Form of Life Settlement Purchase Agreement

Exhibit 10.4


[LOGO] AmeriFirst FUNDING GROUP, INC.


INSURED: ___________________ POLICY NUMBER: _____________ ADDRESS: ____________________ ____________________ ____________________ INSURANCE COMPANY: ____________________ FACE VALUE: ________________ PHONE NUMBER: ______________ SOCIAL SECURITY NUMBER: ____ ___ _____


Dear


We would like to take this opportunity to thank you for choosing AmeriFirst Funding Group, Inc. To ensure rapid processing of your application, please sign and return the enclosed agreements in the self-addressed Federal Express package we have provided.


THIS PACKET, COMBINED WITH THE APPLICATION YOU FILLED OUT WITH YOUR POLICY BROKER, CONSTITUTE THE ENTIRE CONTRACT BETWEEN AMERIFIRST FUNDING GROUP, INC. AND YOU, THE VIATOR.


Enclosed you will find the following forms:


I. DISCLOSURE STATEMENT - Initial, sign and notarize.


II. VIATICAL SETTLEMENT CONTRACT AND ESCROW AGREEMENT - Sign


III. NOTICE OF INTENT TO CHANGE OWNERSHIP AND BENEFICIARY - Sign and notarize


IV. POLICY NOTICE - Sign and notarize.


V. RELEASE AND CONSENT TO CHANGE OF BENEFICIARY FORM - Sign notarize and
witness signature.


VI. MEDICAL RELEASE - Sign and notarize.


VII. POWER OF ATTORNEY - Sign and notarize


VIII. ACKNOWLEDGEMENT AND CONSENT FORM - Sign and notarize


IX. CHANGE OF OWNERSHIP OR ABSOLUTE ASSIGNMENT - Sign.


X. DISTRIBUTION DIRECTIONS (2) - Please fill out ONE page that describes how
you would like to receive your settlement. CHECK or WIRE TRANSFER.


XI. PERSONAL REFERENCES - Please fill this out completely.


XII. NOTICE - Please read and keep for your records.


The funds, which will be used to purchase your policy are currently held by AmeriFirst Fund I, LLC herein known as ("The Fund") a Florida based company authorized to transact business in Georgia. Upon return receipt of these forms two transactions will take place:


1. Your money will be transferred from The Fund to an escrow account
held by AmeriFirst Funding Group and held until closing.


2. Your forms will be sent to the insurance company. Upon written
notification from the insurance company that your life insurance
policy has been assigned to Funding Group the policy will close.


3. At closing Funding Group will transfer ownership to The Fund and
assign The Fund as the beneficiary.


If you have any questions, please feel free to call us.


Sincerely,


DISCLOSURE


You, ______________(hereinafter referred to as "viator") are about to enter into a Viatical Settlement contract, which involves an irrevocable transfer and Assignment of Ownership and beneficial interests in your life insurance policy to The Fund or its nominees. This agreement is for an amount less than the face value of the policy. Before agreeing to the contract, you should be informed of the following:


I. Persons with catastrophic or life threatening illnesses or conditions may have alternatives to viatical settlements, including accelerated benefits offered by the issuer of the policy, loans secured by the policy and the surrender of the policy for cash value.


II. A viator may incur tax consequences from entering into a viatical settlement. Persons interested in entering into a viatical settlement should consult their tax advisor.


III. A viator has the unconditional and absolute right to cancel and rescind the viatical settlement contract at any time prior to the full payment of the proceeds. Additionally, a viator may cancel and rescind this contract not later than the 15th day after full payment of proceeds to the viator provided the full amount of the proceeds and any premiums paid by AmeriFirst Funding Group, Inc. on said policy are returned by the viator to AmeriFirst Funding Group, Inc.


IV. A viatical settlement may affect a viator's ability to receive supplemental social security income, public assistance and public medical services. Persons interested in entering into viatical settlements should consult an attorney, financial advisor or social services agency regarding these potential consequences.


V. The proceeds of a viatical settlement payable to the viator may not be exempt from the viator's creditors, personal representatives, trustees in bankruptcy and receivers in state and federal court. Persons interested in entering into a viatical settlement should consult an attorney of financial advisor regarding these potential consequences.


VI. A viator has the right to know, upon request, the identity of any person who will receive a commission or other form of compensation from the viatical settlement company with respect to the viatical settlement and the amount and terms of such compensation.


VII. The proceeds to the viator shall be made in a lump sum. No portion of the proceeds by the viatical settlement provider or escrow agent will be held back.


VIII. A viator may designate any adult individual in regular contact with the viator as the contact for all inquiries about the viator's health status, and, if such designation is made, a viatical settlement company cannot make such an inquiry to the viator, unless the company is unable, after diligent effort, to contact the designee for more than thirty days. The viator may change this designation at any time, upon written notice to the viatical


settlement company.


IX. The viator should be aware that all medical, financial or personal information solicited or obtained by a viatical settlement company about a viator, including the viator's identity or the identity of family members, a spouse or a significant other, is confidential and shall not be disclosed in any form to any person, unless disclosure is necessary to effect the viatical settlement between the viator and the viatical settlement company and the viator provides prior and knowing written consent to the disclosure. All persons to whom confidential information is disclosed pursuant to the viator's consent shall maintain the confidentiality of such information, and not disclose it to any other person in any form, without prior and knowing written consent of the viator.


X. By entering into a viatical settlement contract all of the right, title, interest and benefit in and to the viator's life insurance policy, including all supplementary contracts and riders attached thereto, will become the property of The Fund. This includes disposition of proceeds, cash values, dividends, double or additional indemnity, accidental death or other riders insuring the lives of spouses, family members or anyone else other than the viator. The premium payments on the viator's life insurance policy will no longer be ...