Section 220. Content of preneed contracts

Part VIII. Required Content of Contracts and Disclosures

The following information shall be contained in any contract for preneed funeral planning.

Date: ______________________________

Contract: ______________________________

PRENEED FUNERAL CONTRACT

for

(Name of Recipient of Services)

______________________________

__________________________ (Zip)________

I. SUPPLIES AND SERVICES PURCHASED

If the prices of goods and services are guaranteed, no additional cost will incur for your family or estate even though the actual prices of goods and services may increase between the date of this contract and the time of need. (Please see the disclosure document.)

Charges are only for those items that you selected or that are required. If we are required by law or by a cemetery or crematory to use an item, we will explain the reasons in writing below. If you selected a funeral that may require embalming, such as a funeral with a viewing, you may have to pay for embalming. You do not have to pay for embalming you did not select if you select arrangements such as a direct cremation or immediate burial.

Guaranteed Services Purchased
I. BASIC SERVICES OF FUNERAL DIRECTOR AND STAFF		$_________
II. FUNERAL HOME FACILITIES
	A. Facilities and Staff for visitation/viewing	$_________
	B. Facilities and Staff for funeral ceremony	$_________
	C. Facilities and Staff for memorial service	$_________
	D. Equipment and Staff for graveside service	$_________
(NOTE TO FUNERAL HOME: If you have additional charges such as facilities and staff for home/church viewing, or a charge for additional staff person or through calculation of manhours, etc., add here as extra items. If you have a charge for equipment for interment, add here.)
III. EMBALMING
	A. Normal remains	$_________
	B. Autopsy remains	$_________
IV. OTHER PREPARATION OF THE BODY		$_________
(NOTE: List all items that you placed under Other Preparation on your General Price List.)
V. IMMEDIATE BURIAL		$_________
VI. DIRECT CREMATION		$_________
VII. TRANSFER OF REMAINS TO FUNERAL ESTABLISHMENT		$_________
VIII. FORWARDING REMAINS TO ANOTHER FUNERAL HOME		$_________
IX. RECEIVING REMAINS FROM ANOTHER FUNERAL HOME		$_________
X. AUTOMOTIVE EQUIPMENT
	A. Hearse	$_________
	B. Limousine	$_________
(NOTE: List all others that you placed on General Price List.)
XI. FUNERAL MERCHANDISE
	A. Casket (*describe)
	_________________________________
	_________________________________	$_________
	B. Outer Burial Container (*describe)
	_________________________________
	_________________________________	$_________
	C. List any others
	_________________________________	$_________
Supplies Purchased
Clothing		$_________
Temporary marker		$_________
Acknowledgment cards		$_________
Register/attendance books		$_________
Memorial folders		$_________
Other		$_________
SUBTOTAL COSTS OF (GUARANTEED) SUPPLIES PURCHASED:		$_________
XII. PACKAGE PRICES
(NOTE: List all package prices by name.)
SUBTOTAL COSTS OF (GUARANTEED) SUPPLIES PURCHASED:		$_________
Nonguaranteed Goods and Services Purchased
The actual prices of goods and services below are NOT GUARANTEED. These items may include, but not be limited to, obituary notices, death certificates, cemetery fees, flowers, sales tax, etc. The prices are estimated and the estimates will be included in the Grand Total Contract Price. The differences between the estimated prices below and the actual cost will be settled with your family or estate at the time of need:
SUBTOTAL ESTIMATED COSTS OF NONGUARANTEED ITEMS:		$________
GRAND TOTAL FOR PRENEED ARRANGEMENTS
	1. Total cost of (guaranteed) services purchased	$_________
	2. Total cost of (guaranteed) supplies purchased	$_________
	3. Total estimated cost of nonguaranteed items	$_________
GRAND TOTAL		$_________
The only warranties, express or implied, granted in connection with the goods sold in this preneed funeral contract, are the express written warranties, if any, extended by the manufacturers thereof. No other warranties and no warranties of MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE are extended by the (funeral home) ____________________.
II. GENERAL INFORMATION
In order that the Buyer may understand the relationship of all parties involved in this preneed arrangement and contract, the following is provided:
	A. Buyer:
	B. Funeral Home Providing Services:
	C. Contract seller:
Employed by: (Funeral Home)
Virginia Funeral Director License Number:

Method of Funding

A. Insurance

B. Trust

1. Amount to be trusted:

2. Name of trustee:

3. Disposition of Interest:

4. Fees, expenses, taxes deducted from earned interest:

5. Buyer's responsibility for taxes owned on interest:

The following information will be given if an insurance policy or annuity contract is used to fund this agreement:

A. Buyer:

B. Insurance Company:

C. Insurance Agent:

Employed by: (Insurance Company)

Licensed Funeral Director in Virginia: ___yes ___no

Funeral Director License Number (If Applicable):

Employed by Funeral Home (If Applicable):

D. The life insurance or annuity contract provides either that:

_____ The face value thereof shall be adjusted annually by a factor equal to the Consumer Price Index as published by the Office of Management and Budget of the United States; or

_____ A benefit payable at death under such contract that will be equal or exceed the sum of all premiums paid for such contract plus thereon at the annual rate of at least 5.0%, compounded annually.

III. CONSUMER INFORMATION

The Board of Funeral Directors and Embalmers is authorized by Chapter 28 (§ 54.1-2800 et seq.) of Title 54.1 of the Code of Virginia to regulate the practice of preneed funeral planning. Consumer complaints should be directed to:

The Board of Funeral Directors and Embalmers

9960 Mayland Drive, Suite 300

Richmond, Virginia 23233

Telephone Number [phone]

Toll Free Number 1-800-533-1560

FAX: [phone]

IV. DISCLOSURES

The disclosure statements will be available for your review. The General Price List shall be furnished to you by the contract seller. These contain information that you must receive by law and/or the authority of the Board of Funeral Directors and Embalmers. You are entitled to receive all information in clear and simple language including the language of the funding agreement for this preneed arrangement.

If any law, cemetery, or crematory requires the purchase of any of those items listed in Part I, the requirements will be explained in writing.

By signing this contract, buyer acknowledges availability of and opportunity to read a copy of all of the required documents.

V. TERMINATION OF CONTRACT

This person who funds this contract through a trust agreement may terminate this preneed contract at any time prior to the furnishing of the services or supplies contracted for:

Within 30 days

If you terminate this preneed contract within 30 days of the date of this contract, you will be refunded all payments of whatever type you have made, plus any interest or income you may have earned.

More than 30 days

If you terminate this preneed contract more than 30 days after the date on this contract, you will be refunded whatever amount was required to be placed in a revocable trust fund, plus any interest or income it has earned.

Any person who funds this contract through a trust fund which is irrevocable or through an insurance/annuity policy or through the transfer of real estate/personal property may not be eligible for a refund.

VI. STATEMENT OF GUARANTEE

By signing this contract, (Funeral Home) __________ agrees to the statement checked below (check one):

______ Prefinancing guarantees that no additional payment will be required from the family or estate for guaranteed services and supplies provided the Grand Total of these arrangements is paid in full and the interest is allowed to accumulate in your account (see page ______ for Grand Total amount). Payment of the difference will be required for the nonguaranteed estimated items if they increase in price.

______ The prices for items under supplies and services are not guaranteed.

VII. AGREEMENT

In witness whereof, the Buyer and the Funeral Home have executed this contract, intending its terms to be in accordance with the Code of Virginia and any regulations implementing the Code. By signing this contract you acknowledge that you have been provided access to and the opportunity to read the Disclosure Statements.

(Designee of Funeral Home)		(Buyer)
(Funeral Home)		(Contract Date)

VIII. PENALTIES OR RESTRICTIONS

The (funeral home) __________, has the following penalties or restrictions on the provisions of this contract.

1. (Insert geographic restrictions);

2. (Insert an explanation of the Funeral Home's inability to perform the request(s) of the Buyer);

3. (Insert a description of any other circumstances which apply);

4. (Insert information that if particular goods and services specified in the contract are unavailable at the time of need):

A. The funeral home shall be required to furnish supplies and services similar in style and at least equal in quality of material and workmanship; and

B. The representative of the deceased shall have the right to choose the supplies or services to be substituted.

Addendum to Preneed Contract

APPOINTEE AGREEMENT

I appoint ____________________ of (address) _______________________ to assist with the preneed arrangements in my behalf. The relationship of my appointee to me is ____________________.

Contract Beneficiary: ____________________ Date: __________

I accept the request of (contract beneficiary) ____________________ to assist with his/her preneed arrangements.

Appointee: _________________________ Date: __________

The foregoing was acknowledged before me this __________ day of __________, 19____

Notary: ____________________________

Date Commission Expires: __________

Historical Notes

Derived from Volume 15, Issue 07, eff. January 20, 1999; amended, Virginia Register Volume 26, Issue 03, eff. November 11, 2009.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.