Application Form - Elysium Funeral Plans

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Elysium Funeral Plan - Spain

CONTRACT

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Contract Info

Funeral Plan No:

(Auto fills)

Date(Required)

The Parties to the Contract: The Company

ELYSIUM FUNERAL PLANS SL

Registered Office:
14, rue Carlos Cervera,
Bajo,
Valencia, 46006,
Espagne

CIF No.: B19931633
Tél. : +34 960 730 230
E-mail : clientcare@elysiumfuneralplans.com

Hereinafter called “THE PLAN HOLDER”.

The Parties to this Contract: Applicant 1

Name(Required)

Prefix First Name Middle Name Surname

Address(Required)

Street Address Address Line 2 City ZIP / Postal Code Country

Date of Birth(Required)

Email(Required)

Telephone(Required)

Nationality(Required)

ID (TIE / NIE)(Required)

PASSPORT ID(Required)

Upload your TIE / NIE & PASSPORT

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 10 MB.

TIE/CDR/MEU21/2/PASSPORT

Religion

Hereinafter called ‘The PLAN HOLDER’

Is there a second Applicant?(Required)

Yes

Applicant 2

Name(Required)

Prefix First Name Middle Name Surname

Address(Required)

Street Address Address Line 2 City ZIP / Postal Code Country

Date of Birth(Required)

Email(Required)

Telephone(Required)

Nationality(Required)

ID Number(Required)

PASSPORT ID(Required)

Upload your ID Copy

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 10 MB.

TIE/CDR/MEU21/2/PASSPORT

Religion

Hereinafter called ‘The PLAN HOLDER’

Next of Kin Applicant 1

Name(Required)

Prefix First Name Middle Name Surname

Address(Required)

Street Address Address Line 2 City ZIP / Postal Code Country

Date of Birth(Required)

Email(Required)

Telephone(Required)

Relationship to Plan Holder(Required)

Plan Holder has confirmed they are aware they have been chosen as Next of Kin.(Required)

Yes

Next of Kin Applicant 2

Same Next of Kin as Applicant 1

Yes

Name(Required)

Prefix First Name Middle Name Surname

Address(Required)

Street Address Address Line 2 City ZIP / Postal Code Country

Date of Birth(Required)

Email(Required)

Telephone(Required)

Relationship to Plan Holder(Required)

Plan Holder has confirmed they are aware they have been chosen as Next of Kin.(Required)

Yes

Purpose & Scope

1. PURPOSE OF THE CONTRACT

The purpose of this contract is the provision and guarantee of funeral services by Elysium Funeral Plans SL, Hereinafter called THE COMPANY
THE COMPANY in accordance with the plan selected by THE PLAN HOLDER.

THE COMPANY undertakes to:

Organise and manage the funeral service.
Co-ordinate all necessary third parties.
Guarantee the proper provision of the contracted services at the time of enactment.

2. SCOPE OF THE SERVICE

The service includes only the items detailed in this contract.

The following is expressly INCLUDED:

Full organisation of the funeral service.
Basic funeral services in accordance with the plan taken out.
Administrative management.

The following is expressly EXCLUDED:

Additional flowers unless specified in a plan.
Obituaries.
Catering.
Headstones.
Niche or burial plots.
Burial taxes.
Municipal fees.
International repatriation unless specified in a plan.
Services not specified in this contract.

Any additional services requested will be quoted for separately and must be paid for in full prior to the enactment.

Plan Purchased - Applicant 1

The Elysium Funeral Plan Payment Calculator (Applicant 1)

Choisissez votre forfait et personnalisez-le en fonction de votre budget.

Choisir un plan funéraire

Funeral Type

Sélectionnez votre lieu

Récapitulatif des paiements

Please select a plan... €0.00

Prix total (caution comprise) €0.00

Select preferred monthly payment date:(Required)

Plan Purchased - Applicant 1

Price: 0,00 €

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Selected Plan Name APP 1

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Funeral Type

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Durée (mois)

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Want to pay Applicant 1

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Payment Selection

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Solde

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Paiement du 1er mois

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Paiement à partir du 2e mois

The specific features of the plan are set out in Clause 8 of this contract.

Beneficiaries - Applicant 1

Under the 10-Year & 14-Year Legacy-Refund Commitments, the Plan Fee will be refunded to the Plan Holder’s nominated Beneficiary/ies, subject to the terms of the Plan.
Payment will be released upon presentation of the original Funeral Plan Certificate and, where a nominated Beneficiary is under 18 years of age, once that Beneficiary has reached the age of 18.

Name(Required)

Prefix First Name Middle Name Surname

Address(Required)

Street Address Address Line 2 City ZIP / Postal Code Country

Telephone(Required)

Date of Birth(Required)

Relationship to Plan Holder(Required)

ID No:(Required)

If you do not have one, write N/A

Nationality(Required)

Is there a second beneficiary?(Required)

Yes

2nd Beneficiary Details - Applicant 1

Name(Required)

Prefix First Name Middle Name Surname

Address(Required)

Street Address Address Line 2 City ZIP / Postal Code Country

Telephone(Required)

Date of Birth(Required)

Relationship to Plan Holder(Required)

ID No:(Required)

If you do not have one, write N/A

Nationality(Required)

Plan Purchased - Applicant 2

The Elysium Funeral Plan Payment Calculator (Applicant 2)

Choisissez votre forfait et personnalisez-le en fonction de votre budget.

Choisir un plan funéraire

Funeral Type

Sélectionnez votre lieu

Récapitulatif des paiements

Please select a plan... €0.00

Prix total (caution comprise) €0.00

Select preferred monthly payment date:(Required)

Plan Purchased - Applicant 2

Price: 0,00 €

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Selected Plan Name (App 2)

This field is hidden when viewing the form

Funeral Type

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Durée (mois)

This field is hidden when viewing the form

Want to pay Applicant 2

This field is hidden when viewing the form

Payment Selection

This field is hidden when viewing the form

Solde

This field is hidden when viewing the form

Paiement du 1er mois

This field is hidden when viewing the form

Paiement à partir du 2e mois

The specific features of the plan are set out in Clause 8 of this contract.

Beneficiaries - Applicant 2

Name(Required)

Prefix First Name Middle Name Surname

Address(Required)

Street Address Address Line 2 City ZIP / Postal Code Country

Telephone(Required)

Date of Birth(Required)

Relationship to Plan Holder(Required)

ID No:(Required)

If you do not have one, write N/A

Nationality(Required)

Is there a second beneficiary?(Required)

Yes

2nd Beneficiary Details - Applicant 2

Name(Required)

Prefix First Name Middle Name Surname

Address(Required)

Street Address Address Line 2 City ZIP / Postal Code Country

Telephone(Required)

Date of Birth(Required)

Relationship to Plan Holder(Required)

ID No:(Required)

If you do not have one, write N/A

Nationality(Required)

Special Instructions

Please enter any special requests or instructions you would like to record in relation to your funeral plan.

You can also use this section to advise us if your plan:

Forms part of a Family Plan;
Is a Living Funeral Plan;
Relates to a pre-arrangement to donate your body to medical research; or
Has been created under our Transfer-In Scheme.

Enter any special requests or instructions, such as a favourite reading, hymn, poem, music or other personal wishes.

You will also receive a separate Funeral Wishes Sheet with your Elysium Funeral Plan Guide for further details.

Enter any special requests or instructions

Payment Terms

3. EFFECTS OF PAYMENT:

3.1 FULL PAYMENT:
The service is fully guaranteed at no additional cost, except for services not included or exceptional circumstances (public charges, regulatory changes etc).

3.2 MONTHLY PAYMENT:
Until payments have completed:

The Next of Kin will be responsible for paying the outstanding balance before the contract can be fulfilled.
If the Next of Kin cannot or refuses to pay the outstanding balance immediately, the balance will be transferred to them less our cancellation fee of €495 (four hundred & ninety-five Euros) and we will not be obliged to fulfil our obligations under this contract.

4. NON-PAYMENT:

In the event of non-payment

1 missed payment: THE COMPANY will notify THE PLAN HOLDER.
2 missed payments: THE COMPANY will notify THE PLAN HOLDER and place a temporary suspension on the plan.
3 missed payments: THE COMPANY will notify THE PLAN HOLDER and give 7 (seven) days notice to bring the account back up to date or the plan will be cancelled.

If the plan is called upon whilst payments are outstanding:

THE COMPANY will not be obliged to provide the contract service.
The plan will be cancelled and the balance outstanding, less our cancellation fee of €495 (four hundred & ninety-five Euros), will be refunded to the Next of Kin.

5. CANCELLATION:

5.1 WITHIN 21 DAYS OF SIGNING THIS CONTRACT:
THE PLAN HOLDER may cancel without penalty within 21 (twenty-one) calendar days of signing this contract and will receive a full refund of monies paid within 72 (seventy-two) hours.

5.2 AFTER 21 DAYS OF SIGNING THIS CONTRACT:
THE PLAN HOLDER may cancel after the 21 (twenty-one) day Consideration Period and will receive monies less our standard cancelation fee of €495 (four hundred & ninety-five Euros). The balance will be transferred back to THE PLAN HOLDER within 5 (five) working days. Full details of our cancellation policy can be found in our Terms and Conditions on our website www.elysiumfuneralplans.com.
EU Consumer Rights Directive: Gives consumers various rights, including the right to withdraw from a sales contract without explanation within 14 (fourteen) days (a “cooling off period”). THE COMPANY offers a 21 (twenty-one) day Consideration Period.
Please Note: Day 1 (one) of this 21 (twenty-one) day period is taken as the day this Contract is signed.

6. LIABILITY:

THE COMPANY assumes full responsibility for the proper provision of the service. It may rely on external suppliers in providing the service,however:

It will remain fully liable to THE PLAN HOLDER for the proper provision of the service.
It will be responsible for any legal or administrative charges arising from the provision of the contracted service.
It will not be responsible for decisions, actions, or delays attributable to public authorities.

7. FINANCIAL PROTECTION:

Funds paid by THE PLAN HOLDER à THE COMPANY:

Are used exclusively for the provision of the contracted plan.
Are managed in a secure ringed fenced account by Amundi Group.

This guarantees the long-term strength and stability of THE COMPANY.

Details of the Plan

8. DETAILS OF THE PLAN:

THE ELYSIUM ASSIST PLAN - WHAT IS INCLUDED:

The unattended cremation at an appointed crematorium.
The cremation fee.
The appointed Funeral Director attending to all the necessary arrangements for the unattended cremation.
The collection and transportation of the deceased from a place of residence, a care home, hospital or resting place in mainland Spain to a mortuary within mainland Spain.
The preparation and care of the deceased at the allocated mortuary (including full hygienic treatment and removal of pacemaker, where required).
The supply of a simple coffin suitable for cremation.
The supply of a simple urn.
The return of ashes directly to the family in Spain.
Une ligne d'assistance en cas de deuil, accessible 24 heures sur 24, avec des opérateurs parlant anglais.
International Death Certifícate.
The Cremation Certifícate to allow ashes to be taken on board an aircraft, where appropriate.

THE ELYSIUM ASSIST PLAN - WHAT IS NOT INCLUDED:

Privilege Collections.
Any services provided by a Funeral Director not appointed by THE COMPANY.
Rendez-vous en personne avec le directeur de pompes funèbres.
Veillée funèbre.
Habillage du défunt avec ses vêtements personnels ou placement d'objets dans le cercueil.
Présence de la famille au crématorium.
Une cérémonie au crématorium ou tous les frais liés à l'organisation d'une cérémonie, y compris un service religieux.
Costs for any mortuary storage.
Choix de la date, de l'heure ou du lieu de la crémation.
A Wake, following the cremation, including the costs associated with catering for the funeral guests.
Obituary notices.
Flowers, floral tributes, or any items requested.
Inhumation des cendres.
Pierres tombales, monuments commémoratifs, plaques ou frais liés à leur installation ou à leur entretien.
Rapatriement depuis l'étranger.
Transfert depuis ou vers l'Espagne continentale, les îles Canaries ou les îles Baléares.
Matériel audio ou vidéo.
Frais de déplacement ou de transport.
Any other items or services not listed in the inclusions section.

8. DETAILS OF THE PLAN:

THE CLARITY PLAN - WHAT IS INCLUDED:

The unattended cremation at an appointed crematorium or burial at an appointed cemetery.
The cremation fee.
The appointed Funeral Director attending to all the necessary arrangements for the unattended cremation.
The collection and transportation of the deceased from a place of residence, a care home, hospital or resting place in mainland Spain to a mortuary within mainland Spain.
The preparation and care of the deceased at the allocated mortuary (including full hygienic treatment and removal of pacemaker, where required).
The supply of a standard coffin – suitable for a burial or a cremation.
The supply of a standard urn if a cremation service chosen.
The return of ashes directly to the family in Spain.
Une ligne d'assistance en cas de deuil, accessible 24 heures sur 24, avec des opérateurs parlant anglais.
International Death Certifícate.
The Cremation Certificate to allow ashes to be taken on board an aircraft, where appropriate.
Sélection des collections « Privilege ».

THE CLARITY PLAN – WHAT IS NOT INCLUDED:

Any services provided by a Funeral Director not appointed by THE COMPANY.
Rendez-vous en personne avec le directeur de pompes funèbres.
Veillée funèbre.
Habillage du défunt avec ses vêtements personnels ou placement d'objets dans le cercueil.
Présence de la famille au crématorium.
Une cérémonie au crématorium ou tous les frais liés à l'organisation d'une cérémonie, y compris un service religieux.
Costs for any mortuary storage.
Choix de la date, de l'heure ou du lieu de la crémation.
Niche and grave fees.
Burial taxes.
A Wake, following the cremation, including the costs associated with catering for the funeral guests.
Obituary notices.
Fleurs, compositions florales ou tout autre article demandé en hommage au défunt.
Inhumation des cendres.
Pierres tombales, monuments commémoratifs, plaques ou frais liés à leur installation ou à leur entretien.
Gifts including charitable donations, unless included in the Privilege selection.
Rapatriement depuis l'étranger.
Transfert depuis ou vers l'Espagne continentale, les îles Canaries ou les îles Baléares.
Matériel audio ou vidéo.
Frais de déplacement ou de transport.
Any other items or services not listed in the inclusions section.

8. DETAILS OF THE PLAN:

THE TRANQUILITY PLAN – WHAT IS INCLUDED:

The appointed Funeral Director attending to all the necessary funeral arrangements prior to and on the day of the funeral.
The appointed Funeral Director providing confidential advice on the certification and registration of the death.
The cremation fee if a cremation has been chosen.
The collection and transportation of the deceased from a place of residence, a care home, hospital or resting place in Spain to the mortuary.
The care and preparation of the deceased at the funeral home (to include full hygienic treatment and removal of pacemaker, where required).
The supply of a standard coffin – suitable for a burial or a cremation.
Up to 4 (four) days in the Chapel of Rest at the Funeral Home/Tanatorio allowing family and friends to travel and attend the funeral. Included in this 4 (four) day period is a 1(one) day Wake (viewing) for family and friends to view the deceased and pay their final respects.
The transportation of the deceased to the Funeral Director’s appointed crematorium or chosen cemetery.
International Death Certifícate.
Une ligne d'assistance en cas de deuil, accessible 24 heures sur 24, avec des opérateurs parlant anglais.
The supply of a standard urn if a cremation was chosen.
The Cremation Certifícate to allow ashes to be taken on board an aircraft, where appropriate.
Sélection des collections « Privilege ».

THE TRANQUILITY PLAN – WHAT IS NOT INCLUDED:

Any services provided by a Funeral Director not appointed by THE COMPANY.
Tous les frais liés à l'organisation d'un événement ou d'un service, y compris un office religieux.
A Wake, following the cremation, including the costs associated with catering for the funeral guests.
Obituary notices.
Flowers, floral tributes, or any items requested.
Niche and grave fees.
Burial taxes.
Pierres tombales, monuments commémoratifs ou frais connexes liés à la maçonnerie et à leur mise en place.
Les cadeaux, y compris les dons caritatifs, sauf s'ils font partie de la sélection « Privilège ».
Frais engagés pour l'entretien et la maintenance d'un monument commémoratif.
Cartes de cantiques et ordre du culte.
Matériel audio ou vidéo.
Inhumation ou dispersion des cendres.
Rapatriement depuis l'étranger.
Transfert depuis ou vers l'Espagne continentale, les îles Canaries ou les îles Baléares.
Viewing of the deceased in the Chapel of Rest on all 4 (four) days.
Any other items or services not listed in the inclusions section.

8. DETAILS OF THE PLAN:

THE SERENITY PLAN - WHAT IS INCLUDED:

The appointed Funeral Director attending to all the necessary funeral arrangements prior to and on the day of the funeral.
The appointed Funeral Director providing confidential advice on the certification and registration of the death.
The collection and transportation of the deceased from a place of residence, a care home, hospital or resting place in Spain to the mortuary.
The care and preparation of the deceased at the funeral home (to include full hygienic treatment and removal of pacemaker, where required).
The supply of a quality veneered coffin – suitable for a burial or a cremation.
A member of the clergy or celebrant for the funeral service.
Relevant funeral staff required to conduct the funeral service.
The cremation fee.
Up to 5 (five) days in the Chapel of Rest at the Funeral Home/Tanatorio allowing family and friends to travel and attend the funeral. Included in this 5 (five) day period is a 1(one) day Wake (viewing) for family and friends to view the deceased and pay their final respects.
The transportation of the deceased to the Funeral Director’s appointed cemetery/crematorium.
International Death Certifícate.
Une ligne d'assistance en cas de deuil, accessible 24 heures sur 24, avec des opérateurs parlant anglais.
The supply of a small spray of flowers.
The supply of a simple urn.
The Cremation Certifícate to allow ashes to be taken on board an aircraft, where appropriate.
Sélection des collections « Privilege ».

THE SERENITY PLAN - WHAT IS NOT INCLUDED:

Any services provided by a Funeral Director not appointed by THE COMPANY.
Additional venue costs to host the funeral service, including a church service.
A Wake, following the cremation, including the costs associated with catering for the funeral guests.
Avis de décès publiés dans les médias.
Extra flowers, floral tributes, or any items requested for the funeral service.
Niche and grave fees.
Burial taxes.
Pierres tombales, monuments commémoratifs ou frais connexes liés à la maçonnerie et à leur mise en place.
Les cadeaux, y compris les dons caritatifs, sauf s'ils font partie de la sélection « Privilège ».
Frais engagés pour l'entretien et la maintenance d'un monument commémoratif.
Tout transport des personnes assistant aux funérailles le jour des funérailles.
Liste des personnes ayant assisté aux funérailles et ayant envoyé des fleurs ou fait des dons à des œuvres caritatives.
Viewing of the deceased in the Chapel of Rest on all five days.
Cartes de cantiques et ordre du culte.
Matériel audio ou vidéo.
Inhumation ou dispersion des cendres.
Repatriation to or from Spain.
Transfer to or from mainland Spain, Canary Islands and Balearic Islands.
Any other items or services not listed in the inclusions section.

8. DETAILS OF THE PLAN:

THE UNITY REPATRIATION PLAN – WHAT IS INCLUDED:

Attending to all legal and administrative formalities required for repatriation from mainland Spain to the UK or any EU member state.
The appointed Funeral Director in Spain attending to all the necessary funeral arrangements prior to and up to delivery of the coffin to the airport.
The Appointed Funeral Directors in Spain providing confidential advice on the certification and registration of the death.
The collection and transportation of the deceased from a place of residence, a care home, hospital, or resting place in mainland Spain to the mortuary in mainland Spain.
The care and preparation of the deceased for transportation (to include full hygienic treatment and removal of pacemaker, where required).
4 (four) days mortuary expenses in Spain.
The supply of a coffin suitable for transportation, including the legally required body bag.
The transportation of the deceased to the airport in Spain.
The flight for the deceased to the Receiving Country.
International Death Certifícate.
Une ligne d'assistance en cas de deuil, accessible 24 heures sur 24, avec des opérateurs parlant anglais.

THE UNITY REPATRIATION PLAN – WHAT IS NOT INCLUDED:

Any services provided by a Funeral Director not appointed by THE COMPANY.
Wake/s following the repatriation including the costs associated with venue and catering for family/guests.
Obituary notices.
Flowers.
Burial fees.
Headstones or memorials.
Family transportation / flights.
Printed materials.
Audio-visual equipment.
Additional airport or handling charges.
Exceptional airline, governmental or authority charges.
Any other goods or services not expressly included.

8. THE NON-RESIDENT PLAN

PLAN INCLUSIONS/EXCLUSIONS

The inclusions and exclusions applicable to this plan are those associated with the plan selected

Donations

9. SOCIAL CONTRIBUTIONS - (NON-CONTRACTUAL):

THE COMPANY may make donations to charitable causes and/or plant trees.
These actions are voluntary and do not form part of the contracted service.

NOMINATED CHARITY IF APPLICABLE

Politiques

10. DATA PROTECTION:

Data held by THE COMPANY regarding THE PLAN HOLDER will be processed in accordance with: General Data Protection Regulation (GDPR) / Organic Law 3/2018 / The Rules of LOPD which THE COMPANY voluntarily subscribes to.

11. APPLICABLE LAW:

This Agreement and the services provided under it shall be governed by and comply with applicable Spanish law and regulations, including those relating to funeral services, consumer protection and data protection. Any mandatory legal requirement shall prevail over any conflicting provision of this Agreement.

12. ACCEPTANCE:

THE PLAN HOLDER declares:

That I have read and understood this contract in conjunction with the Terms and Conditions found at www.elysiumfuneralplans.com.
That I accept all its Terms and Conditions.
That I freely enter into this contract for the plan nominated with the plan payment as declared.

13. SIGNATURES

PLAN HOLDER 1: SIGNATURE(Required)

PLAN HOLDER 1: NAME(Required)

PLAN HOLDER 1: DATE(Required)

PLAN HOLDER 2: SIGNATURE (if applicable)(Required)

PLAN HOLDER 2: NAME(Required)

PLAN HOLDER 2: DATE(Required)

Associate Details

Associate Name

Please leave blank if not known:

THE COMPANY / OFFICE ONLY

COMPANY SIGNATURE

NAME

POSITION

A/AP No.

Office Only

Payment

Coupon

Total

Payment Method(Required)

I would prefer to pay offline

Pay using Card

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Credit Card

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SELECT YOUR LOCATION:

Elysium Funeral Plan - Spain

Contract Info

The Parties to the Contract: The Company

The Parties to this Contract: Applicant 1

Applicant 2

Next of Kin Applicant 1

Next of Kin Applicant 2

Purpose & Scope

1. PURPOSE OF THE CONTRACT

2. SCOPE OF THE SERVICE

Plan Purchased - Applicant 1

The Elysium Funeral Plan Payment Calculator (Applicant 1)

Récapitulatif des paiements

Beneficiaries - Applicant 1

2nd Beneficiary Details - Applicant 1

Plan Purchased - Applicant 2

The Elysium Funeral Plan Payment Calculator (Applicant 2)

Récapitulatif des paiements

Beneficiaries - Applicant 2

2nd Beneficiary Details - Applicant 2

Special Instructions

Payment Terms

3. EFFECTS OF PAYMENT:

4. NON-PAYMENT:

5. CANCELLATION:

6. LIABILITY:

7. FINANCIAL PROTECTION:

Details of the Plan

8. DETAILS OF THE PLAN:

THE ELYSIUM ASSIST PLAN - WHAT IS INCLUDED:

THE ELYSIUM ASSIST PLAN - WHAT IS NOT INCLUDED:

8. DETAILS OF THE PLAN:

THE CLARITY PLAN - WHAT IS INCLUDED:

THE CLARITY PLAN – WHAT IS NOT INCLUDED:

8. DETAILS OF THE PLAN:

THE TRANQUILITY PLAN – WHAT IS INCLUDED:

THE TRANQUILITY PLAN – WHAT IS NOT INCLUDED:

8. DETAILS OF THE PLAN:

THE SERENITY PLAN - WHAT IS INCLUDED:

THE SERENITY PLAN - WHAT IS NOT INCLUDED:

8. DETAILS OF THE PLAN:

THE UNITY REPATRIATION PLAN – WHAT IS INCLUDED:

THE UNITY REPATRIATION PLAN – WHAT IS NOT INCLUDED:

8. THE NON-RESIDENT PLAN

PLAN INCLUSIONS/EXCLUSIONS

Donations

9. SOCIAL CONTRIBUTIONS - (NON-CONTRACTUAL):

Politiques

10. DATA PROTECTION:

11. APPLICABLE LAW:

12. ACCEPTANCE:

13. SIGNATURES

Associate Details

THE COMPANY / OFFICE ONLY

Payment

Non-adhérent au régime

Que faire :