*JKG Surya LLC - Funeral Service Plan Application

FUNERAL SERVICE PLANS
Our collaborator is committed to providing compassionate and personalized service. From pre-planning consultations to the final arrangements, we handle every detail with care and respect. Affordable funeral service plans designed to fit within your budget. Ensure your legacy is celebrated without leaving a financial burden for your family. Say goodbye to loved ones financial worries.

This special offer is a collaborative endeavor with the largest funeral network in the United States and Latin America, backed by the support of Naser Global. As the largest and most renowned corporate group in the industry, Naser Global provides International Funeral Solutions globally through a robust network of over 7,000 affiliates, boasting offices and funeral homes in Latin America and the United States.

Starting with the initial consultations for pre-planning and extending through to the final arrangements, the funeral service plan covers every aspect with meticulous care and the utmost respect throughout the entire process. Guarantee that your legacy is honored without imposing a financial burden on your family, providing them reassurance regarding financial matters as they bid farewell to their loved ones.

For any inquiries or changes to your application, please feel free to contact us at jkgsuryallc@gmail.com.
NATIONWIDE (US) & LATIN AMERICA

A-Z INVIDIVIDUAL FUNERAL PLANS INCLUDES THE FOLLOWING
- Nationwide Emergency Helpline (24/7)
- Legal procedures & formalities
- Body retrieval (home, morgue, hospital or airport)
- Transfer to funeral home
- Thanatopraxy & Embalming (if required)
- Casket (basic)
- Viewing at funeral home or Religious Congregration (up to 2 hours)
- Hearst (1) if needed
- Transfer to cemetery *(up to 25 miles)
- Transfer to crematory (up to 25 miles)
- Cremation service
- Urn for ashes (basic)
- Digital obituary
- Guest book
- Concierge (included)
- (*)Cemetery plot is not included
PLAN "WAITING PERIOD"

Every funeral arrangement comes with a specified waiting period before the policy is deemed active. Those aged 65 and below have a waiting period of 30 days, Aged 66 and above are subject to a waiting period of 90 days and individuals with a terminal illness have a waiting period of 18 months.
FUNERAL SERVICE PLAN APPLICATION
Today's Date

MonthDayYear
Date
Please SELECT the plan you are applying for:

$39.99 per month (1 Applicant)$74.99 per month (2 Applicant)$107.99 per month (3 Applicant)$139.99 per month (4 Applicant)$159.99 per month (5 Applicant)$176.99 per month (6 Applicant)

(1st) Applicant Name:

First NameMiddle NameLast NameSuffix
(1st) Applicant Address:

Street Address

Suite / Apartment No.

CityState

Postal / Zip Code
(1st) Applicant Date of Birth:

MonthDayYear
Date
(1st) Applicant Country of Birth:
(1st) Applicant Country of Residence:
(1st) Applicant Phone Number:
Please enter a valid phone number.
(1st) Applicant Marital Status:
(1st) Applicant Gender:
(1st) Applicant Email:
example@example.com
(1st) Applicant Emergency Contact Name:

First NameMiddle NameLast NameSufix
(1st) Applicant Emergency Contact Phone Number:
Please enter a valid phone number.
(1st) Applicant Emergency Contact Email:
example@example.com
Emergency Contact Relationship to (1st) Applicant
(2nd) Applicant Name:

First NameMiddle NameLast NameSuffix
(2nd) Applicant Address:

Street Address

Suite / Apartment No.

CityState

Postal / Zip Code
(2nd) Applicant Date of Birth:

MonthDayYear
Date
(2nd) Applicant Country of Birth:
(2nd) Applicant Country of Residence:
(2nd) Applicant Phone Number:
Please enter a valid phone number.
(2nd) Applicant Marital Status:
(2nd) Applicant Gender:
(2nd) Applicant Email:
example@example.com
(2nd) Applicant Emergency Contact Name:

First NameMiddle NameLast NameSufix
(2nd) Applicant Emergency Contact Phone Number:
Please enter a valid phone number.
(2nd) Applicant Emergency Contact Email:
example@example.com
Emergency Contact Relationship to (2nd) Applicant
(3rd) Applicant Name:

First NameMiddle NameLast NameSuffix
(3rd) Applicant Address:

Street Address

Suite / Apartment No.

CityState

Postal / Zip Code
(3rd) Applicant Date of Birth:

MonthDayYear
Date
(3rd) Applicant Country of Birth:
(3rd) Applicant Country of Residence:
(3rd) Applicant Phone Number:
Please enter a valid phone number.
(3rd) Applicant Marital Status:
(3rd) Applicant Gender:
(3rd) Applicant Email:
example@example.com
(3rd) Applicant Emergency Contact Name:

First NameMiddle NameLast NameSufix
(3rd) Applicant Emergency Contact Phone Number:
Please enter a valid phone number.
(3rd) Applicant Emergency Contact Email:
example@example.com
Emergency Contact Relationship to (3rd) Applicant
(4th) Applicant Name:

First NameMiddle NameLast NameSuffix
(4th) Applicant Address:

Street Address

Suite / Apartment No.

CityState

Postal / Zip Code
(4th) Applicant Date of Birth:

MonthDayYear
Date
(4th) Applicant Country of Birth:
(4th) Applicant Country of Residence:
(4th) Applicant Phone Number:
Please enter a valid phone number.
(4th) Applicant Marital Status:
(4th) Applicant Gender:
(4th) Applicant Email:
example@example.com
(4th) Applicant Emergency Contact Name:

First NameMiddle NameLast NameSufix
(4th) Applicant Emergency Contact Phone Number:
Please enter a valid phone number.
(4th) Applicant Emergency Contact Email:
example@example.com
Emergency Contact Relationship to (4th) Applicant
(5th) Applicant Name:

First NameMiddle NameLast NameSuffix
(5th) Applicant Address:

Street Address

Suite / Apartment No.

CityState

Postal / Zip Code
(5th) Applicant Date of Birth:

MonthDayYear
Date
(5th) Applicant Country of Birth:
(5th) Applicant Country of Residence:
(5th) Applicant Phone Number:
Please enter a valid phone number.
(5th) Applicant Marital Status:
(5th) Applicant Gender:
(5th) Applicant Email:
example@example.com
(5th) Applicant Emergency Contact Name:

First NameMiddle NameLast NameSufix
(5th) Applicant Emergency Contact Phone Number:
Please enter a valid phone number.
(5th) Applicant Emergency Contact Email:
example@example.com
Emergency Contact Relationship to (5th) Applicant
(6th) Applicant Name:

First NameMiddle NameLast NameSuffix
(6th) Applicant Address:

Street Address

Suite / Apartment No.

CityState

Postal / Zip Code
(6th) Applicant Date of Birth:

MonthDayYear
Date
(6th) Applicant Country of Birth:
(6th) Applicant Country of Residence:
(6th) Applicant Phone Number:
Please enter a valid phone number.
(6th) Applicant Marital Status:
(6th) Applicant Gender:
(6th) Applicant Email:
example@example.com
(6th) Applicant Emergency Contact Name:

First NameMiddle NameLast NameSufix
(6th) Applicant Emergency Contact Phone Number:
Please enter a valid phone number.
(6th) Applicant Emergency Contact Email:
example@example.com
Emergency Contact Relationship to (6th) Applicant

RECURRING PAYMENT AUTHORIZATION
(Payor) Applicant Government Issued ID
(Payor) Applicant ID Upload

Cancelof
(Payor) Email:
example@example.com
(Payor) Phone Number:
Please enter a valid phone number.
(Payor) Name on Debit/Credit Card:

First NameMiddle NameLast NameSufix

Select the Funeral Service Plans below to start the monthly subscriptions on the 1st of every month.

Funeral Service Plan (1 Applicant)Funeral Service Plan (1 Applicant)

$39.99 for each month

Funeral Service Plan (2 Applicant)Funeral Service Plan (2 Applicant)

$74.99 for each month

Funeral Service Plan (3 Applicant)Funeral Service Plan (3 Applicant)

$107.99 for each month

Funeral Service Plan (4 Applicant)Funeral Service Plan (4 Applicant)

$139.99 for each month

Funeral Service Plan (5 Applicant)Funeral Service Plan (5 Applicant)

$159.99 for each month

Funeral Service Plan (6 Applicant)Funeral Service Plan (6 Applicant)

$176.99 for each month

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

(Payor) Debit/Credit Card Address:

Street Address

Street Address Line 2

CityState

Postal / Zip Code
I, the named card holder above, authorize JKG Surya LLC to charge my Debit/Credit Card indicated above on the 1st day of each month following the initial payment. This payment is for the Funeral Service Plan option selected above. I am authorizing JKG Surya LLC to charge my debit/credit card on a regular monthly schedule. I will be charged a monthly fixed amount based on the funeral plan I have selected above and all transactions will appear on my debit/credit card statement as “JKG Surya LLC". I acknowledge that JKG Surya LLC will handle the processing of monthly payments on behalf of Naser Global LLC. Naser Global LLC will furnish the policy number and necessary services to support all currently active policies.

I acknowledge that this authorization will persist until I formally revoke it in writing. I commit to informing JKG Surya LLC in writing about any alterations to my account details or the termination of this authorization at least 15 days prior to the upcoming billing date.

The initial payment for the selected funeral plan will be processed within 1-3 business days following the submission date. Once a Funeral Service Plan is issued, subsequent payments will occur on the 1st day of each subsequent month. Should the specified payment dates coincide with a weekend or holiday, I acknowledge that transactions may occur on the next business day. If payment processing is unsuccessful on the 1st, JKG Surya LLC has the discretion to make another attempt within 1-3 days. If the payment remains unsuccessful after two attempts and a policy with Naser Global LLC is active, I understand that my policy may be terminated.

I understand that the initiation of recurring transactions on my debit/credit card must adhere to U.S. legal provisions. I certify that I am an authorized user of the specified debit/credit card and commit not to dispute these scheduled transactions with my debit/credit institution, provided they align with the terms outlined in this authorization form.
Executed on this Date   ENTER DATE,
in the County of      ,
State of      ENTER STATE.
(Payor) Debit/Credit Card Holder's Signature:

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FUNERAL SERVICE PLANS

RECURRING PAYMENT AUTHORIZATION