2012 NEW YORK STATE ANNUAL STATEMENT
Life Settlement - General Filing Instructions

The Department intends to strictly enforce the statutory filing requirements of Section 7807(a) of the New York Insurance Law and impose penalties for any violations thereof. Penalties of up to $500 per day shall be assessed for failure to file required forms on time and in the prescribed manner outlined below:

The Annual Statement and all related forms are required to be submitted in the prescribed form and size (8 1/2" X 14") in duplicate. Submissions in other than regulation size and non-legible copies will not be accepted and the filing will be considered delinquent.

All correspondence and amendments to your Annual Statement must be filed in duplicate.

CONTACT PERSON:
On the jurat page, be sure to enter the name and telephone number of a contact person whom the Department can reach with questions on your annual statement.

SIGNATURE AND NOTARIZATION:
The jurat in the annual statement must be signed with original signature by the appropriate officers and notarized. Photocopies of signatures and/or notarization will NOT be accepted.

This Web site also provides specific instructions for filing the New York Life Settlement Annual Statement with our Department. A copy of the New York Life Settlement Annual Statement is available in the Download section of this Web site.

Life Settlement - Specific Filing Information

The Life Settlement Filing INSTRUCTIONS AND FORMS PACKET is a self-extracting zipped file; after downloading file, run EXE to obtain the following PDF (Acrobat) files.  You will need the Adobe Acrobat Reader to view or print PDF files. When printing the blanks, be sure to use legal size paper (8 1/2"X14"). Each of the Blanks is bookmarked with a full table of contents for on-line viewing.

FORMS included for Download and/or Print:

• NEW YORK STATE LIFE SETTLEMENT ANNUAL STATEMENT 2012
  (Word Format)
• INSTRUCTIONS FOR COMPLETING 2012 ANNUAL STATEMENT

To view full instructions for unzipping compressed files, please select this link.

The NEW YORK STATE Life Settlement ANNUAL STATEMENT 2012 (in WORD Format) is also available from the SUPPLEMENT BLANKS PAGE.

DUE DATE & MAILING
The following table shows Blank Type in Column One, Due Date in Column Two, Hard Copies in Column Three, Diskette Copies in Column Four and Where to File Hard Copies in Column Five.

PROBLEMS AND QUESTIONS:
If you need help filling out your forms, call: Life Bureau, New York City, Mr. Victor Agbu (212) 480-5019 or Mr. Eugene Murphy (212) 480-5041.