Application Part 3: Contract Worksheet

  • Application Part 3: Contract Worksheet

  • Date of Birth:
     - -

  • The gestational agreement is one of the most important documents in the surrogacy process. This contract is created between you and then intended parents as a way to lay out expectations for the journey, as well as provide a framework for any monetary compensation that you will receive.

    The "Contract Worksheet" is not a binding agreement; it is a document that will be shared with both the intended parents and all attorneys so that a gestational agreement can be created. These are your requests.

    Please expect that there will be negotiable items in this document. It is a normal part of the process. If you have any questions, please contact your case manager or the attorney assisting you.

  • How many embryos are you comfortable transferring? (Remember that each embryo could take and, in very rare instance, split into two.)
  • Are you comfortable with termination in the following instances? (Mark as many below as necessary.)
  • In the event of an emergency, would you consider being kept on life-sustaining medical equipment until the time the baby could be delivered?

  • What kind of communication would you like to have with your Intended Parents?

  • Compensation

    In the next few pages, please enter the information requested. It is important to note that these are just requests - the actual contract may reflect different numbers and items.

  • BASE COMPENSATION: Your "base" compensation is also called "pre-birth" support in some contractions. This is the monthly compensation that you will receive once pregnancy is confirmed by heartbeat on ultrasound. Although compensation may vary based on geographic location and insurance coverage, $45-55,000 is average for 1st time surrogates, $55-$75,000 is average for repeat surrogates.

  • CATEGORICAL COMPENSATION: These are monies that you will receive for various procedures and expenses. Please initial each one AND/OR enter a different amount with your initials in each box.

  • CONTINGENCY COMPENSATION - The "contingency" items are those that we don't necessarily expect to occur, but we want to be sure that we make plans for such. Please initial each one AND/OR enter a different amount with your initials in each box.

  • LOST WAGES - In the event of physician-ordered work or bedrest, and in the absence of disability wages, you may request that the wages lost from missed work be compensated. You will likely not receive lost wages if you are using sick or vacation time from work.

    It is also possible for your husband to request lost wages for the time needed to care for you during bedrest, or peri- post delivery if vacation or sick days cannot be used. Expect that a cap may be placed on the number of weeks to be paid.

  • OTHER ASSISTANCE - you may also request assistance for the following:

  • Items that will be paid on your behalf:

    *Health Insurance Premiums (if not already being paid by GC or husband as an individual or company policy)

    *Copayments, Coinsurance, and Deductibles for pregnancy-related medical expenses

    *Attorney fees for GC's attorney to review the Gestational Agreement

    *Travel Expenses (over 50 miles round trip), airfare for travel to screening appointments and embryo transfer, Uber/Taxi/rental car, if needed, during screening and/or embryo transfer trips, Hotel

  • Date
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  • Should be Empty: