SAMPLE OUTLINE ONLYSAMPLE OUTLINE ONLY
PREPAID CONTRACT– FUNDED BY Growth Funeral Plan GFP or Growth Funeral Plan Annuity GFPA™Contract No.
Business Name(“the Provider”) Licence # ______
123 Establishment Address Here, Ontario DOI TRT (Phone)www. businessname.com [optional]
Name: / Name:
(“Purchaser”) / (“Recipient”)
Address: / Address:
Address: / Address:
Telephone: / Birth date:
e-mail: / Birth place:
Relationship to Recipient:
This contractis between the Purchaser and the Provider(“the parties”) concerning funeral services and supplies and is subject to the provisions of the Funeral, Burial and Cremation Services Act, 2002 (“the Act”).
SERVICES / Package Discount (if applicable)
Professional & Staff Services / Itemized Total (* services or supplies)
Co-ordinating activities, rites, ceremonies / Savings on package
Documentation – permits, forms, etc. / Package Price
Transport remains - initial ( _____ km) / Services and supplies not in package
Basic preparation of remains / Total Services and Supplies (A)
Embalming of remains
Facilities for preparation/embalming/shelter / DISBURSEMENTS (Estimate including applicable taxes)
Staff services for visitation / Coroner’s fee
Facilities for visitation / Clergy honorarium
Staff services for ceremony / Organist
Facilities for ceremony / Notice ______(one column, ___ lines)
Transport remains - additional ( _____ km) / Notice ______(one column, ___ lines)
Vehicle ______/ Municipal fee for registration of death
Vehicle ______/ Other:
______
______
SUPPLIES (manufacturer, model, description)
Casket: / Total Disbursements (Tax included) (C)
Urn:
Outer burial container: / Total Services and Supplies (A)
Other Services or Supplies / HST on Services and Supplies (B)
Additional mileage ( _____ km x $ _____ ) / Total Disbursements (Tax included) (C)
Total (A + B + C)
Discount [Optional]
Amount to be Funded by Insurance/Annuity
Payment terms:This contract is to be funded through an insurance/annuitypolicy. The Purchaser has purchased or agrees to purchase an insurance/annuitypolicy whereby the proceeds of the insurance/annuity policy (i.e. death benefit) are to be paid to the Provider. References to the insurance/annuitypolicy are contained in this contract, but the insurance/annuityenrolment application itself contains the terms of payment, cancellation and refund for theinsurance/annuitypolicypurchased.
Additional Terms: The parties agree to the following additional terms:Delivery time and location: The services or supplies contained in this contract will be delivered following the death of the Recipient, in accordance with this contract and as agreed between the Provider and the Recipient’s legal representative.
Details of Insurance/Annuity Policy: The following insurance/annuity policy will be used to fund the cost of the services, supplies, disbursements and taxes set out in this contract.Growth Funeral Plan Annuity (GFPA™)
Guaranteed Funeral Plan (GFP™)
Insurer Name: Assurant Life of Canada Policy # (if known):______
Insurer Address: P.O. Box 93040, 1111 Davis Drive, Newmarket, ON L3Y 8K31-800-663-8680
Administered by Guaranteed Funeral Deposits of Canada (Fraternal) Phone #: 1-800-268-2466
Enrolment Form: A copy of the Enrolment Form or other documents that confirm the purchase of the insurance/annuity Policyand assignment of the proceeds of the Policy to the Provider, are attached to and form part of this contract.
Insurance/annuity Certificate: If an insurance/annuity policy is being purchased at the time this contract is signed, a copy of the insurance/annuity Certificate will be mailed to the purchaser within thirty days of purchase.
Commissions: The Provider and/or ______[name of person(s) to receive the benefit] will receive commissions, consideration or benefit from Assurant Life of Canada as a result of the Purchaser applying for or buying insurance in connection with this contract.
[Business prompt:Commissions and Benefits for Recommendations to Third Party:Tthe Providerand/or ______[name of person to receive the benefit] will receive consideration or benefit from the following third party suppliers for referrals or recommendations:
[Example:[name of person paying the benefit] (up to _____% or up to $____),
[name of person paying the benefit] (up to _____% or up to $____), …]
Fulfilling this contract: At the time the services and supplies are provided, the price of the supplies and services to be provided under this contract will be calculated based on the price list in effect at that time, and the actual disbursements, if included in this contract and prepaid, and applicable taxes will be added.
Subject to the Limited Death Benefit terms below, if the policy is paid in accordance with the terms of the policy, the death benefit payable to the Provider will be applied to the total price of the services, supplies, disbursements and applicable taxes. If the death benefit is less than the total price of the services, supplies, disbursements and applicable taxes, no further payment will be required. Increases to taxes or fees imposed by the Federal, Provincial or Municipal Governments now or in the future may be owing in addition to the payment and income earned, and they are the responsibility of the Purchaser.
Limited Death Benefit: If the death of the Recipient of the contract occurs:
- Anytime within a multi-payment term of a non-insured annuity product, or
- Within the first two years of a Guaranteed Issue policy, where the applicant has answered yes to one or more of the health questions in the enrollment form or has refused to answer one or both questions and the death is non-accidental,
If at the time of the Recipient’s death, the policy has not been paid in accordance with the terms of payment set out in the Enrollment Form, or the policy is being paid out under the suicide provisions, then any death benefit paid to the Provider will be treated as a deposit toward the total price of services, supplies, disbursements and applicable taxes as at the time of death, and any balance owing will be due in ____ day(s) of the date of the final arrangements, after which interest will be charged at the rate of ____% per month until the date of payment in full.
[Business prompt]:Outline any other amounts to be charged for late or deficient payments or eligibility for discounts for prompt payment. Failure to include this information may prevent you from collecting or charging such amounts.]
If the application for insurance/annuity is denied or the insurance/annuity policy is cancelled, rescinded, or has lapsed, or at the time of the recipient’s death the insurance/annuity policy is not paid in full or the Provider is no longer the assignee of the proceeds of the policy or the Provider may no longer assign or designate the beneficiary of the policy, this Contract will be null and void, and any services and supplies to be provided shall be in accordance with the terms of a new “at need” contract to be entered into between the Provider and the recipient’s authorized representative.
Excess Funds: If the proceeds of the insurance/annuity policy are more than the cost of the Services, Supplies, Disbursements and applicable taxes as at the time of death, the excess amount will be paid to the beneficiary identified in the insurance/annuity policy.
Discount:If this contract includes a discount, the discount applies only at the time of prepayment.
Substitution: The Provider will make reasonable efforts to obtain and provide the services and supplies agreed to in this contract. If the Provider is unable to obtain and provide a service or supply, the Provider will provide a refund of the sum of the initial amount paid for the supply or service and any income earned on the amount paid. The Provider will inform the person entitled under this contract to cancel this contract, of the refund. This contract may be cancelled in accordance with the terms of cancellation. If the Provider and the person entitled to cancel this contract agree, the Provider may substitute a supply or service, which will be of comparable quality and value, and similar in style, design and construction to, the supply or service that is unavailable. The substitution will be made at no increase in price.
Cancellation of this Contract: The following individuals may cancel this contract by providing notice of the cancellation in writing to the Provider:
- Before the death of the Recipient, the Purchaser or a person designated in this contract by the Purchaser may cancel this contract at any time.
- Before the death of the Recipient, but after the death of the Purchaser, the Recipient or the Recipient’s personal representative or a person designated in this contract by the Purchaser may cancel this contract at any time.
- After the death of the Recipient, the Recipient’s personal representative may cancel this contract at any time prior to it being fully performed.
If this contract fails to meet the requirements of ss.40(1) of the Act, the maximum refund required will be the amount to be paid out under the terms of the insurance/annuitypolicy, and in some circumstances permitted by the Act, the Provider may retain the value of the services and supplies that have been delivered.
If this Contract is cancelled, the insurance/annuity policy may be assigned to another Provider, or a named beneficiary, under the terms of the insurance/annuity policy; please contact the Insurer for more information about policy reassignment.
Cancellation of the insurance/annuity policy: Cancellation of this Contract does not cancel the Purchaser’s GFPA™ or GFP™ policy, which can only be terminated by the provisions of the policy.
Growth Funeral Plan Annuity (GFPA™): If the policy is terminated after thirty (30) days from the date the policy is issued the Cash Surrender Value (CSV) will be return of premiums paid plus growth without exceeding the face amount plus growth. A T-5 form may be forwarded to the Purchaser as required by the Income Tax Act.
Guaranteed Funeral Plan (GFP™): If the policy is terminated after thirty (30) days from the date the policy is issued the premium on a single pay plan is refunded. For a time pay plan, the Cash Surrender Value is paid as per the provisions of the policy and may be less than the original premiums paid or nothing. A T-5 form may be forwarded to the Purchaser as required by the Income Tax Act.
The purchaser has an existing insurance/annuity policy which provides a death benefit provision for the recipient and which he/she agrees to assign to the Provider as payment in consideration for services and supplies to be provided under this contract. If the policy is terminated the Cash Surrender Value is paid as per the provisions of the policy. Information regarding the CSV must be determined by the policy holder directly with the Underwriter of the Life Insurance Policy. The Provider is not responsible for the CSV provisions of existing policies. Refer to the Acknowledgement of prepayment clause for more information.
[Business prompt:This contract should outline the terms should one or more items be cancelled at the time of need, i.e. a package of services was originally purchased, but now one or more services or supplies are being cancelled. Does this mean the entire contract must be cancelled or may just that one item be cancelled? Describe how the value of the cancelled item will be calculated, i.e. original amount paid, plus prorated growth on that amount.)
[Business prompt: Cancellation – include here any additional cancellation policies you may have at your establishment in addition to FBCSA]
[Business prompt: If a business is going to store supplies, it must include the relevant FBCSA requirements and disclosures in the body of this contract or in an appendix.]
[Business prompt: If a business sells a customized supply, it must include the relevant FBCSA requirements and disclosures in the body of this contract or in an appendix.]
Warranties:The Provider warrants that it will provide the services agreed to in this contract to the best of its abilities. The warranties granted in connection with the supplies provided as part of this contract are the express written warranties, if any, extended by the manufacturer of such supplies, and as required by Ontario consumer protection legislation.
[Business prompt: Include any additional warranties the operator may extend.]
[Business prompt: Additional terms and conditions concerning: Privacy, Warranties, Failure to Pay, any additional business policies or disclosures.]
Purchaser’s Declarations and Acknowledgements:
Initial
____ / Legal authority: The Purchaser declares that he/she is legally authorized to make, or charged with the responsibility for, the arrangements contained in this contract.
____ / Consumer Information Guide and business price list: The Purchaser acknowledges having received copies of the business price list and the Consumer Information Guide prepared by the Bereavement Authority of Ontario.
____ / Embalming: The Purchaser authorizes the body to be embalmed.
____ / Disbursements/Third party supplier(s): The Purchaser acknowledges and agrees that the Provider will be acting on behalf of, and only as agent for, the Purchaser in obtaining the services from a third party supplier. The Purchaser acknowledges that unless other arrangements are made with the Provider, the Purchaser will be liable to pay the supplier directly for the supplies or services and agrees to save the Provider harmless from any claims by the third party supplier for payment.
____ / Possession of Cremated Remains and Refundable Deposit:The Purchaser authorizes the Provider to take possession of the cremated remains of the recipient. The Purchaser agrees to pay a refundable deposit of $350 to the Provider. The Provider will retain the cremated remains for one year from the date of cremation. If the cremated remains are not claimed within one year, the Provider may inter them in a cemetery, including in a common lot for which the cemetery is the interment rights holder, and the Provider may retain the deposit referred to in this section. If the cremated remains are claimed before they are interred, the operator will refund any deposit paid.
____
Initial / Acknowledgement of prepayment: The Purchaser acknowledges that once the beneficiary’s rights to proceeds of the insurance/annuity policy are assigned to the Provider, money is considered, for the purposes of section 38 of the Act, to have been paid under this contract for the provision of the services and supplies in an amount equal to the amount of the proceeds under the insurance/annuity policy that will be paid to the Provider.
Business Name is operated by [Operator name], which is controlled by [controlling person].
Licensee (print, sign & licence #______)For [operator name] / Date / Purchaser (print & sign) / Date
Negotiated by (print, sign & registration #______)
(Funeral Director and Funeral Preplanner interns only)
For [operator name] / Date / Purchaser (print & sign) / Date
____
Initial / Contract: The purchaser acknowledges having received a copy of this contract.
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