Transfer of Pre-planned Contract

Please read the following information carefully and complete all fields below.

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* 1. This Amendment BETWEEN [Contract Owner Named Below] AND: Martin Brothers Funeral Services,

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* 2. Please enter your date of birth - this information is used to verify identity.

Date of Birth

Date

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* 3. This amendment is effective on this date:

Date of Signing

Date

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* 4. Please enter your mailing address - this information is used to confirm identity.

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* 5. TO WIT:

1. The contract owner entered a pre-planned contract with Elements Cremation, Pre-planning & Burial, a division of 1096486 BC Ltd.

2. Elements is assigning the obligations of each pre-planned contract to Martin Brothers Funeral Services 4305 Halifax Street, Burnaby B.C.

3. Martin Brothers agrees to fulfill the obligations under the pre-planned contract and deliver the contract owner, at time of death, the goods and services set forth in the pre-planned contract, at the prices guaranteed therein.

4. The Contract Owner: (please select option 1 OR option 2)

Option 1: Agrees to Martin Brothers fulfilling the obligations of the pre-planned contract and holding all related documentation (your “file”) until the death of the name contract owner

Option 2: Does not wish to assign their pre-planned contract to Martin Brothers and takes full responsibility to negotiate a transfer of their pre-planned contract with another funeral provider, at their own risk and full responsibility, or can cancel their policy with TruStage for any applicable refund.

5. The contract owner agrees to be bound by all other terms of this "Transfer of pre-planning" contract.