Tribute Insurance Assignments

Process claims faster and easier for both your funeral home and your client families

Why Tribute Insurance Assignments?

• Your funeral home gets funded before you even have a death certificate, in as little as 24 hours rather than waiting 60-90 days.

• Families pay the most competitive processing fees in the industry.

• With 63+ years of experience in life insurance claims and assignment funding, we have the most knowledgeable reps in the industry! They will use that knowledge and experience to process each claim accurately and efficiently.

• We complete ALL claim forms and affidavits required by the insurance company on behalf of the beneficiary and your funeral home. Alleviate those insurance-related headaches by letting us handle it for you!

• Our excellent customer service representatives will keep you up-to-date on the status of your request at all stages of the process and answer any questions you may have.

• We accept any type of assignable claim; even pending, coroner, homicide, and suicide cases.

• There is no limit on the amount families can request immediate funding for, giving them peace of mind and more options when it comes to:

• Funeral costs• Medical bills for the deceased, if applicable• Living expenses if they relied on the deceased’s income• Other expenses that arise after a loss

• Your accounting becomes infinitely easier when you have all your payment options in one place — Tribute Insurance Assignments, Tribute Loans, Tribute Crowdfunding, and other Tribute Pay functionality all appears in one location on your admin panel with easy-to-read statements.

• We provide personalized funding reports and outstanding document reports to your firm based on what you prefer. Our reps will work with you to determine which reports you need, what information is needed in each report, how often you receive them, and how they are delivered to you to suit your needs.

Frequently Asked Questions

How much does this service cost my funeral home?

Tribute Insurance Assignments doesn’t cost anything for your funeral home to use. The beneficiary pays the processing fee for the convenience of expediting a portion of their life insurance payout.

What do you need from our firm to verify a policy?

To verify a policy, we typically only need the deceased’s name, date of birth, date of death, social security number, insurance company name, policy number, and an assignment signed by the beneficiary. But in many cases, we can verify a policy with as little as the deceased’s name, insurance company name, and policy number.

Do you need a death certificate?

Though we don’t need a death certificate to verify a policy, we will need you to mail us a death certificate for each insurance company that we fund a policy for.

How much of the paperwork do you handle?We complete ALL claim forms and affidavits required by the insurance company on behalf of the beneficiary and your funeral home.

What happens to the rest of the money owed to the family from the insurance policy?

After we fund the assignment to your funeral home, we continue to work with the insurance company on behalf of the beneficiary to finish their claim.

What happens if a claim is unassignable?

Though it’s rare for this to occur, when it does happen we will notify you immediately so that you can work with the family to find another method of payment such as Tribute Loans or Tribute Crowdfunding.

How does our funeral home get paid?

We will ACH the funds directly to the bank account you have set up through Tribute Pay in as little as 24 hours after a policy is verified. If you haven’t set up Tribute Pay yet, all you have to do is click on the “Tribute Pay” tab in your admin panel and fill out the enrollment form. A designer will add it to your site within 24 hours.

Is there a limit on how much you will fund as an advancement to the family?

We can fund as much as the family requests, even up to the full amount of the insurance policy. This can be useful if they need additional money for purposes such as paying debts of the deceased or other expenses they need the deceased’s life insurance for. Any funds that remain after the ACH to your funeral home for funeral costs will be sent to the family directly via ACH or check.

Can we use this service to pay other providers such as a florist or cemetery?

Yes, you can! We can even ACH their portion to them directly or mail them a check for the amount owed to them.

After the assignment, how long does it take before a beneficiary receives the remaining funds from a policy?

The insurance company will issue a check to the beneficiary after the claim is fully processed, which typically takes 30-90 days but can take longer.

The Tribute Insurance Assignment Process

1. Complete a quick and easy online funding request on the “Tribute Pay” tab of your website’s admin panel. Include as much or as little information as you have regarding the deceased, the insurance policy, and the beneficiaries. You also can submit a request via fax by completing our funding request form and faxing it to 866-447-0311.

2. Have any possible beneficiaries complete an Assignment of Policy of Proceeds to Tribute Insurance Assignments. Make sure that a funeral home representative signs the Reassignment portion as well. Upload via the Tribute Assignment “Forms” section in the admin panel of your website or fax to 866-447-0311.

3. We will use the information you provide to verify each policy with its insurance company. We often can verify a policy within 24 hours. You will receive a confirmation via fax or email, whichever you prefer, indicating exactly how much we funded as well as any follow-up documentation we may need.

4. Mail us the original assignment(s) and a death certificate for each insurance company that we funded policies for. After that, you are done! We take care of all remaining paperwork, claim forms, and affidavits an insurance company may require.

Throughout the process, we keep you in the loop in the Tribute Pay tab of your admin panel so that you can track the progress of each claim and report back to your families.

Ready to offer this exceptional service to your families? Talk to your account representative today to learn how or call us at 866-372-9372 if you have any questions. We’re committed to your success!

Mark has 10 years of insurance experience. He lives in Albany, Indiana with his wife of 12 years, Jennifer, and their three children — Kylie, Kaleb, and Kamden.

M A R K

Tribute Insurance Lead

A N D R I A N

Tribute Insurance Lead

Andrian has 7 years of insurance experience. He lives in Fisherville, Kentucky with his wife of 5 years, Crosby. They are expecting their first child in May 2018.

Meet the Tribute Insurance Assignment team!

Charity has 13 years of insurance experience. She enjoys traveling the world and learning new cultures and is in the process of adopting a child from Malaysia.

C H A R I T Y

Tribute Insurance Agent

A U D R E Y

Tribute Insurance Lead

Audrey has 4 years of insurance experience. She is originally from southern Indiana and lives in Hermosa Beach, California, with her husband of 2 years, Tom.

L U E Y

Tribute Insurance Agent

Luey has 10 years of insurance experience. He has three daughters who keep him plenty busy, but in his rare free time he enjoys spending time with friends.

H E R S H I E

Tribute Insurance Agent

Hershie has 7 years of insurance experience. As a mother of three, she rarely has free time — but when she does, she enjoys reading and cooking.

Danna has 7 years of insurance experience. She is in love with the outdoors, and you often can find her hitting the trails or the beach and exploring.

D A N N A

Tribute Insurance Agent

C E C E

Tribute Insurance Agent

Cece has 5 years of insurance experience. She was born in Boracay and in her free time she enjoys running and discovering new trails with her husband.

A B O U T F R A Z E R C O N S U L T A N T S

Frazer Consultants is a technology company that helps funeral professionals reimagine the funeral experience for their families.

(866) 372-9372 | info@frazerconsultants.com | www.frazerconsultants.com

DECEASED (AS IT APPEARS ON INSURANCE POLICY SOCIAL SECURITY NUMBER

DATE OF BIRTH DATE OF DEATH

Cause of death: NATURAL HOMICIDESUICIDE ACCIDENTCORONER CASE/PENDING DEATH CERTIFICATE

Was the death local? YES NO Who picked the body up?FUNERAL HOME PHONE NUMBER

Are there any other assignments on these policy(ies)? YES NO

Is this policy through an employer? YES NO If YES, is deceased: EMPLOYEE DEPENDENT ON EMPLOYEE POLICY

If dependent, what is the deceased relationship to employee? Employee is: ACTIVE RETIRED

If Employer coverage, provide name and phone number of employer:

INSURANCE INFORMATION:

POLICY #1 POLICY AMOUNT

If you have verified this claim, please furnish us the number you called for each insurance company and your contact person, if one:

TOTAL AMOUNT REQUESTED

$

ADDITIONAL INFO/REQUESTS

ADDRESS CITY, STATE, ZIP

ADDRESS CITY, STATE, ZIP

Tribute Insurance Assignments Tribute Insurance Assignments, LLC - PO Box 2190 New Albany, Indiana 47151

P: (844) 993-3440 F: (866) 219-0669 TAX ID: 82-2652037

INSURANCE COMPANY BENEFICIARY(IES)

POLICY #2 POLICY AMOUNTINSURANCE COMPANY BENEFICIARY(IES)

POLICY #3 POLICY AMOUNTINSURANCE COMPANY BENEFICIARY(IES)

POLICY #4 POLICY AMOUNTINSURANCE COMPANY BENEFICIARY(IES)

BENEFICIARY #1 SOCIAL SECURITY NUMBERRELATIONSHIP DATE OF BIRTH

PHONE NUMBER EMAIL

ADDRESS CITY, STATE, ZIP

BENEFICIARY #2 SOCIAL SECURITY NUMBERRELATIONSHIP DATE OF BIRTH

PHONE NUMBER EMAIL

ADDRESS CITY, STATE, ZIP

BENEFICIARY #3 SOCIAL SECURITY NUMBERRELATIONSHIP DATE OF BIRTH

PHONE NUMBER EMAIL

Is the family requestig an advance? YES NOAMOUNT FAMILY TO NET AMOUNT FUNERAL HOME TO NET

FUNERAL HOME/CEMETERY TAKING ASSIGNMENT PHONE NUMBER

A DVA N C E R E Q U E S T

FUNERAL HOME/CEMETERY/LOCATION PHONE NUMBER

CONTACT PERSON EMAIL ADDRESSFAX NUMBER

FOR VALUE RECEIVED, I (WE), THE UNDERSIGNED BENEFICIARY(IES) UNDER THE INSURANCE POLICY(IES), OR DEATH BENEFIT CERTIFICATE NUMBER, OR BEING THE PERSON ENTITLED TO THE

BENEFITS THEREUNDER ON,

AND ANY OTHER POLICY ISSUED BY ON THE LIFE OF

DO HEREBY IRREVOCABLY ASSIGN, SET OVER AND TRANSFER UNTO IT’S/HIS/HER SUCCESSORS AND ASSIGNS, THE SUM OF

($ )

POLICY NUMBER(S)

BENEFICIARY NAME ADDRESS DOB SSN/TAX ID PHONE NUMBER RELATIONSHIP

PLUS, STATUTORY INTEREST FROM THE DECEASED INSURED’S DATE OF DEATH, WHICH IS TO BE PAID FROM THE BENEFIT(S) OF THE ABOVE MENTIONED POLICY(IES) OR CERTIFICATE AND ANY UNEARNED PREMIUMS, THE

CONSIDERATION FOR THE ASSIGNMENT OF THIS AMOUNT BEING: (1) FUNERAL AND/OR CEMETERY GOODS AND SERVICES PROVIDED FOR THE DECEASED BY THE FUNERAL HOME AND/OR CEMETERY, WHICH SERVICES HAVE

BEEN ACCEPTED BY US; AND/OR (2) ADVANCE PAYMENT OF PROCEEDS OF THE ABOVE-MENTIONED POLICY(IES). I/WE HEREBY AUTHORIZE AND DIRECT THE ABOVE-NAMED INSURANCE COMPANY TO PAY $_______________________

__________________________ TO TRIBUTE INSURANCE ASSIGNMENTS, LLC, a Wisconsin limited liability company (“TRIBUTE”) at the address listed above. IN THE EVENT THAT ANY PAYMENTS OF THE SAID PROCEEDS ARE ERRONEOUSLY PAID

TO ME/US BY THE ABOVE-NAMED INSURANCE COMPANY, SUBSEQUENT TO THE EXECUTION OF THIS ASSIGNMENT TO THE FUNERAL HOME AND/OR CEMETERY NAMED ABOVE OR THE REASSIGNMENT BY THE FUNERAL HOME

AND/OR CEMETERY TO TRIBUTE, THEN THE UNDERSIGNED AGREES TO IMMEDIATELY REMIT SAID FUNDS TO TRIBUTE. I/WE APPOINT TRIBUTE AS OUR ATTORNEY-IN-FACT TO ACT FOR THE UNDERSIGNED WITH FULL POWER TO

MAKE COLLECTIONS OF, COMPROMISE, SETTLE AND ENDORSE OR RECEIPT IN MY (OUR) NAMES, OTHERWISE, ANY CHECK, DRAFT, RECEIPT OR RELEASE FOR THE PROCEEDS OF SAID POLICY(IES) OF INSURANCE OR CERTIFICATE

AND TO PROCESS ALL NECESSARY FORMS, EXECUTE PROOFS OF LOSS OR PROOFS OF CLAIM AND TO EXECUTE ALL NECESSARY PAPERWORK TO OBTAIN SAID INSURANCE PROCEEDS, AS FULLY TO ALL INTENTS AND PURPOSES AS

WE OURSELVES COULD DO, HEREBY RATIFYING AND CONFIRMING ALL THAT OUR SAID ATTORNEY MAY DO OR CAUSE TO BE DONE BY VIRTUE HEREOF. THIS POWER OF ATTORNEY SHALL BE IRREVOCABLE AND COUPLED WITH

AN INTEREST. I/WE ALSO AUTHORIZE AND DIRECT THE ADOVE NAMED INSURANCE COMPANY, AND/OR THE EMPLOYER OF THE ABOVE-NAMED DECEASED INSURED, AND/OR ANY ORGANIZATION, AGENCY, ENTITY, OR PERSON,

ACTING AS CARETAKER OF THE INFORMANT ABOUT THE POLICY(IES), BENEFICIARY(IES) OF THE POLICY(IES) AND ANY CLAIM(S), TO GIVE AND RELEASE TO TRIBUTE ANY AND ALL INFORMATION IT REQUESTS REGUARDING THE

POLICY(IES), BENEFICIARY(IES), AND CLAIM(S) ON THE POLICY. THE UNDERSIGNED HEREBY GRANTS TRIBUTE PERMISSION TO OBTAIN FROM THE AFORESAID PARTY(IES) ALL PRIVACY ACT, HIPPA AND FREEDOM OF INFORMATION

ACT INFORMATION REQUESTED BY IT TO PROCESS ALL INSURANCE CLAIMS HEREUNDER, INCLUDING OBTAINING CERTIFIED COPIES OF THE DEATH CERTIFICATE FOR THE DECEASED INSURED. FOR VALUE RECEIVED, I/WE AGREE TO

HOLD HARMLESS THE ABOVE- NAMED LIFE INSURANCE COMPANY AND/OR THIRD PARTY OF THE INSURANCE COMPANY, EMPLOYER AND/OR THIRD PARY/BENEFITS RECORD HOLDER FROM ANY AND ALL LIABILTY TO ME/US WITH

REGUARD TO ITS/THEIR RELEASE OF INFORMATION TO TRIBUTE ASSIGNMENTS, LLC ABOUT THE ABOVE MENTIONED LIFE INSURANCE CONTRACT/POLICY(IES)/POLICY BENEFITS, AND BENEFICIARY DESIGNATION. EACH ASSIGNOR

HEREIN DOES HEREBY ACKNOWLEDGE THAT HE/SHE DOES NOT RETAIN OR KEEP CONTROL OVER THE FUNDS ASSIGNED TO THE FUNERAL HOME AND/OR CEMETERY, AND REASSIGNED TO TRIBUTE ASSIGNMENTS, LLC AND THAT

THE ABOVE-SPECIFIED LIFE INSURANCE PROCEEDES ARE IRREVOCABLY ASSIGNED AND REASSIGNED TO TRIBUTE INSURANCE ASSIGNMENTS, LLC. FOR VALUE RECEIVED, THE RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED BY

THE UNDERSIGNED BENEFICIARY(IES). IF, FOR ANY REASON, TRIBUTE DOES NOT RECEIVE FULL PAYMENT WITHIN NINETY (90) DAYS, I/WE AGREE TO IMMEDIATELY PAY TRIBUTE THE AMOUNT OF ITS LOSS ON THIS ASSIGNMENT AND

INTEREST SHALL BE DUE AND PAYABLE ON THE REMAINING PRINCIPAL BALANCE, CALCULATED RETROACTIVELY FROM THE DATE OF ENTERING THIS NOTE AT THE RATE OF 18% PER ANNUM, OR THE MAXIMUM RATE OF INTEREST

PERMITTED BY LAW NOT EXCEEDING 18% PER ANNUM UNTIL THE PRINCIPAL AMOUNT IS PAID IN FULL. IF FOR ANY REASON IT BECOMES NECESSARY FOR TRIBUTE TO PROCEED AGAINST ME/US, I/WE UNDERSTAND THAT I/WE ARE

LIABLE FOR ALL COST OF COLLECTIONS, INCLUDING BUT NOT LIMITED TO, REASONABLE ATTORNEY’S FEES, AND COURT COST. EACH ASSIGNOR DOES HEREBY ACKNOWLEDGE THAT HE/SHE IS A U.S. CITIZEN, AT LEAST EIGHTEEN (18)

YEARS OF AGE AND IS NOT SUBJECT TO BACKUP WITHHOLDINGS BY THE IRS AND IS NOT SUBJECT TO BACKUP WITHHOLDINGS FOR CHILD SUPPORT. I/WE AUTHORIZE TRIBUTE AS MY POWER OF ATTORNEY TO COMPLETE, SIGN,

AND ENDORSE ANY AND ALL CLAIM FORMS/CLAIMANT STATEMENTS, SMALL ESTATE AFFIDAVITS, PROOF OF DEATH FORMS, LOST POLICY AFFIDAVITS, SAME NAME AFFIDAVITS REQUIRED TO COMPLETE ANY AND ALL CLAIM(S) ON

THE ABOVE POLICY(IES) AND CLAIM(S) FOR THE ABOVE INSURANCE COMPANY INCLUDING FOR THE FULL PROCEEDS OF SAID POLICY(IES) AND CLAIM(S).

1ST BENEFICIARY’S SIGNATURE

DATE SIGNED

NOTARY PUBLIC SIGNATURE

Tribute Insurance AssignmentsI R R E VO C A B L E A S S I G N M E N T A N D P O W E R O F AT TO R N E Y

Tribute Insurance Assignments, LLC - PO Box 2190 New Albany, Indiana 47151

P: (844) 993-3440 F: (866) 219-0669 TAX ID: 82-2652037

NAME OF INSURANCE COMPANY NAME OF DECEASED INSURED

NAME OF FUNERAL HOME/CEMETERY

WRITE IN AMOUNT BEING ASSIGNED DOLLARS

PRINTED NAME

2ND BENEFICIARY’S SIGNATURE PRINTED NAME

3RD BENEFICIARY’S SIGNATURE PRINTED NAME

4TH BENEFICIARY’S SIGNATURE PRINTED NAME

THE FOREGOING IRREVOCABLE ASSIGNMENT WAS EXECUTED BY

WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED IDENTIFICATION,

SIGNED BEFORE ME ON THE __________ DAY OF ____________________, ______________.

IN THE AMOUNT OF $_______________________________________ (ASSIGNED AMOUNT) FOR PURPOSE OF PROVIDING GOODS AND SERVICES IN CONJUNCTION WITH THE DECEDENT’S FUNERAL AND/OR BURIAL FOR VALUE RECEIVED, THE

UNDERSIGNED DOES HEREBY IRREVOCABLY ASSIGN, TRANSFER, CONVEY, AND SET OVER UNTO TRIBUTE, ITS SUCCESSORS AND ASSIGNS, ALL OF UNDERSIGNED’S RIGHT, TITLE, INTERST AND CLAIM TO THE ABOVE POLICY(IES),

AND APPOINTS TRIBUTE AS ITS ATTORNEY-IN-FACT, HEREBY RATIFYING AND CONFIRMING ALL THAT SAID ATTORNEY MAY DO OR CAUSE TO BE DONE BY VIRTUE HEREOF. THIS POWER OF ATTORNEY SHALL BE IRREVOCABLE, AND

COUPLED WITH AN INTEREST. THE UNDERSIGNED ALSO DIRECTS PAYMENT BE MADE DIRECTLY AND SOLELY TO TRIBUTE IN THE EVENT THAT ANY PAYMENTS OF PROCEEDS ARE MADE BY THE INSURANCE COMPANY, OR IT’S AGENT, TO

THE UNDERSIGNED, ERRONEOUSLY, SUBSEQUENT TO THE EXECUTION OF THIS REASSIGNMENT TO TRIBUTE, THEN THE UNDERSIGNED AGREES TO IMMEDIATELY PAY THE PROCEEDS TO TRIBUTE. FAILURE TO REALIZE THE PROCEEDS

ASSIGNED BY THE BENEFICIARIES IN THE FULL AMOUNT ASSIGNED FOR THE LIFE INSURANCE POLICY(IES) SHALL NOT RELIEVE THE UNDERSIGNED TO PAY THE FULL AMOUNT OR THE UNPAID BALANCE OF THE FULL AMOUNT. IN

THE EVENT THAT FULL PAYMENT IS NOT RECEIVED BY TRIBUTE WITHIN NINETY (90) DAYS OF THIS REASSIGNMENT (DUE DATE), THEN THE UNDERSIGNED FUNERAL HOME AND/OR CEMETERY, HEREBY UNCONDITIONALLY AND

IRREVOCABALLY, GUARANTEES TO FULLY AND PROMPTLY REIMBURSE TRIBUTE THE UNPAID AMOUNT OF THE REASSIGNMENT BENEFITS IMMEDIATELY UPON DEMAND AND WITHOUT RESORT BY TRIBUTE TO ANY PERSON OR PARTY.

IF THE ASSIGNED AMOUNT IS NOT PAID WITHIN NINETY (90) DAYS OF THE ASSIGNMENT, THEN INTEREST SHALL BE DUE AND PAYABLE ON THE REMAINING PRINCIPAL BALANCE, CALCULATED RETROACTIVELY FROM THE DATE OF

ENTERING THIS NOTE AT THE RATE OF 18% PER ANNUM, OR THE MAXIMUM RATE OF INTEREST PERMITTED BY LAW NOT EXCEEDING 18% PER ANNUM UNTIL THE PRINCIPAL AMOUNT IS PAID IN FULL. THE UNDERSIGNED FUNERAL

HOME AND/OR CEMETERY AGREES TO PAY ANY AND ALL EXPENSES, INCLUDING REASONABLE ATTORNEY FEES AND LEGAL EXPENSES, PAID OR INCURRED BY TRIBUTE IN PROTECTING AND ENFORCING TRIBUTE’S RIGHTS UNDER

ANY PROVISION OF THIS IRREVOCABLE ASSIGNMENT. THE UNDERSIGNED FUNERAL HOME AND/OR CEMETER AGREES THAT MADISON, WISCONSIN, SHALL BE THE EXCLUSIVE JURISDICTION AND VENUE FOR LEGAL PROCEEDINGS

HEREUNDER. IN THE EVENT ANY PROVISIONS OF THIS IRREVOCABLE ASSIGNMENT SHALL BE FOUND NULL AND VOID, UNLAWFUL OR OTHERWISE UNENFORCEABLE, THEN THAT PROVISION SHALL BE DEEMED TO BE SEVERED FROM

THIS IRREVOCABLE ASSIGNMENT AND THE REMAINDER SHALL BE ENFORCEABLE.

FUNERAL HOME/CEMETERY NAME AUTHORIZED SIGNATURE

NOTARY PUBLIC SIGNATURE SEAL

THE FOREGOING IRREVOCABLE REASSIGNMENT WAS EXECUTED BY WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED IDENTIFICATION,

SIGNED BEFORE ME ON THE __________ DAY OF ____________________, ______________.

MY COMMISSION EXPIRES

IRREVOCABLE REASSIGNMENT AND POWER OF ATTORNEY TO TRIBUTE INSURANCE ASSIGNMENTS, LLC

SEALMY COMMISSION EXPIRES