California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 12.9 - Life Settlements › Section 2548.20 - Life Producer Notification of Brokering Life Settlements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
State of California
Department of Insurance
Life Producer Notification of Brokering Life
					 Settlements
LIC 441-20N (Rev 04/2014)
_ ___________________________
Producer Licensing Bureau
P.O. Box 1139
Sacramento, CA 95812-1139
(916) 492-3085
Pursuant to Section
					 10113.2
					 (b)(1)(D)(ii) of the California Insurance
					 Code
A life insurance producer who is duly licensed as a life
					 agent for at least one year in California or as a licensed nonresident producer
					 in California for one year shall be permitted to operate as a life settlement
					 broker. Not later than 10 days from the first day of operating as a life
					 settlement broker, the life insurance producer shall notify the Commissioner
					 that he or she is acting as a life settlement broker by submitting this form
					 and a fee of $154.
1.
___________________________Name:
Last
First
Middle
2. Social
				  Security Number*: __________-__________-__________
3. Current Producer License Number:
				  ____________________ (include seven digit-license number)
Applicant's Certification
:
I certify under penalty of perjury that I have read the
					 foregoing application and know the contents thereof and that each statement
					 therein is full, true and correct. I also certify under penalty of perjury that
					 I have reviewed California Insurance Code, section
					 10113.1
					 through
					 10113.3 and
					 the Commissioner's Life Settlement Regulations, codified in Title 10, Section
					 2548.1 et seq. of the California
					 Code of Regulations and thoroughly understand the business of life settlements
					 and my obligations as a life settlement broker. I understand that pursuant to
					 sections 10113.1(g)(2)(D)
					 and 10113.2 (b) of
					 the California Insurance Code, any false statement may subject my application
					 to denial and may subject my license/s to suspension or revocation.
APPLICANT'S SIGNATURE:
-
					 ______________________________
CITY ______________________________ DATE
__________
All fees are filing fees and are not refundable, whether or
					 not the application is acted upon.
MAIL NOTIFICATION AND FEES TO:
DEPARTMENT OF
							 INSURANCE
P.O. BOX 1139
SACRAMENTO, CA 95812-1139
* Disclosure of your U. S. social security number is
					 mandatory pursuant to Cal. Civil Code, §
											1798.17; Cal.
					 Family Code, §
											17520(d);
					 and Federal Privacy Act of 1974, §§
											7(a) (2) (B) and
					 7(b). Your social
					 security number will be used primarily for purposes of processing your
					 application, including conducting any necessary investigation into your
					 background. If you fail to disclose your social security number, your
					 application will not be reviewed. An individual has a right of access to
					 certain records containing personal information pertaining to that individual.
					 Individuals may obtain information regarding the location of their records by
					 contacting the Bureau Chief, Producer Licensing Bureau, California Department
					 of Insurance by phone (800-967-9331) or by mail, to the following address: 320
					 Capitol Mall, Sacramento CA 95814.
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
					 2548.20 to section
					 2548.21 and renumbering of former
					 section 2548.19 to new section
					 2548.20 filed 11-25-2014;
					 operative 1-1-2015 (Register 2014, No. 48).