Life Settlement Provider License Application Forms

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Unless noted otherwise, the forms available below are in Word format.

• Application (PDF format)
• Power of Attorney (3 forms in this set)
  • Resolution of Board of Directors
  • Certificate of designation by life settlement provider
  • Appointment of Superintendent of Financial Services as Attorney
• Biographical Affidavit (PDF format)
• Untrustworthy Commitment
• Plan of Operation Commitment
• Revised! - Experience Demonstration - Filing Notes Added on LSP-Exp1 and LSP-Exp3
  • Policies Settled and Paid During Calendar Year 2009 Where Insureds Death Did Not Occur Prior to December 31, 2009 or Insureds Death is Unknown - LSP-Exp1(Revised 05/13/2010)
  • Development of Life Settlements Paid and Revenues Received from Matured Insurance Policies - LSP-Exp2
  • Paid Life Settlements Where Insured's Death Occurred During Calendar Year 2009 - LSP-Exp3 (Revised 05/13/2010)
• Escrow Agreement

Updated 10/03/2011