Form 08-102 - Registration Of Viatical Settlement Interest Transactions Under 3 Aac 08.700 - 08.740

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Registration of Viatical Settlement Interest Transactions
Under 3 AAC 08.700 – 08.740
(To be filed along with the required fee described at 3 AAC 08.920(a)(10))
Please fill out this form and submit to:
Administrator of Securities
Alaska Division of Banking, Securities, and Corporations
P.O. Box 110807
Juneau, AK 99811-0807
(907) 465-2521
1. Name, Address, and Telephone number of the viatical settlement company filing this registration
and contact person:
Full Name of Company
Address
Phone
Contact:
Position:
2. Agents:
Use extra sheets as needed
Application enclosed
ü
Name of Agent
Date of Registration
Affiliation
3. Specify type of organization of company (corporation, LLC, etc.) ____________________________.
State of organization: ____________. Date of organization: __________. Company has been in
operation continuously since: ______________.
COMMENTS:
4. Please provide a brief description of terms of the offering, including types of programs:
08-102 (8/01)
2

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