Provider for trust administration.REVOCATIONIf this contract is revocable, in order for the Purchaser to revoke it he must deliver to the Provider/Trustee a written demand for refund before Provider furnishes any services or merchandise hereunder. Within Thirty (30) days of receipt of such a demand from the purchaser the trustee or Provider will notify the financial institution of the demand and authorize the financial institution to refund the trust fund and all its income (less any amount due to pay taxes, or trust administration).Except for withdrawals to pay applicable taxes and trust administration fees, any withdrawal from the trust fund before the furnishing of the services and merchandise, will terminate this contract, and Provider and financial institution will be relieved from further liability. Revocation of this contract does not cancel the life insurance, which may only be terminated in accordance with the terms and conditions of the life insurance policy.USE OF OTHER FACILITYIf a facility other than Provider provides the services and merchandise for Beneficiary, the other Providers charges will be paid upon submission to the Provider/Trustee of a certified copy of the death certificate and a certified copy of the charges. The charges will be paid from the trust fund, including its income, or the insurance proceeds.BENEFICIARYS DEATH BEFORE PAYMENT COMPLETEIf Beneficiary dies before the purchase price has been paid in full, at the option of the Beneficiarys representative, the trust fund and its income will be credited against services and merchandise purchased.PURCHASERS DEATH BEFORE BENEFICIARYS DEATHIf Purchaser and Beneficiary is not the same person, Purchasers death before Beneficiarys death will terminate any interest of Purchaser in the trust fund and will give no right to Purchasers representatives or heirs to withdraw it.REMAINING FUNDSIf after Beneficiarys death any balance remains in the trust fund after Provider provides the services and merchandise, or after the termination of this contract under Revocation, or because of a failure of Provider to provide the services and merchandise, or alter the other facilitys charges are paid under Use of Other Facility, or because no credit against services and merchandise is made under Beneficiary s Death before Payment Complete, the balance, including income, will be paid to Beneficiarys estate.TAXESAll taxes on the trust fund will be paid in accordance with the Internal Revenue Code and applicable rules and regulations.RIGHTS RESERVEDIf a labor dispute, strike, government action, fire, war, epidemic, other disaster, changes in products or other causes beyond its control prevent or delay Provider from providing the services, facilities or merchandise, Provider may make reasonable substitutions of comparable services, facilities or merchandise, and it will not be liable for inconvenience delay, emotional upset, pain and suffering loss or damage experienced by Purchaser or Beneficiary, their estate, families, legatees, heirs or legal representatives. If merchandise selected is not available the Provider will make available to the Purchaser or his representative merchandise of equal or greater value. 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This contract will be construed according to Chapter 7 of Title 32, Code of Laws of South Carolina and other applicable provisions of South Carolina Law.EXCLUSION OF WARRANTIESThere are no warranties of merchantability or fitness for a particular purpose extended by Provider. The only warranties, expressed or implied, which are granted in connection with the services and merchandise sold under this contract, are the expressed written warranties, if any, extended by the manufacturers of the merchandise sold, and no warranties are expressed or implied by Provider.TRANSFER OF CONTRACTThis contract may be transferred to another Provider at the written request of the Purchaser or Beneficiary, if the Purchaser dies before the Beneficiary the selling provider must be paid a fee equal to 10% of the contract face amount. The selling Provider also must be paid 10% of the earnings in that portion of the final year before transfer. Within 30 days of receipt of a written request for transfer the selling Provider will transfer to the new Provider all of the funds in trust with all earnings less the fees indicated above in this paragraph. If this contract is funded by insurance, the selling Provider is not entitled to be paid a transfer fee.PURCHASERThe Purchaser is the person whose funds are placed into trust or who purchases an insurance policy to fund this contract. The Purchasers tax identification number (Social Security Number) must appear on the contract.DISCLOSUREBy completing this form, you acknowledge that you were given a current General price list and shown current Casket and Outer Burial Container lists prior to discussing those prices, services or merchandise.Purchaser SignatureDate FORMTEXT      Seller SignatureF.D. License No. FORMTEXT       FORMTEXT      Print NameInsurance License/Agent No. FORMTEXT      Address of Seller  Non-Guaranteed Price Preneed Contract Rev. 09/22/06 Page  PAGE 1 of   *VU[*V1$ 5hp@ P !$`'0*$Ifa$gd lTBkdQ$$Ifl*_+ t_+644 la. 5hp@ P !$`'0*$Ifgd:OlT*VGU*VBkdR$$Ifl*_+ t_+644 la1$ 5hp@ P !$`'0*$Ifa$gd-lTBkdRR$$Ifl*_+ t_+644 laU*VGUBkdS$$Ifl*_+ t_+644 la1$ 5hp@ P !$`'0*$Ifa$gd-lTBkdRS$$Ifl*_+ t_+644 laMNO*V[*V1$ 5hp@ P !$`'0*$Ifa$gd-lTBkdRT$$Ifl*_+ t_+644 la. 5hp@ P !$`'0*$Ifgd:OlTOPefgU*VGU*VBkdRU$$Ifl*_+ t_+644 la1$ 5hp@ P !$`'0*$Ifa$gd-lTBkdT$$Ifl*_+ t_+644 laghU*VJk BkdRV$$Ifl*_+ t_+644 la. 5hp@ P !$`'0*$Ifgd:OlTBkdU$$Ifl*_+ t_+644 la   *VU*VGU*VBkdRW$$Ifl*_+ t_+644 laBkdV$$Ifl*_+ t_+644 la1$ 5hp@ P !$`'0*$Ifa$gd-lT U*VJBkdRX$$Ifl*_+ t_+644 la. 5hp@ P !$`'0*$Ifgd:OlTBkdW$$Ifl*_+ t_+644 la "$  24VXZڄn*jhgCJOJQJUaJmHnHu+jr]hhgCJOJQJUaJjhgCJOJQJUaJhA5hgCJ OJQJaJ hA5hgCJOJQJaJ"h>hg5CJOJQJ\aJhgCJOJQJaJh>hgCJOJQJaJh>hgCJaJ+*VU*VGU*VBkdRY$$Ifl*_+ t_+644 laBkdX$$Ifl*_+ t_+644 la1$ 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