Shareholder Bereavement Assistance Request

Far West, Inc. Section 7(r) Bereavement Policy provides Shareholder's Bereavement Assistance of up to $1,000.00 on behalf of a FWI shareholder, or $500.00 on behalf of a lineal descendant of a FWI shareholder, to help defray the cost of funeral expenses for the deceased FWI shareholder or lineal descendant. “Lineal descendant” means a child or grandchild of a FWI shareholder. Payment is subject to the following:

1. This form must be signed by next of kin family representative or court appointed personal representative.
2. Payment will be made directly to funeral home or other approved vendor (please attach invoice if available).
3. The deadline for filing for bereavement assistance is within thirty (30) days of date of death.