MEMORANDUM OF ASSIGNMENT (REASSIGNMENT REQUEST)

Transcription

1 (REASSIGNMENT REQUEST) To whom it may concern: RE: Member Name:... Membership No:... Funeral Policy No:... I would like to request the following changes to my policy shown above Reassign my policy from...(funeral Director) to...(funeral Director s Name & Address) Unassign my policy from...(funeral Director) to myself (PRINT name of the member/s) Please note change of address and contact number (if applicable) Member Signature & Date Joint Member Signature & Date PRINT Name of Member/s... FFS MOA1/03/17 *Please forward the Original Membership Certificate along with these documents for the endorsement of Reassignment.

2 (FUNERAL DIRECTOR TO FUNERAL DIRECTOR) Please us CAPITAL letters. Two forms must be completed for Policy Assignment. Pursuant to the Life Insurance Act 1995 Member Name:..... Member No:... Funeral Policy No:... Reassignment Ref No:..... Date Commenced:..... Originally Assigned to... (Assignor ) (Name or Original Funeral Firm) Address of Assignor:... Postcode... I/We..... (Funeral Director/Assignor) subject to the provisos herein HEREBY ASSIGN all my/our rights, title and interest in respect of the Ancient Order of Foresters in Victoria Friendly Society Limited ( Foresters ) Funeral Policy details above TO the Funeral Director, who signs hereunder as Assignee Funeral Director. CONDITION OF ASSIGNMENT This assignment is conditional upon payment, of an agreed administration fee of $... or... % (insert amount) of the policy value at time of claim, by the Assignee Funeral Director to the Assignor Funeral Director. Name of Assignee Funeral Director... Address:... Postcode... Name of Authorised Person of Assignee Funeral Director:... Signature of Authorised Person of Assignee Funeral Director:... Signature of Witness..... Name of Authorised Person of Assignor Funeral Director:... Signature of Authorised Person of Assignor Funeral Director:..... Signature of Witness..... FFS MOA2/03/17

3 (FUNERAL DIRECTOR TO FUNERAL DIRECTOR) NOTES 1. The Assignee Funeral Director can only be a natural person or company. 2. The Assignor Funeral Director can only be a natural person or company. 3. This assignment transfers complete ownership of the Funeral Policy to the Assignee Funeral Director subject to any conditions stated above. 4. Where this assignment is made pursuant to, or as a result of any contract, trust or any other type of arrangement between the Assignor Funeral Director and the Assignee Funeral Director in respect of a fixed price funeral contract or other similar arrangement, Foresters does not accept any liability or responsibility to ensure that such contract, trust or other obligations are met in part or in full. 5. This assignment is not valid until registered by Foresters. 6. The Assignor must forward two copied of this assignment to the Foresters and after registration shall be returned to the Assignee Funeral Director. OFFICE USE ONLY Date of Assignment Registration: Assignment Register No:... Signature of Authorised Officer of Ancient Order of Foresters in Victoria Friendly Society Limited (ABN ): FFS MOA3/03/17...

4 (AGREEMENT TO RE-ASSIGN FUNERAL POLICY) LETTER FROM ASSIGNOR FUNERAL DIRECTOR ADMINISTRATION MANAGER Dear Administration Manager RE: Agreement to Re-Assign Funeral Policy Member Name:... Member No:... Funeral Fund Policy Number:... Reassignment Ref No:... Name of current Assigned Funeral Firm ( Assignor ):... Name of Proposed Assignee Funeral Firm ( Assignee ):... We acknowledge that we, the above Assignor Funeral Firm are the current owners of the above funeral fund policy that was assigned to our firm by the Member named above. As per the attached Memorandum of Assignment Form we have agreed, subject to the terms and conditions stipulated therein to re-assign this policy to the Assignee Funeral Firm name above. * We also acknowledge that the individuals who have signed both this letter and the attached form are authorised by the Assignor to undertake such action.... (Signature of Authorised Representative)... (Print name and position of Authorised Representative) FFS MOA4/03/17 *This document should be executed under company seal or identifying company stamp.

5 (AGREEMENT TO ACCEPT REASSIGNMENT OF FUNERAL POLICY) LETTER FROM ASSIGNEE FUNERAL DIRECTOR ADMINISTRATION MANAGER Dear Administration Manager RE: Agreement to accept reassignment of Funeral Policy Member Name:... Member No:... Funeral Fund Policy Number:... Reassignment Ref No:... Current Policy Balance:... Name of current Assigned Funeral Firm ( Assignor ):... Name of Proposed Assignee Funeral Firm ( Assignee ):... We acknowledge that we, the above Assignee Funeral Firm agree subject to the terms and conditions stipulated in the attached Memorandum of Assignment form, to accept the re-assignment of above funeral fund policy from the Assignor Funeral firm named above under the Terms and Conditions of the Executed Contract between Mr/Mrs... and..., the Funeral Director. * We also acknowledge that the individuals who have signed both this letter and the attached form are authorised by the Assignee to undertake such action.... (Signature of Authorised Representative)... (Print name and position of Authorised Representative) FFS MOA5/03/17 *This document should be executed under company seal or identifying company stamp.