2023 New York State Annual Statement

Life Settlement Provider - 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 (Word and pdf).  The hard copy of the Annual Statement should not be sent, mailed or delivered to the Department. Submissions in other than regulation size and illegible 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.


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


The jurat in the annual statement must be signed with original signatures 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 compressed zipped file; after downloading, unzip to obtain the following files:

FORMS included for Download and/or Print:

When printing the blanks, be sure to use legal size paper (8 1/2" X 14").

The NEW YORK STATE Life Settlement ANNUAL STATEMENT 2023 (in WORD Format) is also available from the Annual Statements NY Supplement Page.


The following table shows Blank Type in Column One, Due Date in Column Two, Hard Copy in Column Three, Electronic Copies in Column Four and Where to File in Column Five.

Blank TypeDue DateHard CopyElectronic Copies (Word & pdf)Where to File
Life Settlement Annual Statement Blank3/1/202402Email electronic copy to:
[email protected]


If you need help filling out your forms, email: Mr. Edgardo Sison at [email protected].