California Code of Regulations
Title 10 - Investment
Chapter 5 - Insurance Commissioner
Subchapter 3 - Insurers
Article 12.9 - Life Settlements
Section 2548.29 - Life Settlement Broker Disclosure to Owner and Insured
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
State of California Department of Insurance Life Settlement Broker Disclosure to Owner and Insured (To be provided prior to the execution of the life settlement contract)
IMPORTANT: READ THIS DISCLOSURE FORM BEFORE SIGNING ANY LIFE SETTLEMENT CONTRACT.
The Commissioner may consider any failure to provide the disclosures in this form as a basis for suspending or revoking a broker's license. You should carefully read all of the following and seek financial, insurance, tax and other advice where appropriate.
1. The name, business address, and telephone number of the life settlement broker are as follows:
Broker's (printed) name: ______________________________
Address: ______________________________
Telephone number: ______________________________
2. A full, complete, and accurate description of all the offers, counteroffers, acceptances, and rejections relating to the proposed life settlement contract (including name of party, date made, price and any other material terms) is:
[] Attached.
[] As follows:
___________________________
___________________________
___________________________
3. The following affiliation or contractual arrangements exists between the broker and the provider making an offer in connection with the life settlement arrangement:
[] None
[] As follows:
___________________________
___________________________
___________________________
4. To be provided only where the owner of the policy is also the insured: the following life expectancy estimates were provided in connection with the life settlement:
___________________________LE Provider | ___________________________ Life Expectancy Estimate | ||
___________________________LE Provider | ___________________________ Life Expectancy Estimate | ||
___________________________LE Provider | ___________________________ Life Expectancy Estimate |
LIFE INSURANCE POLICY INSURED AND OWNER'S ACKNOWLEDGMENT: I have read and fully understand this disclosure form and have received a copy to keep for my records.
LIFE SETTLEMENT BROKER | ||
By:___________________________ | ||
Printed Name:___________________________ | ||
Date:___________________________ | ||
LIFE INSURANCE POLICY INSURED | LIFE INSURANCE POLICY OWNER | |
By:___________________________ | By:___________________________ | |
Printed Name:___________________________ | Printed Name:___________________________ | |
Date:___________________________ | Date:___________________________ |
1. New section
filed 7-29-2010 as an emergency; operative 7-29-2010. Emergency regulation shall
remain in effect, not to be repealed by the Office of Administrative Law, unless
repealed by the Department of Insurance pursuant to Insurance Code section
10113.35
(Register 2010, No. 31).
2. Change without regulatory effect amending
NOTE filed 1-24-2012 pursuant to section
100, title 1, California Code of
Regulations (Register 2012, No. 4).
3. Renumbering of former section
2548.29 to section
2548.30 and renumbering and amendment
of former section
2548.28 to new section 2548.29 filed
11-25-2014; operative 1-1-2015 (Register 2014, No.
48).
Note: Authority cited: Section 10113.35, Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); 20th Century Ins. Co. v. Garamendi, 8 Cal.4th 216 (1994). Reference: Section 10113.2, Insurance Code.