Prepaid Funeral Fund Application Form Personal DetailsName* First Last Email* Address Street Address Address Line 2 City Post Code IRD NumberTelephone Number*Date of Birth* Contribution AmountHave you pre-arranged your funeral? Yes No Who is your funeral director?I acknowledge and confirm that:* Select All Hereby apply to settle on Legacy Prepaid Funerals Limited as Trustee and establish with effect from the date of acceptance by the Trustee (the “Commencement Date”) a Client Funeral Trust for the purpose of contributing toward the payment of my funeral expenses in the event of my death (“my Fund”). I have read the said terms and conditions of my Fund as set out in the Trust Deed establishing the Legacy Prepaid Funeral Trust (and any amendments thereto) (“Deed”) and this Application Form My Contributions shall be held in a sub-trust account in the name of the Trustee and specifically identified as my Fund My Fund shall not be settled and established unless and until the Trustee accepts this Application Form together with my payment of the amount stipulated above I specifically acknowledge that all interest earned on money held in my Fund shall be paid to Legacy Trust after administration costs I specifically acknowledge that it has been explained to me that I will not be entitled to receive any income or any gains on my Fund, and the real purchasing power of my contribution(s) may be eroded over time due to inflation. I am satisfied with this arrangement in the knowledge that the surplus income earned on my Fund will be benefitting charitable purposes within the community through distribution to Legacy Trust Signature* In place of a signature, please select the checkbox. By doing so you acknowledge that all information submitted is true and correct to the best of your knowledge. NameThis field is for validation purposes and should be left unchanged.