Life Settlement Broker (Resident and Non-Resident)

Forms and Applications

Application Type # of pages

Individual Life Settlement Broker - Original/Relicensing Application Form and Instructions (PDF)

12 Pages

Entity (Corporations/Partnerships/LLCs) Life Settlement Broker- Original/Relicensing Application and Instructions (PDF)

16 Pages

Statement of Employer Form - Life Settlement Brokers (PDF)

2 Pages

Submission Requirements

Online licensing is available to first time RESIDENT applicants applying for an INDIVIDUAL/TBA license who have taken the exam within the past two (2) years. RESIDENT applicants are to apply online. Non-resident online licensing is also available to first time non-resident applicants applying for an INDIVIDUAL license through the National Insurance Producer Registry (NIPR) website.

INDIVIDUAL/TBA license is issued with an Expiration date determined by birth:

  • If you were born in an even numbered year, your license will expire on your birthday in an even numbered year.
  • If you were born in an odd numbered year, your license will expire on your birthday in an odd numbered year.

Match the submission code numbers listed under the “Resident” or “Non-Resident” columns with the corresponding numbers on “Submission Requirement Code Chart” to determine what is needed to obtain a license.

  • Resident - one who has declared New York as their Home State; Home State means the District of Columbia or any state or territory of the United States in which the applicant maintains his, her or its principal place of residence or principal place of business.
  • Non-Resident - licensee who has declared a state OTHER than New York as their Home State. Home State is where you maintain a principal place of residence or business AND are licensed in good standing for the lines of authority being applied for in this application.
LB life, accident & health, variable life/variable annuities broker 2104(b)(1)(A) 1,2,3,4,7 1,2,5,6,7

(1) one qualified by examination who was licensed as LA or LB within last 2 years (2) one who has been licensed within the last 90 days and in good standing in the declared home state for the lines of authority being applied for in this application (3) non-resident LA or LB

Individual/TBA - up to 2 years from date of issue to Date of Birth Expiration (See Note Above)

Entities - 2 yrs-11/1 to 10/31 of odd years

See Fee Schedule 

Application. Download form from this Department's website.


FEE -- See “Fee” columns. Full fees are charged when a license is issued for a licensing period greater than one year; half fees are charged when a license is issued for a licensing period of one year or less. Make check payable to “Superintendent of Insurance.” $20 will be charged for each check dishonored by the bank. RESIDENT: Partnership, corporation, limited liability company fee is per sub-licensee. NON-RESIDENT: See Fee Schedule.


Original passed score report for life/accident & health exam taken within 2 years unless "exempt from #3" above. Call PSI* for examination information. Life qualifications and proof of having passed the applicable NASD or SEC examination are required for Variable Life/Variable Annuities. A first time applicant must submit either (1) School Certificate (course must be completed prior to sitting for the examination) OR (2) Statement of Employer form documenting that the applicant has been regularly employed by a licensed insurance company, broker or agent for not less than 1 year during the 3 years preceding the date of application, and has been employed in responsible insurance duties relating to the use of life insurance, accident & health insurance and annuity contracts in the design and administration of plans for estate conservation and distribution, employee benefits and business continuation.


Proof of accumulation of Continuing Education credits if such proof was required had the last license been renewed and the $10.00 Continuing Education filing fee unless filing under #3 for Life/Accident & Health.


Must be currently licensed and in compliance in your declared home state. NOTE: Your license information MUST be included in the National Producer Database; if not, you must submit a currently dated Certification from the state you have declared as your home state and in which your principle place of business or residence is located.


Code 4, if applicable, unless the home state information shows that the Continuing Education requirements of that state have been met.


Proof of required filing of a partnership, corporation, limited liability company, or trade name. It is recommended that applicant obtain name approval for use of the name in the insurance industry from this Department before filing the name with a County Clerk office or the New York State Department of State. You may submit a list of proposed names in the order of preference to New York State Department of Financial Services, Licensing Bureau, One Commerce Plaza, Albany, NY 12257 or to our e-mail address, [email protected]. Once a name is approved, licensing instructions will be provided.

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