Form 08-114b Viatical Settlement Disclosure Part B printable pdf download

Form 08-114b Viatical Settlement Disclosure Part B

VIATICAL SETTLEMENT DISCLOSURE PART B

This part of the disclosure tells you exactly what you are buying.

What you are purchasing

You are investing $

and will receive, subject to certain possible

deductions for premiums (see Disclosure Part A), on the death of the insured.

The life expectancy of the insured in whose policy you are investing is estimated to

be _______________.

You are purchasing (check one):

% (percent) ownership of a life insurance policy with a

$ _____________ death benefit

the entire ownership of a life insurance policy with a $ ___________

death benefit

____________% (percent) of the death benefit of a life insurance policy

with a $ ______________death benefit

the entire death benefit of a life insurance policy with a $

__________death benefit

The insurance policy

The life insurance policy was issued by:

Company:

Address:

Telephone Number:

The policy number is _______________. It was issued on ____________________.

The policy is (check all that apply):

A term policy

The term of the policy is:

A group policy

Name of the Group

08-114B (3/00)

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Form 08-114b Viatical Settlement Disclosure Part B