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. 28, July 12, 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.