Irrevocable Assignment And Power Of Attorney

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IRREVOCABLE ASSIGNMENT AND POWER OF ATTORNEY

Insurance Company

Policy Number (s)

Deceased / Insured

Beneficiary(s) Name

Address, City, State, Zip

Date of Birth

Social Security #

Phone #

Email

Funeral Home and /or Cemetery

Total Amount Assigned

$

This Irrevocable Assignment is made between Beneficiary above and the Funeral Home/Cemetery above. In consideration for the Funeral Home/Cemetery providing services

in the burial of the above Insured, said services having requested and accepted by Beneficiary and/or additional funds have been advanced and paid to the Funeral Home/Cemetery

and/or the Beneficiary by Funeral Funding Center (FFC). The undersigned irrevocably assigns to the Funeral Home/Cemetery, the above Assignment Amount, plus statutory

interest from deceased’s date of death until claim paid plus any unearned premiums. Beneficiary hereby guarantees the validity and sufficiency of the foregoing irrevocable

assignment to the Funeral Home /Cemetery and FFC, and Beneficiary further guarantees to warrant title to the policy(s) and defend FFC against any claims on the policy(s).

Beneficiary hereby irrevocably authorizes said Insurance Company to make payment of the sum specified above, plus statutory interest and unearned premiums to Funeral Funding

Center. Beneficiary hereby irrevocably authorizes said Insurance Company to give Funeral Home/Cemetery or FFC any information that it may require regarding said

policy(s). Beneficiary hereby appoints FFC as their Attorney-in-fact and to act on their behalf with regard to the collection of, settlement of, and receipt of proceeds of

said policy(s) or certificate(s), including but not limited to, giving FFC the right to endorse checks and claimant statement forms in my name. If, for any reason, FFC does

not receive full payment within 90 days I agree to immediately pay FFC the amount of its loss on the assignment. If for any reason it becomes necessary for FFC to proceed

against me, I understand that I am liable for all costs of collections, including but not limited to, reasonable attorney’s fees, and court costs. I agree that the exclusive jurisdiction

for legal proceedings hereunder is Salt Lake County, Utah. In the event the policy(s) is not enclosed, I certify that the policy(s) has been lost or destroyed.

__________________________________________ ____________________ __________________________________________ ____________________

st

nd

1

Beneficiary’s Signature

Relationship to Deceased

2

Beneficiary’s Signature

Relationship to Deceased

__________________________________________ ____________________ __________________________________________ ____________________

rd

th

3

Beneficiary’s Signature

Relationship to Deceased 4

Beneficiary’s Signature

Relationship to Deceased

The foregoing Assignment was executed by _____________________________________________________, who is personally known to me or who has produced identification.

BENEFICIARY’S NAME

_________________________________________________ ___________________ ____________________________________________

NOTARY PUBLIC SIGNATURE

DATE

NOTARY STAMP OR SEAL

IRREVOCABLE REASSIGNMENT AND POWER OF ATTORNEY

To: Funeral Funding Center · P. 954.874.2474 F. 954.874.2475

Mail Payments to: P.O. Box 57250 · Salt Lake City, UT 84157-0250

All Other Correspondence: P.O. Box 841009 · Pembroke Pines, FL 33084

The undersigned representative and funeral home or cemetery (collectively “the Funeral Home”) irrevocably reassigns to Funeral Funding Center, PO Box 841009, Pembroke

Pines, FL 33084 or assigns, all of its interest in the above Assignment and further appoints FFC to act as its Attorney-in-fact with regard to the collection of, settlement of, and

receipt of the proceeds as said policy(s) or certificate(s) noted above, including but not limited to, the right to endorse checks. Any payment made by FFC to the Funeral Home

pursuant to this Assignment agreement is without recourse, except where the assignment or funding was procured by fraud on the part of the Funeral Home. The Funeral Home

hereby authorizes the above Insurance Company to issue a check(s) directly to Funeral Funding Center. In the event that any payments of proceeds are made by the Insurance

Company, its agent or the beneficiary (ies) to the Funeral Home, the Funeral Home agrees to hold the proceeds in trust and to immediately pay the proceeds to FFC within 10 days,

without necessity of any request to so pay the funds. The Funeral Home further agrees that upon request by either FFC or the Insurance Company it will promptly provide all

documents, material or information identified and needed to process a claim on the decedent’s policy. Funeral Home shall be liable to FFC for any attorney’s fees and costs FFC

incurs in having to enforce any of the terms of this assignment. The undersigned agrees that the exclusive jurisdiction and venue for legal proceedings hereunder is in Salt Lake

County, Utah.

____________________________________________________________

_________________________________________________________________________

Signature of Funeral Home/Cemetery Authorized Representative

Name of Funeral Home / Cemetery

The foregoing Reassignment was executed by____________________________________________________, who is personally known to me or who has produced identification.

FUNERAL HOME/CEMETERY AUTHORIZED REPRESENTATIVE

______________________________________________________________

__________________

__________________________________________________________

NOTARY PUBLIC SIGNATURE

DATE

NOTARY STAMP OR SEAL

IAPOA rev 2/15