----------
UNIFORM QUALIFIED ASSIGNMENT
"Claimant"
"Assignor"
"Assignee"
"Annuity Issuer"
"Effective Date"
This Agreement is made and entered into by and between the parties hereto as of
the Effective Date with reference to the following facts:
A. Claimant has executed a settlement agreement or release
dated_________________, 19_______ (the "Settlement Agreement") that
provides for the Assignor to make certain periodic payments to or for
the benefit of the Claimant as stated in Addendum No. 1 (the "periodic
Payments"); and
B. The parties desire to effect a "qualified assignment" within the
meaning and subject to the conditions of Section 130(c) of the Internal
Revenue Code of 1986 (the "Code").
NOW THEREFORE, in consideration of the foregoing and other good and valuable
consideration, the parties agree as follows:
1. The Assignor hereby assigns and the Assignee hereby assumes all of the
Assignor's liability to make the Periodic Payments. The Assignee
assumes no liability to make any payment not specified in Addendum No.1
2. The Periodic Payments constitute damages on account of personal injury
or sickness in a case involving physical injury or physical sickness
within the meaning of Sections 104(a)(2) and 130(c) of the Code.
3. The Assignee's liability to make the Periodic Payments is no greater
than that of the Assignor immediately preceding this Agreement.
Assignee is not required to set aside specific assets to secure the
Periodic Payments. The Claimant has no rights against the Assignee
greater than a general creditor. None of the Periodic Payments may be
accelerated, deferred, increased or decreased and may not be
anticipated, sold, assigned or encumbered.
4. The obligation assumed by Assignee with respect to any required payment
shall be discharged upon the mailing on or before the due date of a
valid check in the amount specified to the address of record.
5. This Agreement shall be governed by and interpreted in accordance with
the laws of the State of________________________________
6. The Assignee may fund the Periodic Payments by purchasing a "qualified
funding asset" within the meaning of Section 130(d) of the Code in the
form of an annuity contract issued by the Annuity Issuer. All rights of
ownership and control of such annuity contract shall be and remain
vested in the Assignee exclusively.
7. The Assignee may have the Annuity Issuer send payments under any
"qualified funding asset" purchased hereunder directly to the payee(s)
specified in Addendum No.1. Such direction of payments shall be solely
for the Assignee's convenience and shall not provide the Claimant or
any payee with the rights of ownership or control over the "qualified
funding asset" or against the Annuity Issuer.
--------------------------------------------------------------------------------
8. Assignee's liability to make the Periodic Payments shall continue
without diminution regardless of any bankruptcy or insolvency of the
Assignor.
9. In the event the Settlement Agreement is declared terminated by a court
of law or in the event that Section 130(c) of the Code has not been
satisfied, this Agreement shall terminate. The Assignee shall then
assign ownership of any "qualified funding asset" purchased hereunder
to Assignor, and Assignee's liability for the Periodic Payments shall
terminate.
This Agreement shall be binding upon the respective representatives, heirs,
successors and assigns of the Claimant, the Assignor and the Assignee and upon
any person or entity that may assert any right herenunder or to any of the
Periodic Payments.
Assignor
------------------------------
By:
-----------------------------------
Authorized Representative
Title
---------------------------------
Assignee:
-----------------------------
By:
-----------------------------------
Authorized Representative
Title
---------------------------------
================================================================================
NSSTA National Structured Settlements Trade Association
ADDENDUM NO. 1
DESCRIPTION OF PERIODIC PAYMENTS
Initials
Assignee:
---------------------------
Assignor:
---------------------------
================================================================================
