; Consent of Beneficiary - Settlement Group Inc
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Consent of Beneficiary - Settlement Group Inc

VIEWS: 61 PAGES: 2

  • pg 1
									                             CONSENT TO CHANGE OF BENEFICIARY

                                                     AND

                      RELEASE AND WAIVER OF BENEFICIARY RIGHTS
          (If multiple beneficiaries, a separate consent must be signed by each beneficiary)


The undersigned beneficiary (the “Beneficiary”) currently is a named beneficiary of Life Insurance Policy
Number FIELD 5 (the “Life Insurance Policy”), issued by FIELD 8 (the “Life Insurance Company”),
insuring the FIELD 9 of FIELD 4 (the “Insured”), which is owned by FIELD 7 (the “Policyowner”).

          The Beneficiary understands that as a named beneficiary of the Life Insurance Policy, the
Beneficiary is now entitled to receive benefits payable under the Life Insurance Policy if the Insured dies
while the Beneficiary is a named beneficiary of the Life Insurance Policy. The Beneficiary understands
that Policyowner, as owner of the Life Insurance Policy, is selling, assigning, conveying and transferring
in a life settlement transaction all the Policyowner's right, title and interest in the Life Insurance Policy to
The Settlement Group, Inc., a Georgia corporation (the “Life Settlement Provider”), in its capacity as a
life settlement provider or its financing entity. The Beneficiary acknowledges and understands that, as a
result of the Policyowner's sale, assignment, conveyance and transfer of all the Policyowner's right, title
and interest in the Life Insurance Policy, the Policyowner will cease to be the owner of the Life Insurance
Policy and will change the named beneficiary of the Life Insurance Policy from the Beneficiary to the
Life Settlement Provider or its designee and therefore, the Beneficiary will cease to be a named
beneficiary of the Life Insurance Policy and will no longer have any rights to receive any benefits or
proceeds of the Life Insurance Policy.

         In consideration of the benefits to the Policyowner from such life settlement transaction, the
Beneficiary hereby irrevocably consents to the Policyowner's sale, assignment, conveyance and transfer
of the Life Insurance Policy to the Life Settlement Provider or its designee and the Policyowner's change
of the named beneficiary of the Life Insurance Policy from the Beneficiary to the Life Settlement
Provider or its designee as the new named beneficiary of the Life Insurance Policy. The Beneficiary
hereby forever waives, releases and discharges any and all actions, claims, causes of action, damages,
demands and remedies of whatever kind and character, including without limitation, against the Life
Settlement Provider or its designee or any of their assigns or successors, arising out of or in connection
with (a) the Policyowner's sale, assignment, conveyance and transfer of the Life Insurance Policy to the
Life Settlement Provider or its designee and (b) the Policyowner's change of the named beneficiary of the
Life Insurance Policy from the Beneficiary to the Life Settlement Provider or its designee, including all
rights to receive any benefits or proceeds of the Life Insurance Policy.

        The Beneficiary further agrees, upon request, to execute any additional or further releases,
documents or instruments, including without limitation, any forms provided by the Life Insurance
Company, which may be necessary or desirable more fully to vest all right, title and interest in and to the
Life Insurance Policy in the Life Settlement Provider, its designee or any of their assigns or successors.

        This Consent to Change of Beneficiary and Release and Waiver of Beneficiary Rights shall be
binding on the heirs, assigns, successors, executors and administrators of the Beneficiary.




                                                                                                     Page 1 of 2
Acknowledgement of Change of Beneficiary Form Release and Waiver of Beneficiary Rights
(Signature of Beneficiary)


(Print Name of Beneficiary)


(Date)


State of ___________________________
                                              ) SS:
County of:                                    )

Subscribed and affirmed to before me this
day of              , 200 .

(Seal)
                                                       (Signature of Notary Public)

                                                       My commission expires:




                                                                                         Page 2 of 2
Acknowledgement of Change of Beneficiary Form Release and Waiver of Beneficiary Rights

								
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