Edit, sign, and share Deferred Payment Agreement Form online. No need to install software, just go to DocHub, and sign up instantly and for free.Resident must complete and submit a confidential Financial Disclosure. The agreement must have you pay a specific fee as a condition for the home's promise to provide lifetime care that includes medical care. Enrollment Center at the above address. A deferred payment agreement is an arrangement with your council that lets you use your home's value to cover care home costs. Use this form to authorize an exchange from a non-qualified deferred annuity contract to a Long Term Care Insurance policy. Dementia Care Standard for Nursing. Homes. Of ______, ______ County, Massachusetts (the "Husband") and.