CS Agreement - Portfolio Funding Rider, Lifetime Member
CRYONIC SUSPENSION AGREEMENT − PORTFOLIO FUNDING RIDER
Lifetime Membership
This Rider is attached to the Cryonic Suspension Agreement between
______________________________________________________________________________
currently residing at _____________________________________________________________
(hereinafter referred to as the "Patient") and the CRYONICS INSTITUTE, a Michigan nonprofit corporation (hereinafter "CI").
- The Patient has agreed to fund his or her contract by the use of an investment portfolio. This form of funding is acceptable to CI provided the Patient provides CI with quarterly investment account statements showing a balance of at least $30,000 plus cost of local help (where applicable) with CI shown as beneficiary (Transfer on Death). If the patient has balances of $40,000 or more (plus cost of local help) in the investment account with CI as beneficiary of that amount, yearly statements sent to CI will be adequate.
- If quarterly or yearly statements have not been provided to CI under the terms of the preceding clause of this agreement, if the patient becomes legally dead on a weekend, evening or holiday, the patient may have to await funding verification before receiving cryonics services — which could risk being straight-frozen rather than being perfused. The patient agrees to the foregoing.
PATIENT (CI MEMBER) _______________________________, dated ______________
Subscribed and sworn to before me this _____ day of ________________________________
Signature of Notary Public _____________________________________________________
Name of Notary ________________________ County and State _______________________
If two witnesses are used instead of a notary, for each witness please show signature, printed name, address, and date:
Witness 1 Signature __________________________________________Date ____________
Printed Name _______________________________________________________________
Address ___________________________________________________________________
Witness 2 Signature __________________________________________Date ____________
Printed Name _______________________________________________________________
Address ___________________________________________________________________
IN WITNESS WHEREOF, the parties have signed this Agreement, which is finally executed at Clinton Township, Michigan.
CRYONICS INSTITUTE: by _________________________________________________
It's Contract Officer, dated ___________________