Code of Massachusetts Regulations
940 CMR - OFFICE OF THE ATTORNEY GENERAL
Title 940 CMR 18.00 - Viatical Settlements And Viatical Loans
Section 18.06 - Viatical Loan Disclosures

(1) It is an unfair or deceptive act or practice for a Viatical Loan Provider, Broker, or Representative to fail to mail to the last known address(es) of, or to provide in person to, the Viatical Loan Applicant/Borrower and the Insured the following Attorney General's Viatical Loan Disclosure Form (the "Form"). This Form shall be completed and mailed to the last known address(es) of, or provided in person to, the Viatical Loan Applicant/Borrower and the Insured pursuant to 940 CMR 18.06(6), on a separate document in at least ten point type or ten pitch courier.

VIATICAL LOAN DISCLOSURES REQUIRED BY THE ATTORNEY GENERAL'S CONSUMER PROTECTION REGULATIONS

Business Name:

Business or Mailing Address:

Viatical Loan Provider/Broker/Representative Massachusetts License Number: (if applicable)

Date License Issued:

License Expiration Date:

I am/We are a Viatical Loan Provider/Broker/Representative. With this application, you are applying for a Viatical Loan. I/We shall not divulge Patient Identifying Information of the Insured without the express, written consent of the Insured. I/We shall take every reasonable precaution to ensure that those individuals or entities who rightfully obtain Patient Identifying Information do not further divulge such information without the express, written consent of the Insured.

We shall provide the Insured with a copy of this completed disclosure form. We shall attempt to obtain the consent of the Insured to the dissemination of his/her Patient Identifying Information, if necessary to effectuate this Viatical Loan.

As part of the Viatical Loan process, the health of the Insured may be monitored. If monitoring is required, we must obtain the consent of the Insured to the method of monitoring prior to the execution of the Viatical Loan Agreement. (If monitoring is required, state method in specific, detailed terms).

You will/will not pay an application fee of $ . This fee is/is not refundable. You will/will not pay a brokerage fee of $ . This fee is/is not refundable.

The loan proceeds will be sent to you within two business days after the Viatical Loan Provider, (insert name here, if known) has received confirmation from your insurer or group administrator that you own the policy or are the certificateholder and the beneficiary has been designated pursuant to the Viatical Loan Contract.

We will provide you with the name, address and telephone number of the source of the loan proceeds within two business days of our identifying that source.

The Annual Percentage Rate ("APR") of interest charged against this loan is: . You shall be responsible for the following payment schedule: . You will have/not have to pay an additional fee ("prepayment penalty") if you pay off this loan early or re-negotiate the loan.

Additional estimated fees that you will pay in connection with the above described loan which are not included in the APR are listed below: (Specify in detail any additional fees.)

The maturity date of the loan is: . Upon reaching the loan maturity date, if you wish to renegotiate the loan, the following terms and conditions apply:

If you have any question about your legal rights, you should consult your own lawyer, especially before you sign any documents or pay any money or anything of value.

DO NOT sign any application forms with blank spaces or with incorrect information.

PLEASE NOTE:

You do/do not have the RIGHT TO CANCEL this contract within ____ days following any of the following events: [Provide detailed method for cancellation and for effective notification. Include notice of the effects of cancellation and the Applicant's responsibilities thereunder.]

We shall not pay a finder's fee to any Person who is providing, or has previously provided, care or services to the Insured, including, but not limited to, any medical or mental health provider, social services provider, attorney, accountant, financial advisor or planner, investment advisor or planner, or any other Person who has a demonstrable conflict of interest in collecting a finder's fee.

The Viatical Loan proceeds may be subject to the claims of your creditors.

If you have any problems, please call us at:

Printed Name and Address of Viatical Loan Applicant/Borrower

Please sign and date below after you receive these disclosures.

Signature of Viatical Loan Applicant/Borrower Date:

(2) It is an unfair or deceptive act or practice for a Viatical Loan Provider, Broker or Representative to fail to disclose, during the initial meeting with the Viatical Loan Applicant, its licensing status in Massachusetts.

(3) It is an unfair or deceptive act or practice for a Viatical Loan Provider, Broker or Representative to fail to take reasonable steps to communicate the material facts of the Viatical Loan Agreement in a language that is understood by the Applicant/Borrower and the Insured, respectively. Reasonable steps which shall comply with 940 CMR 18.00 may include, but shall not be limited to:

(4) It is an unfair or deceptive act or practice for a Viatical Loan Provider or Broker to fail to disclose to the Applicant/Borrower, prior to the execution of the Viatical Loan Agreement, whether the Applicant/Borrower has the right to cancel in compliance with applicable state law or with a right to cancel provision included by the Viatical Loan Provider or Broker within the contract, and, if such a right to cancel provision is available to the Applicant/Borrower, the disclosure must include the specific method for cancellation and effective notice of such cancellation and the responsibilities of the Applicant/Borrower thereunder.

(5) It is an unfair or deceptive act or practice for a Viatical Loan Provider, Broker or Representative to fail to mail to the last known address of, or to provide in person to, the Applicant/Borrower, legible copies of the application and loan agreement within 48 hours of the contract execution.

(6) It is an unfair or deceptive act or practice for a Viatical Loan Provider, Broker or Representative to fail to mail to the last known address(es) of, or to provide in person to, the Applicant/Borrower and the Insured, legible copies of the disclosures described in 940 CMR 18.06(1), within 48 hours after the earliest of the following events:

(7) It is an unfair or deceptive act or practice for a Viatical Loan Provider to fail to mail to the last known address of, or to provide in person to, the Viatical Loan Applicant/Borrower, the following written information, at least two business days prior to the date the Viatical Loan Agreement is signed by all parties:

(8) It is an unfair or deceptive act or practice for a Viatical Loan Provider, Broker or Representative to conceal or to fail to disclose to an Applicant/ Borrower any fact within the knowledge of the Viatical Loan Provider, Broker or Representative relating to the Viatical Loan Agreement, disclosure of which may have influenced the Applicant/Borrower not to enter into the Agreement with the Viatical Loan Provider or Broker.

(9) It is an unfair or deceptive act or practice for a Viatical Loan Provider, Broker, or Representative to fail to disclose to an Applicant/Borrower, as soon as practicable, any information contained on the disclosures mandated by 940 CMR 18.06(1) which has been changed by the Viatical Loan Provider or Broker.