Exhibit A - Viatical Settlement Provider Report and Instructions - All States and Territories (Form VSP-001)
Current through Register Vol. 46, No. 15, April 8, 2022
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______________________ |
Viatical Settlement Provider Report |
Calendar year |
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Viatical Settlement Provider's Name |
All States and Territories |
20____ |
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1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
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States |
Are you doing business in this state? (Y/N) |
Total number of policies reviewed for consideration |
Total number of policies where an offer was made |
Total number of policies where an offer was not made |
Total number of policies purchased |
Aggregate total net death benefit |
Aggregate amount paid to viators |
Secondary market transactions |
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pur |
sold |
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Alabama |
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Alaska |
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Arizona |
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Arkansas |
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California |
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Colorado |
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Connecticut |
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Delaware |
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Dist. of Columbia |
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Florida |
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Georgia |
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Hawaii |
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Idaho |
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Illinois |
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Indiana |
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Iowa |
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Kansas |
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Kentucky |
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Louisiana |
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Maine |
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Maryland |
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Massachusetts |
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Michigan |
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Minnesota |
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Mississippi |
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Missouri |
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Montana |
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Nebraska |
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Nevada |
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New Hampshire |
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New Jersey |
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New Mexico |
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New York |
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North Carolina |
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North Dakota |
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Ohio |
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Oklahoma |
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Oregon |
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Pennsylvania |
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Rhode Island |
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South Carolina |
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South Dakota |
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Tennessee |
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Texas |
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Utah |
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Vermont |
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Virginia |
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Washington |
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West Virginia |
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Wisconsin |
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Wyoming |
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American Samoa |
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Guam |
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Puerto Rico |
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U.S Virgin Islands |
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Canada |
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TOTALS |
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Name of Preparer: ________________________________
Instructions for Viatical Settlement Provider Report - All States and Territories
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- COLUMN |
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1 |
By a "Y" for yes or an "N" for no, indicate if you have or have not done business in the state during the calendar year being reported. |
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2 |
For each state or territory in which you have done business during the calendar year being reported, indicate the total number of policies reviewed for consideration. |
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3 |
For each state or territory in which you have done business during the calendar year being reported, indicate the total number of policies for which an offer was made. |
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4 |
For each state or territory in which you have done business during the calendar year being reported, indicate the total number of policies for which an offer was refused. |
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5 |
For each state or territory in which you have done business during the calendar year being reported, indicate the total number of policies purchased. |
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6 |
For each state or territory in which you have done business during the calendar year being reported, list the total aggregate net death benefit of the policies viaticated. |
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7 |
For each state or territory in which you have done business during the calendar year being reported, list the total aggregate amount paid to viators. |
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8 |
For each state or territory in which you have done business during the calendar year being reported, list the total number of policies purchased and/or sold in the secondary market. |
Notes
The following state regulations pages link to this page.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.