2025 New York State Life Settlement Provider Annual Statement
The Department strictly enforces the statutory filing requirements of Section 7807(a) of the New York Insurance Law and imposes penalties for any violations thereof. Penalties of up to $500 per day will be assessed for failure to file required forms on time and in the prescribed manner outlined below. It is the responsibility of each licensed entity to comply with applicable statutes and regulations at all times.
The Annual Statement and all related forms are required to be submitted in the correct format (MS Word and PDF) and size (8 1/2" X 14"). You do not need to mail or deliver a hard copy to the Department.
Submissions in other than regulation size and illegible copies will not be accepted and the filing will be considered delinquent. Correspondence and amendments to your Annual Statement should also be filed in both Word and PDF.
Provide a 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 about your filed annual statement.
Signatures and Notarization
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.
Filing Blank
Specific instructions for filing the New York Life Settlement Annual Statement and the blank statement for this year can be found below.
Specific Filing Instructions
Complete copies of the 2025 Annual Statement must be filed online by March 1, 2026, one in MS Word format and one in PDF format.
For the Microsoft Word document, do not use any format other than Microsoft Word. The MS Word version does not need to be notarized.
For the PDF copy, follow instructions 2 to 10 below. Once the PDF is completed, signed and notarized, scanned and saved in PDF format, attach both the MS Word and the signed, notarized PDF to an email and send the email to the address noted below. You do not need to mail a hard copy to the Department.
- The PDF must contain a Jurat, signed by at least two principal officers. All signatures must be original. The signatures must be in the correct place indicated at the bottom right, below the sworn statement, next to the officer’s title. The original signed Jurat must be properly notarized. To be properly notarized, the “State” where the Jurat is signed and the “State” of the Notary stamp must be the same. Statements received without a properly executed Jurat will not be accepted.
- Do not change the size of the document. Statements must be submitted (and the PDF generated) at 8.5" by 14". The MS Word blank is provided at that size.
- Print the name of the life settlement provider at the top of all pages where indicated.
- Respond fully to each item. Statements filed containing blank lines or unanswered questions may be deemed incomplete. Reply with “None”, “Not Applicable”, “N/A”, or “0”, as applicable. If no entries are to be made in a Schedule, write “N/A” somewhere in the Schedule and include an explanation as to why the requested information is not applicable.
- Report all amounts in whole dollars only. You may elect to report the amounts to the nearest dollar or through truncation of digits below a dollar. (Example: $583,683.52 may be reported as $583,684 by rounding or as $583,683 by truncation). It is expected that the failure of items to add to the summary of totals may reflect this treatment.
- Do not change the page numbers in the Statement. If extra pages are needed, use decimals after the page number, for example: 2.1, 2.2, etc.
- Pay attention to designations. All amounts on the Schedules are to be reported according to designations within the Schedules. (Example: “Life Settlement Transactions Involving New York Residents” should not include transactions for other than New York).
- For Annual Statement lines labeled “Aggregate Write-ins”, enter the total of the write-ins listed in the Section “DETAILS OF WRITE-INS AGGREGATED AT LINE...” (Example: In Page 2, “ASSETS”, copy the number in line 1199 to line 11. List separately each category of miscellaneous assets for which there is no pre-printed line on Page 2. An overflow page is provided on the last page of the Annual Statement if you need space for more write-ins. Use an aggregate write-in only if the item being reported is completely incompatible with any of the pre-printed lines on Pages 2, 3, and 4.
- Protect PPI. Individual policyowners or insureds should not be identified by name in the Annual Statement.
The New York State Life Settlement Provider Annual Statement blank is also available on the Annual Statements NY Supplement Page.
Questions?
If you have questions regarding compliance or this filing, email Edgardo Sison at [email protected] or call (212) 709-7710.
Due Date and Email Address
The following table shows Blank Type in Column One, Due Date in Column Two, Electronic Copies in Column Three and Where to File in Column Four.
| Blank Type | Due Date | Electronic Copies (MS Word & PDF) | Where to File |
| Life Settlement Annual Statement | March 1st. | 2 | Email both documents as attachments to [email protected] |
Questions?
If you need help filling out the statement or have questions, email Edgardo Sison at [email protected] or [email protected]