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Appendix T(5) ____________________________________________________________________________________________________________Attorneys for ABC Investment, Inc.(Applicant/Transferee) IN THE SUPERIOR COURTOF THE STATE OF ARIZONA IN AND FOR THE COUNTY OF ________________ In re: Approval of Transfer of Structured Settlement Payment Rights by __________, Transferor and Payee, to ABC INVESTMENT, INC., Transferee. Case No . ________________ORDER APPROVING TRANSFER OF STRUCTURED SETTLEMENT PAYMENT RIGHTS (A.R.S. § 12-2901 et seq.THIS CAUSE COMING TO BE HEARD on the Application (the “Application”) of ABC Investment, Inc. (hereinafter “Applicant” or “Transferee”) for the approval of the transfer, sale and assignment by Transferor and Payee NAME (“Transferor/Payee”) to Transferee or Transferee’s successors or assigns (collectively “Transferee”) or transferor’s right to receive, and interests in, certain structured settlement payments hereinafter defined in Section 14 hereof (“Assigned Payments”) under Annuity Contract Number _________ (the “Annuity”) which is owned by NAME OF ANNUITY OWNER (“Owner”) and issued by NAME OF ANNUITY ISSUER (“Annuity Issuer”) pursuant to that certain Transfer Agreement for the Purchase and Sale of Structured Settlement Payment Rights entered into between Transferor and Transferee on _______________, 20__ (“Transfer Agreement”) and due notice having been given to all interested parties, and the Court being fully advised in the premises; NOW, this _____ day of ___________. 20__, IT IS HEREBY ORDERED, ADJUDGED AND DECREED as follows: 1.Venue is properly laid in this Court in __________ County, the residence of the Transferor/Payee, pursuant to A.R.S. § 12- 2903; 2. All interested parties were given notice in connection with the hearing on this matter as required under A.R.S. § 12-2903;3.Applicant has specifically warranted and represented that, to the best of its knowledge after diligent inquiry, no structured settlement transfer act (sometimes also known as a structured settlement protection act) enacted in any state other than Arizona applies to the transfer [alternatively, in the event that the SSPA of another state is also triggered, the additional SSPA(s) should be identified together with any requirements thereunder to the extent they differ from those of the forum state’s SSPA];4. Applicant has specifically warranted and represented that, to the best of its knowledge and its counsel’s knowledge after diligent inquiry, the transfer does not contravene any federal or Arizona state [or, if applicable, any other state’s] statute or the order of any court or responsible administrative authority and, after confirming that the underlying structured settlement is governed by Arizona law and that the order approving that settlement does not prohibit this transfer, the Court finds that this transfer does not contravene applicable law;5. At least three (3) business days before the date on which the Transferor/Payee signed the Transfer Agreement, the Applicant provided to the Transferor/Payee a Disclosure Statement as required by A.R.S. § 12-2902(B)(2);6.After having reviewed the Affidavit of the Transferor/Payee and having had the opportunity to question him/her directly, the Court finds that the aforesaid transfer is in the best interests of the Transferor/Payee, having taken into account the welfare and support of the payee’s dependents of which there are none;7.The Transferor/Payee has been advised by Applicant to seek professional advice regarding this transfer of payment rights, and has waived such advice in writing;8. ABC Investment has given written notice of the Transferee’s name, address and taxpayer identification number to NAME OF ANNUITY OWNER and to NAME IF ANNUITY ISSUER and has filed copies of those notices with this Court;9. The Transfer Agreement provides that if the Transferor/Payee is domiciled in the State of Arizona that any disputes between the parties will be governed in accordance with the laws of the State of Arizona and that the domiciled state of the Transferor/Payee shall be the proper venue to bring any cause of action arising out of a breach of the Transfer Agreement;10. Applicant has specifically warranted and represented that, to the best of its knowledge and its counsel’s knowledge, this transfer complies with all requirements of A.R.S. § 12-2901 et seq. , and the Court likewise adopts this finding on its own;11.The Transferor/Payee consents to and authorizes the filing by transferee or any assignee or successor of Transferee, of any applicable UCC financing statements against Transferor/Payee or any other applicable persons relating to the interests which are the subject of the transfer;12. Notwithstanding any antiassignment or antiencumbrance language in the underlying Settlement Agreement and Release dated __________, 20__ and in related contracts and annuity documents, the Court finds that notice of this proposed transfer was clearly given to all interested parties, that objections, if any, based on such antiassignment or antiencumbrance language has been effectively waived, and that the Transfer Agreement and transfer of the Assigned Payments are approved. The provisions of the Transfer Agreement are hereby incorporated by reference into this Order. The Transferor/Payee shall not retain and shall not be permitted to assign or transfer to any other person or entity any interest in the Assigned Payments or any rights and interests related thereto;13. As and when due, the Assigned Payments, detailed below, shall be made payable and forwarded to ABC Investment, Inc. or to its successors and/or assigns at ADDRESS;14. The Assigned Payments as described in the Transfer Agreement are those payments that SPECIFY AMOUNT AND DUE DATE FOR EACH SUCH PAYMENT, with an agreed purchase price of $__________;15. The Annuity Issuer and Annuity Owner shall not change or cause to be changed the payment recipient’s name or payment address for the Assigned Payments stated above unless they have received express written notice from Transferee to do so;16.Following this transfer of structured settlement payment rights, and pursuant to A.R.S. § 12-2902(C): a.The structured settlement obligor/annuity NAME OF ANNUITY OWNER and the annuity NAME OF ANNUITY ISSUER shall, as to all parties except the Transferee, be discharged and releases from any and all liability for the Assigned Payments; b.The Transferee shall be liable to the structured settlement obligor/annuity owner NAME OF ANNUITY OWNER and to the annuity issuer NAME OF ANNUITY ISSUER: i.if the transfer contravenes the terms of the structured settlement, for any taxes incurred by the parties as a consequence of the transfer; and ii.for any other liabilities and costs, including reasonable costs and attorneys’ fees arising from compliance by the parties with this Order or arising as a consequence of the Transferee’s failure to comply with A.R.S. § 12-2901 et. seq.; c. Neither the annuity issuer nor the structured settlement obligor/annuity owner may be required to divide any periodic payment between two or more transferees or assignees; and d.Any further transfer of structured settlement payment rights by the Transferor/Payee may be made only after compliance with all of the requirements of A.R.S. § 12-2901 et. seq. [and of any other state’s SSPA that may apply]. 17.This Order in no way modifies or negates ownership or control over the Annuity by the structured settlement obligor/annuity owner; 18.This Order is intended to be and is a final order for all purposes under Arizona’s Structured Settlement Transfer Act (A.R.S. § 12-2901 et. seq.), all without further order of this Court.NOW, THEREFORE, IT IS HEREBY ORDERED that said transfer is hereby approved on the terms set forth in the Transfer Application, and for all other purposes as set forth in A.R.S. § 21- 2901 et. seq.DATED this ______ day of ________________, 20__. BY THE COURT: ______________________________ Approved as to form and content:By:___________________________Dated:___________Attorney for ABC Investment, Inc.